Purpose of Review <p>Transitional urology is a critical bridge in the care of adolescents and young adults with congenital urologic conditions. Many of these patients will require urologic surgery, thus we herein review important operative considerations in this population.</p> Recent Findings <p>Transitional urologists face challenging and high-risk operations given the surgical complexity and patient-specific factors prevalent in this population. Their armamentarium must include the technical capacity to undertake difficult operations and an in-depth understanding of the patients’ clinical history and how disease and patient specific factors impact patient outcomes.</p> Summary <p>Comprehensive surgical management is an important underpinning of a successful transitional urologic clinic. The transitional urologist should consider important pre- (surgical history, current anatomy, functional status, bowel and bladder regimen), peri- (presence of ventriculoperitoneal shunt, pain goals, risk of venous thromboembolism), and post-operative (ERAS pathways, skin care, surgical site infection reduction, hernia risk) factors that drive patient outcomes.</p>