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Kidney stones account for considerable morbidity and numbers of hospitalizations annually. Many management options are now available, including newer medications and percutaneous or extracorporeal means of destroying or removing stones. The literature offers a somewhat bewildering array of suggestions on how to decide which patients to treat, how to classify associated metabolic abnormalities, and which management strategies to use. Drs Kanig and Conn describe an approach to help the practitioner deal with this complex problem logically and effectively.