Of the primary treatments for urolithiasis, URS is noted as having the highest stone free rates, while the noninvasive shockwave lithotripsy is known to have the lowest complication rates. Urologists balance the benefits of treatment success with the costs of complications when selecting a treatment modality. The Stone Decision Engine is a precision medicine tool that predicts success and complication rates based on patient and stone demographics. These predictions allow physicians and patients to weigh the likelihood of treatment success and complications for a specific patient to help them choose the best treatment option for the patient. The algorithms that run the Stone Decision Engine are driven by big data and scientific research and allow users to leverage evidence-based findings to help optimize quality, cost, and outcomes.