Song S, Thomas IC, Ganesan C, et al. - Given that the assessment and management of individuals with high-risk urinary stone disease should be guided by 24-hour urine testing has been suggested by current guidelines, researchers analyzed 130,489 patients with incident urinary stone disease in the Veterans Health Administration, to define the extent to which clinicians start or continue stone disease-associated medications in response to 24-hour urine testing. The probability of being prescribed thiazide diuretics, alkali therapy, and allopurinol was significantly more in stone formers who finished 24-hour urine testing (n = 17,303; 13%) vs those who did not finish a 24-hour urine test (n = 113,186; 87%). Patients with hypercalciuria had increased thiazide diuretics prescriptions, and those with hypocitraturia and hyperuricosuria had increased prescription of alkali therapy and allopurinol, respectively. A greater chance of having been prescribed stone-related medications was seen in those who had attended both a urologist and a nephrologist within 6 months of 24-hour urine testing vs those who visited one, the other, or neither. Findings revealed the clinical practice of adjusting treatment regimens in response to 24-hour urine testing by increasing the prescription of medications believed to decrease the risk for urinary stone disease. Untreated were the majority of those for whom targeted medications might be beneficial.