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Patients with recurrent stones who undergo thorough metabolic evaluation and specific therapy enjoy a remission rate in excess of 80% and can decrease the rate of stone formation by 90%.

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Therapeutic effects principally result from local actions on small intestine; no evidence that systemic absorption contributes to therapeutic response.

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Adding contrast to the CT scan study may sometimes help clarify a difficult or confusing case, but, in general, contrast obscures calcific densities, and, as such, contrast scans are usually indicated only during subsequent evaluation of patients with stones.

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In the same 2016 guidelines, ureteroscopy (URS) is considered the first-line therapy for mid-distal ureteral stones that require intervention, although patients should be offered ESWL if URS is declined.

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