# Current Perspectives on Urolithiasis: Pathogenesis, Clinical Management, and Treatment

## TL;DR

This paper reviews the causes, diagnosis, and treatment of kidney stones, emphasizing recent advances in managing this common and recurring condition.

## Contribution

A comprehensive summary of current evidence and guidelines for evaluating and managing urolithiasis.

## Key findings

- Calcium-based stones are the most common type, influenced by diet, metabolism, environment, and genetics.
- Non-contrast CT is the gold standard for diagnosis, while ultrasonography is often used initially.
- Treatment options include medical therapy and minimally invasive procedures, tailored to stone characteristics and patient needs.

## Abstract

Urolithiasis is a common and recurrent urological condition with significant clinical and economic implications worldwide. In light of new evidence on evaluating and managing urolithiasis, this review summarizes the current literature and guidelines. The development of urolithiasis is influenced by a complex interplay of dietary, metabolic, environmental, and genetic factors, with calcium-based stones constituting the majority of cases. Patients may present with a wide spectrum of symptoms, ranging from severe renal colic to incidental, asymptomatic findings. Accurate diagnosis requires the appropriate use of laboratory testing and imaging modalities. Non-contrast CT is considered the gold standard for diagnosis, and ultrasonography is recommended as the primary initial tool in many clinical settings. Management strategies depend on stone size, location, symptom severity, and the presence of complications, such as infection or obstruction. Most stones are expelled spontaneously; however, effective treatment options are available, including nonsteroidal anti-inflammatory drugs for pain control, medical expulsive therapy, and minimally invasive procedures such as extracorporeal shock wave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. These options allow for individualized and highly successful care. Ongoing advances in imaging, medical therapy, and surgical techniques enhance outcomes, reduce recurrence rates, and lessen the overall healthcare burden posed by urolithiasis.