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This chapter reviews a pivotal trial on the role of increased water intake for secondary prevention of recurrent stone formation patients with idiopathic calcium nephrolithiasis. Patients randomized to the intervention arm were instructed to titrate their water intake to a daily urine output of at least 2 liters; patients in the control arms were not given any specific instructions. Increased water intake resulted in fewer stone recurrences, longer time to recurrence, and reduced calcium oxalate and calcium phosphate supersaturation.

This chapter summarizes the results of the SUSPEND trial, a methodologically rigorous three-armed randomized controlled trial of medical expulsive therapy in the form of the alpha-blocker tamsulosin or the calcium channel blocker nifedipine versus placebo. The mean stone size in all three groups was comparable and three-quarters of the stones were 5 mm or less. It was a “negative trial” that failed to demonstrate a substantial benefit from the widely established practice of treating patients with small ureteral stones with medical expulsive therapy. Serious adverse events were very infrequent.

This chapter reviews the findings of the initial case series of patients with renal stones treated with extracorporeal shock wave lithotripsy (ESWL) with 12 months of follow-up. In the majority of patients, the renal stones were broken up into fragments that could pass spontaneously, and only a few patients required surgical interventions. Renal function did not appear adversely impacted by the procedure.

This chapter reviews the findings of an important randomized controlled trial of ureteroscopy versus shock wave lithotripsy in adult patients with isolated lower pole stones 1 cm or less in size in whom treatment was indicated. The type of ureteroscope and shock wave lithotripter, the power settings used, and the number of shocks administered were left to the discretion of the treating physician. The study suggested that there is little to no difference in stone-free rates between the two modalities for the treatment of small lower pole renal calculi.

This chapter reviews the results of an important observational study seeking to establish how, in individuals without a history of nephrolithiasis, dietary calcium intake is associated with the risk of symptomatic stone disease. The study found that the mean daily dietary calcium intake was lower in the group who formed stones compared to those who did not and that, after adjusting for covariates, high daily dietary calcium intake was strongly associated with decreased risk of stones.

This chapter summarizes the results of the Lower Pole Study I study in which patients with symptomatic lower pole renal calculi were randomized to receive extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL). The study found that patients receiving ESWL had lower stone-clearance rates and a more frequent need for retreatment but lower morbidity, whereas those receiving PCNL had higher stone-clearance rate and fewer retreatments but greater morbidity.