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Urinary stone disease is increasingly prevalent, with a lifetime risk of about 12% in men and 6% in women. 1 Age of onset of a first stone episode for men rises from their 20s and peaks at age 40-60 years, with an incidence of three cases per 1000 population per year. Women appear to peak a little younger in their late 20s. The male to female ratio is narrowing, with one study showing a reduction from 1.7:1 to 1.3:1 over a five year period. 2 Presentation varies according to geographical and seasonal factors, with higher incidences in warmer climates and during the summer months. 3This review includes the latest information from meta-analyses, systematic reviews, randomised trials, current guidelines, and other peer reviewed evidence to provide a background on presentation, investigation, and medical and surgical management of patients with renal colic. What are urinary stones?Urinary stones are formed by the aggregation of crystals with a non-crystalline protein (matrix) component. 3 These crystals clump together to form a stone and then move when they reach a certain size and pass down the ureter, frequently causing colic symptoms. Eighty per cent of stones contain calcium, most commonly in the form of calcium oxalate (60%). Calcium phosphate accounts for 20% of stones, with uric acid forming approximately 7%, 3 although this uric acid proportion may rise in obese patients. Another 7% are infection stones containing magnesium ammonium phosphate. Bladder stones usually have a different cause, often as a result of bladder outflow obstruction.

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Cystinuria is a genetic disease that leads to frequent formation of stones. In patients with recurrent stone formation, particularly patients <30 years old or those who have siblings with stone disease, urologists should maintain a high index of suspicion of the diagnosis of cystinuria. Patients with cystinuria require frequent follow-up and a multidisciplinary approach to diagnosis, prevention and management. Patients have reported success in preventing stone episodes by maintaining dietary changes using a tailored review from a specialist dietician. For patients who do not respond to conservative lifestyle measures, medical therapy to alkalinize urine and thiol-binding drugs can help. A pre-emptive approach to the surgical management of cystine stones is recommended by treating smaller stones with minimally invasive techniques before they enlarge to a size that makes management difficult. However, a multimodal approach can be required for larger complex stones. Current cystinuria research is focused on methods of monitoring disease activity, novel drug therapies and genotype-phenotype studies. The future of research is collaboration at a national and international level, facilitated by groups such as the Rare Kidney Stone Consortium and the UK Registry of Rare Kidney Diseases.