Bladder stones have been a torment to humankind since ages. Despite its ancient and well descripted history, bladder calculi nowadays are relatively rare and account for approximately 5% of all urinary calculi. Primary bladder stones occur in the absence of other urinary tract abnormalities. Typically, these are seen in children in areas with either a diet lacking animal protein and vitamins and/or excessive oxalate consumption, or poor hydration and recurrent diarrhea. Secondary Bladder stone formation is mostly associated with other urinary tract abnormalities like: bladder outlet obstruction, underactive bladder, recurrent UTI, neurogenic bladder, bladder diverticula, foreign bodies, Bladder augmentation or urinary diversion. Bladder stones present predominantly with lower urinary tract symptoms (LUTS), suprapubic pain and hematuria. Endemic bladder stones typically consist of ammonium acid urate and calcium oxalate. Current surgical treatment choices include suprapubic cystolithotomy, transurethral cystolihtotripsy and percutaneous cystolithotripsy. Extracorporeal shock wave lithotripsy (ESWL) and chemolysis might also be a treatment choice in selected patients. Management of urinary bladder calculi is a multi-dimensional procedure including patient and stone characteristics and underlying pathology. There are several surgical treatment options which must be considered according to armamentarium and patient and stone characteristics.