The recommendation to limit soda/soft drinks in adult patients with kidney stones is supported by an RCT and observational studies. An RCT showed that among 1,009 male stone-forming patients of any stone type who regularly consumed at least 160 mL of soft drinks daily, the recommendation to refrain from soft drink consumption resulted in a 6.4% absolute reduction in stone recurrence rates at 3 years compared to a control group who continued soft drink consumption (p=0.023).62 The effect of abstaining from soft drink consumption on reducing the risk of stone recurrence appeared to be largely driven by the benefit of abstaining from phosphoric acid-based soft drinks (e.g., colas) rather than citric acid-based soft drinks. However, there was no difference in recurrence rates between the study groups and control groups when the study group was limited to either sugar-sweetened or artificially sweetened soft drink consumption, suggesting that beverage composition may be impacted by factors other than sugar content alone. The mechanistic basis for the lithogenic potential of sugar-sweetened beverages is not clear. Short- and long-term studies investigating the effect of sucrose and fructose intake on urinary stone risk factors yielded conflicting evidence as to whether stone risk is mediated through urinary calcium changes.227 A prior study of healthy volunteers demonstrated that fructose consumption may increase kidney stone risk through multiple mechanisms, including uric acid overproduction, insulin resistance, and metabolic syndrome.228 Another study attributed stone risk to an alternative pathway whereby fructose metabolism may increase stone risk independent of urinary oxalate excretion.229 Large prospective epidemiologic studies have shown that consumption of sugar-sweetened soft drinks (both colas and non-colas) is associated with an increased risk of incident kidney stones (23% increase for colas and 33% increase for non-colas; p<0.001 for both), while artificially sweetened soft drinks showed no increased risk of incident stone formation.230 Of note, when counseling patients to reduce soda intake and other sugar-sweetened beverages, particularly among high consumers who may obtain substantial daily fluid volume from these sources, clinicians should address the need to replace this "missing" fluid intake with other appropriate beverages to maintain adequate urine volume, a cornerstone of stone prevention.