The prevalence of equine urolithiasis has been estimated to be low. In horses with clinical signs of urolithiasis, uroliths are most commonly encountered in the urinary bladder, but it is not uncommon to detect uroliths in more than one location. The most common clinical signs for cystic calculi are urine scalding of the hind limbs, hematuria, tenesmus and dysuria. Numerous surgical techniques and approaches have been described for the treatment of urolithiasis in horses; however, independent of which approach is chosen, the goal should be to remove all calculi completely from the urinary tract, thus decreasing the chance of recurrence of urolithiasis. Laser lithotripsy and shock wave lithotripsy represent means to fragment uroliths with little morbidity, but limited availability of and costs associated with the equipment have precluded these technologies from being used more commonly in horses.