This review discusses the pathophysiology and main molecular mechanisms of urinary stone formation and recurrence. Kidney stones are mineral deposits in the calyces or pelvis, containing crystals and organic components. Calcium oxalate is the most common component, often forming on Randall's plaques. The etiology is multifactorial, with a high recurrence rate of up to 50% within 5 years. Prevention requires understanding the mechanisms involved to develop effective drugs. The review covers the pathophysiology and molecular mechanisms of kidney stones, including the role of diet, obesity, and genetic factors. It also discusses the formation of different types of stones, such as calcium-containing, uric acid, and struvite stones, and their associated risk factors. The review highlights the importance of early diagnosis and treatment to reduce recurrence rates and the impact of kidney stones on patients and healthcare systems. It also discusses the role of the microbiome in stone formation and the importance of dietary and lifestyle changes in prevention. The review concludes with recommendations for treatment and prevention strategies, including the use of medications and dietary modifications to reduce the risk of stone formation and recurrence.This review discusses the pathophysiology and main molecular mechanisms of urinary stone formation and recurrence. Kidney stones are mineral deposits in the calyces or pelvis, containing crystals and organic components. Calcium oxalate is the most common component, often forming on Randall's plaques. The etiology is multifactorial, with a high recurrence rate of up to 50% within 5 years. Prevention requires understanding the mechanisms involved to develop effective drugs. The review covers the pathophysiology and molecular mechanisms of kidney stones, including the role of diet, obesity, and genetic factors. It also discusses the formation of different types of stones, such as calcium-containing, uric acid, and struvite stones, and their associated risk factors. The review highlights the importance of early diagnosis and treatment to reduce recurrence rates and the impact of kidney stones on patients and healthcare systems. It also discusses the role of the microbiome in stone formation and the importance of dietary and lifestyle changes in prevention. The review concludes with recommendations for treatment and prevention strategies, including the use of medications and dietary modifications to reduce the risk of stone formation and recurrence.