The essence of Urolithiasis - one of the oldest diseases known by the mankind - is still not understood completely. For a long time the comprehension of Urolithiasis was based on matrix, colloid, ionic, inhibitory and precipitation theories. In these cases it was impossible to single out separate pathogenetic patterns. Besides, in spite of the absence of in vivo proofs the fact that new concrement nucleus forming (de novo nucleation) is only possible outside of the stone-forming metastability range should be taken into consideration for metaphilactic purposes. Fortunately, certain progress in understanding Urolithiasis started with the onset of studies devoted to detailed scrutiny of stone-forming patients’ metabolic peculiarities as well as with the introduction into clinical practice of the up-to-date digital endoscopes. Based on existing publications one may classify pathogenesis of stone-forming into 4 major groups: growth of calcium-oxalic stones on Randall’s plaques in patients with hypercalciumuria; excrescences on the of Belliny’s ducts’ “gags”; microlites forming within the internal medullar layer discharging tubules’ lumen in patients with cystineuria; stones forming in free solution. There is no doubt this classification is not the final one, neither does it exclude mixed variants, however better understanding of the aforementioned pathogenic variants would facilitate a novel view at Urolithiasis and in patients with kidney stones would increase anti-relapse measures’ effectiveness.