Urolithiasis is commonly encountered and frequently a fatal disease in the ruminant species. Clinical signs of urolithiasis are related to both its severity and chronicity. After complete obstruction of 24–48 h, bladder or urethral obstruction can occur. The varying urinary environments affect the type of stone development: phosphatic stones occur when cattle consume high phosphate diets; silica calculi form when grazing native grasses in the Western US; and calcium stones form when cattle consume high amounts of lush clover grass or alfalfa hay. Medical management is rarely successful as lone treatment but is used in conjunction with a surgical procedure. For a bull to return to reproductive function, the surgical procedure chosen must leave the urethra intact. The two procedures discussed presently are the ischial urethrostomy and tube cystostomy.