The development of efficacious techniques for stone elimination, and in particular of extracorporeal lithotripsy, slackened, in the last two decades, the pharmacological research on nephrolithiasis, with the result that the currently available efficacious drugs are very few. Instead, the recent elucidation of some relevant etiopathogenetic aspects, with special reference to the quantitative and qualitative changes of specific urinary inhibitors of crystallization, could open new therapeutic avenues for many lithiasic forms, now considered idiopathic.