Urolithiasis, commonly referred to as kidney stone disease, remains a significant global health burden with rising incidence across diverse populations. The condition is characterized by the formation of calculi within the urinary tract, primarily composed of calcium oxalate, uric acid, struvite, or cystine. The underlying pathophysiology involves urinary supersaturation, nucleation, crystal growth, and aggregation, influenced by metabolic, dietary, genetic, and environmental factors. Recent research has highlighted the role of oxidative stress, altered urinary inhibitors and promoters, and genetic predisposition in stone formation, providing deeper mechanistic insights into disease progression. Advances in diagnostic modalities, including high-resolution imaging (CT, ultrasound) and biochemical markers, have improved early detection and risk stratification. Conventional management strategies encompass pharmacological interventions such as thiazide diuretics, citrate therapy, and allopurinol, alongside surgical techniques like extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, and percutaneous nephrolithotomy (PCNL). However, recurrence rates remain high, necessitating preventive approaches and long-term management strategies. Emerging therapeutic perspectives emphasize the role of phytochemicals and herbal formulations, with plants such as Tribulus terrestris, Crataeva nurvala, and Sphaeranthus indicus demonstrating promising anti-urolithiatic activity through mechanisms including crystallization inhibition, antioxidant effects, and modulation of urinary biochemistry. Novel drug delivery systems, nanomedicine, and targeted inhibitors of crystallization are being explored to enhance efficacy and reduce recurrence. This review consolidates current knowledge on the pathophysiology, risk factors, diagnostic advances, conventional therapies, and novel strategies for urolithiasis. By bridging mechanistic insights with clinical care, it underscores the importance of multidisciplinary approaches in reducing disease burden and improving patient outcomes. Future directions should focus on translational research, clinical validation of phytochemicals, and development of personalized therapeutic regimens to address the persistent challenge of recurrence and enhance long term management.