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The medical management of urolithiasis is complex. There are many papers written on the topic and many conflicting views. It can be difficult for physicians to interpret these data and have a stepwise approach to the medical treatment of stones.Thus this study provides a framework and a review of the literature to allow physicians to practise evidence-based medicine when medically managing urolithiasis.This review paper provides a summary of medical therapies available for urolithiasis. The summary includes general medical advice, prophylactic medications, dissolution therapy and medical expulsion therapy. The paper is designed to provide a management strategy for all physicians who treat urolithiasis, from general practitioners, to emergency physicians, to urologists.To provide an up to date review of the literature in relation to the medical management of stone disease. This will encompass prophylaxis, dissolution therapy and medical expulsion therapy.First-time stone formers do not regularly have a full urine and electrolyte evaluation due to the low incidence of a reversible metabolic cause.However, stone disease is common and over a lifetime urolithiasis can affect up to 10–15% of the population.Medical management of stone disease encompasses preventative measures, medical dissolution and medical expulsion therapy.Recurrent stone formers should have dietary optimization to decrease the risk of further stones.Furthermore, the correct use of prophylactic and therapeutic medications can decrease the morbidity associated with ureteric calculi.