Purpose of Review <p>Urinary stone disease is among the most common non-obstetric conditions in pregnancy and carries significant maternal-fetal morbidity. Diagnosis and management are challenging, as the accuracy and efficacy of different modalities must be balanced against their pregnancy-specific risks. This narrative review evaluates society guidelines and emerging evidence on stone disease in pregnancy, focusing on population-based and comparative studies published since 2010.</p> Recent Findings <p>Adverse maternal-fetal outcomes associated with urinary stone disease in pregnancy may be exacerbated by delays and inconsistencies in care. Ultrasound is the recommended first-line imaging modality, but diagnostic accuracy is limited; emerging evidence supports low-dose CT as an alternative when diagnostic certainty is required. Conservative management remains the standard initial approach in uncomplicated cases. Evidence regarding tamsulosin in medical expulsive therapy is inconclusive. When surgical management is necessary, prompt decompression should be considered; ureteral stenting may be favored over percutaneous nephrostomy in certain cases. Primary ureteroscopy is increasingly supported as a safe and effective definitive treatment.</p> Summary <p>Management of urinary stone disease in pregnancy is challenging and demands a multidisciplinary, patient-centered approach. Practice patterns are highly variable, both reflecting and contributing to the limited scope of current guidelines. Further research is needed to establish comprehensive, evidence-based guidelines.</p>