The introduction of extracorporeal shockwave lithotripsy (ESWL), with its noninvasive removal of stones and considerable reduction in the morbidity of stone disease, has revolutionized the therapy of urolithiasis. Unfortunately the propensity for stone recurrence is not altered by removal of stones with ESWL and stone recurrence is still about 50%. Progress in medical treatment has shown how different therapies can prevent the stone recurrence, even though it is often difficult to predict which patient will go on to become a recurrent stone former. With the right evaluation, however, the cause of calculi formation can be treated in 97% of the patients. Primary prevention of urolithiasis includes general prophylaxis in a no-risk population that has never been affected by urinary tract stones, is without familial predisposition, metabolic or genetic alterations, or urinary tract abnormalities or infections and who live in a geographical area that is at risk. Secondary prevention or metaphylaxis of stone disease is aimed at the population at risk, that is patients already affected by the stone disease, with familial predisposition, with urinary tract alterations, with metabolic or genetic alterations (gout, bone or bowel diseases) and urinary infection.