Urinary Stones: Improving Fluid Intake & Preventing Recurrence

March 23, 2026 Dr. Michael Lee – Health Editor Health

A multi-center randomized controlled trial is underway to assess whether a behavioral intervention program can improve fluid intake and reduce the recurrence of kidney stones. The study, known as PUSH (Prevention of Urinary Stones with Hydration), is enrolling participants with a history of urinary stone disease and low 24-hour urine volume.

Urinary stone disease is a significant health concern, impacting quality of life and frequently recurring after initial treatment. Even as increasing fluid consumption is a long-established preventative measure, adherence to recommended intake levels remains a challenge for many patients. Researchers have identified practical, behavioral and environmental obstacles that contribute to difficulties in maintaining long-term behavior change.

The PUSH trial employs a smart water bottle to monitor fluid intake and utilizes a combination of behavioral strategies – including personalized fluid prescriptions, financial incentives, and coaching – to encourage sustained higher fluid consumption. The trial is designed to determine if this adaptive, multi-component approach can effectively improve adherence and ultimately reduce the incidence of stone recurrence.

The study protocol, published in 2024, focuses on a primary endpoint of 24-hour urine volume. Four other trials examining adherence interventions for fluid intake in the prevention of urinary stone disease were initiated following the start of the PUSH trial. The PUSH trial is a randomized clinical trial assigning participants aged 12 and over with a history of urinary stone disease and low 24-hour urine volume to either the behavioral intervention program or usual care, which includes advice to increase fluid intake.

Researchers hope the findings from the PUSH trial will provide evidence-based strategies to support long-term adherence to increased fluid intake, addressing a critical gap in the prevention of urinary stone disease. The sipIT2 trial, also focused on fluid intake adherence, began after the PUSH trial was initiated.