Hsi RS, Yan PL, Goldfarb DS, et al. - Whether an empiric approach to metabolic stone prevention would be effective was determined herein using medical claims from a cohort of working age adults with kidney stone diagnoses (2008-2017). The subset with prescription of thiazides, alkali therapy, or allopurinol—collectively known as preventive pharmacologic therapy (PPT) was identified. Those who underwent 24-hour urine testing before starting PPT (selective therapy) were distinguished from those without it (empiric therapy). A lower hazard of a stone-related event was noted in relation to greater adherence to PPT and older age. Findings revealed that PPT guided by 24-hour urine testing, on average, was not related to a lower hazard of a stone-related event when compared with empiric therapy. These data indicate a requirement to detect kidney stone cases who benefit from 24-hour urine testing.