Determination of stone composition is considered to be crucial for the optimal management of urolithiasis. It is important for three reasons. Firstly, composition is related to hardness, which in turn affects the outcome of extracorporeal shockwave lithotripsy (ESWL); hard stones may be resistant to ESWL treatment. Secondly, stones related to various metabolic syndromes, such as cysteine stones or uric acid stones may require systemic medical treatment. Finally, knowing the stone composition enables some preventive efforts. This is a study conducted to find the ability of a simple test i.e. urine microscopy to predict the actual composition of stone. Total 346 patients participated in this study conducted at Government Medical College Trivandrum and it was concluded that urine microscopy is a good predictor of actual stone composition.