After detailed instruction, 62 patients with urolithiasis treated at Taichung Veterans General Hospital entered this program, which ran from September 1987 to November 1988. Based on Pak's classification, there were 13 cases (21.0%) of absorptive hypercalciuria, type I (AH-I); 12 cases (19.4%) of absorptive hypercalciuria, type II (AH-II); 16 cases (25.8%) of renal hypercalciuria (RH); 3 cases (4.8%) of hyperuricosuric calcium urolithiasis (HUCU); 11 cases (17.7%) of hypocitraturia (Hypocit); 3 cases (4.8%) of hyperoxluria (HO); one case (1.6%) of primary hyperparathyroidism (PHPT) and one case (1.6%) of infectious lithiasis. Two cases (3.2%) with no metabolic abnormalities were found. Hypocitraturia, HUCU, and HO can be the primary abnormal findings, but more often coexist with various forms of hypercalciuria as a second factor. If the coexistence is considered, hypocitraturia (33 cases, 53.2%) and HUCU (24 cases, 38.7%) were the most prevalent categories. Meanwhile, 24 cases (38.7%) had only one physiological derangement, 25 cases (40.3%) had two derangements, and 13 cases (21.0%) had three. This study indicates that metabolic evaluation can elucidate the physiological derangements of urolithiasis, so that further medical treatment can be administered selectively.