Patients presenting with urological emergencies require rapid decision-making balanced by a comprehensive and structured evaluation. This chapter outlines a systematic approach to managing such patients, emphasizing the importance of an initial thorough history and physical examination to guide diagnosis and treatment. A structured ABCDE protocol ensures early detection of life-threatening conditions, facilitating stabilization and subsequent diagnostic steps. Advanced diagnostic tools, including sonography, computed tomography, and contrast-enhanced imaging, are discussed for their roles in emergency urology. The integration of telemedicine and its potential to enhance emergency care is highlighted. By combining clinical acumen with advanced diagnostic modalities, the chapter aims to equip urologists with the tools to manage the dynamic and high-stakes environment of acute urological care effectively.