Objective To describe parainguinal laparocystotomy for urolith removal and to report outcome. Study Design Prospective clinical study. Animals Ten geldings with uroliths. Methods Signalment, number, size, type of uroliths, surgical technique, and complications were recorded. Long-term follow-up was obtained by telephone interviews with the client and/or examination by the referring veterinarian. Results Cystic calculi, 3–9 cm in diameter, were removed by parainguinal laparocystotomy. Mean surgical time was 59 minutes (range, 40–100 minutes). With this approach, ligation of the pudendal or superficial epigastric vessels was not needed. Serous incisional drainage resolved without treatment in 3 horses and 2 horses developed moderate-to-severe incisional swelling. On long-term follow-up (mean, 52 months; range, 11–82 months) for 9 horses, owners reported no recurrence of clinical signs associated with cystic calculi. Conclusions Parainguinal laparotomy represents a satisfactory alternative approach to the apex of the bladder for urolith removal. Clinical Relevance Parainguinal laparocystotomy avoids the pudendal and superficial epigastric blood vessels that are encountered when performing median or paramedian laparocystotomy in geldings. This approach minimizes dead space by avoiding the reflection of the prepuce in paramedian or median approaches.