This review provides an overview and comprehensive update on urological guidelines for kidney stone disease (KSD). The American Urological Association (AUA) and European Association of Urology (EAU) guidelines are compared, highlighting their alignment and subtle differences in recommendations. Both guidelines offer guidance on imaging, treatment options, and management for specific patient groups, such as children and pregnant women. While the guidelines are generally consistent, they differ in the grading of evidence and the terminology used for recommendations. The AUA uses letters (A, B, C) to grade evidence, while the EAU uses "strong" or "weak" recommendations based on the GRADE methodology. Both emphasize the importance of personalized treatment plans, considering patient preferences, surgical expertise, and individual factors. The guidelines recommend initial imaging for asymptomatic patients, such as ultrasound (US), and for symptomatic patients, non-contrast-enhanced computed tomography (NCCT). The EAU recommends NCCT for symptomatic patients due to its accuracy in assessing stone characteristics. Both guidelines emphasize the importance of urine culture and microscopy before any intervention. Medical treatment options include alpha-blockers for distal ureteral stones, oral chemolysis for uric acid stones, and extracorporeal shock wave lithotripsy (ESWL) for smaller stones. Ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are recommended for larger stones. The EAU recommends URS for stones >10 mm in the ureter, while the AUA suggests URS for stones <10 mm. PCNL is the first-line treatment for large renal stones. Both guidelines emphasize the importance of post-procedural imaging and the need for personalized treatment plans. The guidelines also address specific patient groups, including children, pregnant women, and renal transplant patients. For children, US is preferred as the initial imaging modality, and for pregnant women, US is recommended over NCCT. Renal transplant patients may require different treatment approaches due to anatomical variations and the need for renal function preservation. The guidelines emphasize the importance of metabolic evaluation and dietary management to prevent stone recurrence. Both guidelines recommend increasing fluid intake to reduce the risk of stone formation. Specific dietary and medical interventions are recommended based on the type of stone and metabolic findings. Future research should focus on patient-reported outcomes and the development of new technologies to improve treatment options. The guidelines should be regularly updated to reflect the latest evidence and clinical practices. Overall, the guidelines provide a framework for the management of kidney stone disease, emphasizing the need for personalized treatment plans that consider individual patient factors.This review provides an overview and comprehensive update on urological guidelines for kidney stone disease (KSD). The American Urological Association (AUA) and European Association of Urology (EAU) guidelines are compared, highlighting their alignment and subtle differences in recommendations. Both guidelines offer guidance on imaging, treatment options, and management for specific patient groups, such as children and pregnant women. While the guidelines are generally consistent, they differ in the grading of evidence and the terminology used for recommendations. The AUA uses letters (A, B, C) to grade evidence, while the EAU uses "strong" or "weak" recommendations based on the GRADE methodology. Both emphasize the importance of personalized treatment plans, considering patient preferences, surgical expertise, and individual factors. The guidelines recommend initial imaging for asymptomatic patients, such as ultrasound (US), and for symptomatic patients, non-contrast-enhanced computed tomography (NCCT). The EAU recommends NCCT for symptomatic patients due to its accuracy in assessing stone characteristics. Both guidelines emphasize the importance of urine culture and microscopy before any intervention. Medical treatment options include alpha-blockers for distal ureteral stones, oral chemolysis for uric acid stones, and extracorporeal shock wave lithotripsy (ESWL) for smaller stones. Ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are recommended for larger stones. The EAU recommends URS for stones >10 mm in the ureter, while the AUA suggests URS for stones <10 mm. PCNL is the first-line treatment for large renal stones. Both guidelines emphasize the importance of post-procedural imaging and the need for personalized treatment plans. The guidelines also address specific patient groups, including children, pregnant women, and renal transplant patients. For children, US is preferred as the initial imaging modality, and for pregnant women, US is recommended over NCCT. Renal transplant patients may require different treatment approaches due to anatomical variations and the need for renal function preservation. The guidelines emphasize the importance of metabolic evaluation and dietary management to prevent stone recurrence. Both guidelines recommend increasing fluid intake to reduce the risk of stone formation. Specific dietary and medical interventions are recommended based on the type of stone and metabolic findings. Future research should focus on patient-reported outcomes and the development of new technologies to improve treatment options. The guidelines should be regularly updated to reflect the latest evidence and clinical practices. Overall, the guidelines provide a framework for the management of kidney stone disease, emphasizing the need for personalized treatment plans that consider individual patient factors.