What is your approach to the medical management of struvite kidney stones?

It is difficult to separate medical and surgical management of struvite stones, since these stones are typically the consequence of persistent or recurring infections.

Surgically, risk factors for infection need to be addressed, which may include efforts to remove any retained stone material, followed by appropriate antibiotics to "clear" the residual infection. It may also involve addressing drainage pathways surgically to eliminate need for chronic instrumentation.

Medically, all stone recurrence rates can be reduced by making the urine more dilute through drinking more fluid (increasing urine volume). 

Lowering urine pH to normal will suppress struvite formation, usually accomplished primarily through suppression or curing of bacterial colonization in the urine.

If 24-hour urine phosphate levels are high, work to reduce unnecessary dietary sources of phosphate, like from soda, specifically colas.