Which strategies reduce urinary stone recurrence?

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Preventing urinary stone recurrence relies on lowering urine saturation and tailoring approaches to the stone type. Start with ample hydration to dilute urine and reduce crystallization risk. Then apply dietary modifications: limit oxalate intake and, for calcium stones, consume calcium with meals to help binding oxalate in the gut and lower urinary oxalate. For those with calcium stones, thiazide diuretics can decrease calcium excretion in urine, further reducing recurrence. For uric acid and cystine stones, citrate therapy is helpful because citrate binds calcium and raises urine pH, making urine less prone to crystallization and helping keep stones dissolved. Adjusting urine pH specifically supports this goal—alkalinizing urine reduces uric acid stone formation and improves solubility of cystine. This combined approach—hydration, targeted dietary changes, appropriate medications, and urine pH management—provides the best strategy to prevent recurrence, whereas strategies that promote dehydration or neglect dietary and pharmacologic prevention do not address the underlying processes.