A 20 year-old Standardbred breeding stallion presented to the Cornell Equine Hospital for evaluation of a bladder stone diagnosed by the referring veterinarian. The stallion was acutely colicky and anuric, and the referring veterinarian extracted multiple marble- to golf-ball sized stones from the urethra. Upon presentation, the stallion had vital signs within normal parameters with pollakiuria and hematuria. Bloodwork indicated mild dehydration and a neutrophilia. On rectal palpation, a soft-ball sized stone was palpated within the urinary bladder at the level of the pelvic inlet. A renal ultrasound was performed which detected a small nephrolith in the left kidney but no evidence of chronic renal failure. A novel surgical approach, combining a ventral midline celiotomy with a parainguinal incision, was performed under general anesthesia to remove the bladder stone. In the surgeon’s opinion, this procedure allowed increased visualization and manipulation of the urinary bladder compared to other published techniques.