Amy E. Krambeck, M.D., from the Mayo Clinic in Rochester, Minn., and colleagues studied a random sample of Olmsted County, Minn., residents with their first diagnostic code for urolithiasis (1984 to 2003). Symptomatic stone formers (1,590 patients) were validated with imaging or stone passage.The researchers found that older individuals were significantly more likely to present with atypical or no pain, fever, diarrhea, pyuria, urinary tract infections, and bacteremia. Patient age did not affect stone size and location. Younger age was significantly associated with calcium phosphate stone disease, while uric acid stone and atypical stone composition was significantly associated with older age. Surgical intervention was significantly more likely among older individuals, who were less likely to pass the stone spontaneously. Nearly one-third of individuals (516) required surgical intervention. Ureteroscopy was more likely in younger individuals, while older individuals were more likely to undergo shock wave lithotripsy, temporizing stent placement, and percutaneous nephrolithotomy.