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Objective To report laparoscopic-assisted cystotomy and inguinal cystostomy for treating bladder urolithiasis in a gelding. Study Design Clinical report. Animals Twelve-year-old Appaloosa gelding. Methods A laparoscopic approach was used to locate and grasp the bladder, which was exteriorized through an enlarged instrument portal for cystotomy to remove the calculus. During withdrawal, the calculus fragmented into multiple pieces. To avoid urethral occlusion and facilitate elimination of these fragments, an inguinal cystostomy was created. The seromuscular layer of the bladder was circumferentially secured to the abdominal fascia and bladder mucosa margins were sutured to the skin. Results At 2-year follow-up, the gelding was in good condition with mild urine scald of the left ventral abdomen. Conclusion Laparoscopic-assisted cystotomy was used for calculus removal and inguinal cystostomy for successful fragment elimination.