Objective <p><?tk 4?>To evaluate patient adherence to prescribed medical therapy for urolithiasis following multidisciplinary consultation in a specialized stone clinic.</p> Patients and methods <p><?tk 4?>A prospective survey-based study was conducted among high-risk stone formers treated at a multidisciplinary metabolic stone clinic staffed by an endourologist, nephrologists, and dietitians. Patients prescribed medical therapy were contacted by phone. After oral consent, a structured questionnaire assessing adherence and reasons for non-compliance was administered. Patients who declined or were unreachable after three attempts were excluded.</p> Results <p><?tk 4?>A total of 100 patients were included (median age 55 years; 65% male). A family history of nephrolithiasis was reported by 57.4%. Prior interventions included ureteroscopy (URS) (74%), shock wave lithotripsy (SWL) (18%), and percutaneous nephrolithotripsy (PCNL) (15%). The most common stone type was calcium oxalate monohydrate (45.5%). Metabolic abnormalities included hypercalciuria (38.6%), hypocitraturia (34.7%), and hyperuricosuria (23.8%). Full compliance was reported by 57%, partial by 21%, and non-compliance by 22%, with a median adherence duration of 16 months among fully adherent patients. Common reasons for non-compliance included lack of understanding (28%), adverse effects (19%), and perceived lack of necessity (19%). Multivariable analysis identified higher level of education as the only significant predictor of improved adherence (OR 0.38, 95% CI: 0.18–0.78, <i>p</i> = 0.008). Use of specific medications was not significantly associated with the reported adherence or lack there of.</p> Conclusions <p><?tk 4?>Adherence rates were higher than previously reported, highlighting the benefit of a multidisciplinary approach with individualized metabolic evaluation and targeted therapy in stone-forming patients.</p>