Patients suffering from urinary stone are traditionally referred to a surgeon. Most are investigated only as far as establishing the site of the stone and its effect on renal function. Although a number of patients may require surgery, the majority pass the stone spontaneously and are discharged within a few days. If the patient has a recurrence, as most eventually have, it is not routine practice to establish the type of stone, screen for underlying disease, identify the urinary abnormalities or to institute preventive medical treatment. Although it was considered that surgery itself had something to offer in reducing the recurrence rate this is no longer generally held except in infected stone disease. Nevertheless it is still uncommon to involve a physician, and in particular a nephrologist, in the investigation and management of urinary stone-formers. Urinary stone disease still remains, to a large extent, outside the field of nephrology.