Urinary tract infections (UTIs) are among the most common bacterial infections during childhood. Early diagnosis and prompt treatment are necessary to prevent long-term sequelae. Pyuria, a key diagnostic marker for UTIs, is defined as the presence of ≥5 white blood cells per high-power field in urine obtained by centrifugation of urine and microscopic analysis. However, there is a debate around pyuria's role in UTI diagnosis, which highlights the need for a comprehensive evaluation of its diagnostic accuracy in pediatric settings. This study aims to evaluate the diagnostic accuracy of pyuria as a marker for UTIs in pediatric patients by analyzing the sensitivity, specificity, and various factors affecting the diagnostic performance of pyuria and the alignment of these findings with the current clinical guidelines of pediatric UTI management. A comprehensive search was conducted through the following electronic databases: PubMed, Central, and Science Direct. The articles underwent a two-phase filtration process: first by title and abstract and second by full text, conducted by two independent reviewers. Data was extracted using a Google form (Google LLC, Mountain View, CA, USA) covering study details, participant characteristics, biomarkers, and diagnostic methods. The methodological quality of the studies was assessed using the National Institutes of Health tool, and the detailed protocol is available on PROSPERO (CRD42023399392). Our search yielded 491 results, with 18 studies meeting the inclusion criteria. The mean age across the studies was 2.7 years, and the majority of patients were females.