The PUSH (Prevention of Urinary Stones with Hydration) randomized trial tested whether a multicomponent behavioral program to promote high fluid intake reduces the recurrence of urinary stones in patients with a history.[1][2] The study included 1,658 adults and adolescents from six US centers, of whom 1,104 (66.6%) were recurrent stone patients.[1][5] Participants in the intervention group used Bluetooth smart bottles to measure intake, personalized goals (to achieve a urinary volume of at least 2.5 liters per day), financial rewards, SMS reminders, and health coaching.[2][5] The primary objective was symptomatic stone recurrence (passing stones or procedural interventions) during a 2-year follow-up in the intention-to-treat population.[1] The program did not increase 24-hour urine volume enough to reduce symptomatic stone recurrence compared with standard care.[1][2] Urine volume increased in the intervention group at 6, 12, 18, and 24 months compared to the control group, but symptoms such as urinary frequency, urgency, and nocturia were more frequent in the intervention group at 6 and 12 months.[1] The study confirms the difficulty of long-term adherence to high fluid intake even with support.[2][5]