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Introduction: Renal lithiasis affects approximately 5% of the general population, with higher risks for men and increasing risks with increasing age. The forward deployment of the Air Force into austere desert environments with integration of the active duty, Reserves, and Guard presents increasing risks to mission accomplishment with the increased risk of developing renal lithiasis. Methods: This paper describes seven cases of presumed renal lithiasis in a deployed desert setting in Air Force personnel on flying status. Their status and the location of the base acted as a focus for a review of the literature on kidney stone causation, prevention, diagnosis, and management. Results/Discussion: A review of the literature revealed that current military recommendations to hydrate in the field may not be sufficient for the primary prevention of kidney stones. Beverage choice may prove more useful for prevention. Situations precipitating voluntary dehydration need to be prevented. Although there are superior ways to diagnose renal lithiasis, in the deployed setting patient history and physical examination are usually the only available means. Ultrasound is a viable diagnostic option for use in the deployed setting based on its portability, affordability, and ease of use. Additions to the standard management of renal lithiasis, such as subcutaneous Lidocaine and heat may have value in the deployed setting if the supply of narcotics is limited. Conclusion: In the deployed setting, hydration choices, the addition of portable Ultrasound to the diagnostic process, and pain management with nontraditional therapies need to be explored.