Nephrolithiasis is a common problem that results in considerable cost and morbidity. Stone risk is associated with multiple risk factors such as diet and fluid intake, age, gender, ethnicity, geography, occupation, and comorbidities such as diabetes and obesity. There is evidence that high volume intake can reduce the risk of stone disease by 40% to 50%. While there are currently no recommendations to prevent kidney stones, a strategy to reduce risk of stone formation, such as increasing fluid intake, could reduce both morbidity and cost of stone disease. Using France as a model, increased intake of water (>2 L/d) results in considerable cost savings ranging from €273 million in a highly compliant population to €68 million in a population of low compliance (25%). Focusing prevention strategies on high-risk populations can significantly increase cost effectiveness. Future prospective studies will be necessary to demonstrate the potential benefits of primary prevention of nephrolithiasis.