Urinary stone disease is characterized by crystalline depositions, which are classified due to their location in the renal calyces, pelvis, or ureter (urolithiasis) and composition. With its rising prevalence, especially in countries with a high standard of living, urinary stone disease causes a significant health-care burden in the working-age population. High stone recurrence rates demand a proper metabolic workup and efforts to prevent new urinary stone formation. In this chapter, a compact review of the pathophysiology of stone disease, its metabolic evaluation, and selective medical treatment, which is highly effective in preventing stone recurrence, is provided.