This study is from Dallas, USA and appears on the front cover of the BMJ. About 1 in 11 people will have a kidney stone at some point in their lifetime. There is a linear increase in stone prevalence in the USA over the past four decades. Diet and environmental factors play an important role. Underlying anatomical urology defects should also be looked at. Evaluation should include blood tests (calcium and urate), urine analysis, imaging and metabolic testing. Pharmacological management is also discussed in detail – calcium based stones and non-calcium based stones. Special mention is made about treatment of uric acid stones, cysteine stones and struvite stones. European Association of Urology (EAU) and American Urological Association (AUA) guidelines are also touched upon while a useful table describes the adverse effects of current drugs used for stone disease. All in all this article makes for very interesting reading.