Aim: Ultrasound scanning has been defined as the urologist’s stethoscope. These recommendations have been drawn up with the aim of ensuring minimum standards of excellence for US imaging in urological and andrological practice. A series of essential recommendations are made to be followed during US investigations in the kidney, prostate, bladder, scrotal, and penile diseases. Methods: According to recent evidence, we updated the previous document approved in 2014 by members of the Imaging Working Group of the Italian Society of Urology (SIU) in collaboration with experts’ opinions of the Italian Society of Integrated Diagnostic in Urology, Andrology, and Nephrology (SIEUN), and surveyed by members of the Italian Society of Radiology. Results: Recommendations are listed in five chapters, focusing on the kidney, bladder, prostate and seminal vesicles, scrotum and testis, and penis, including penile echo-Doppler. In each chapter, clear definitions are made of indications, technological standards of the devices, and the method of performance of the investigation. The findings to be reported are described and discussed, and examples of final reports for each organ are included. In the tables, the US features of the principal male urogenital diseases are summarized. Diagnostic accuracy and second-level investigations are considered. Conclusions: Ultrasound is an integral part of the diagnosis and follow-up of diseases of the urinary system and male genitals in patients of all ages in both the hospital and outpatient settings. These recommendations are dedicated to enhancing communication and evidence-based medicine in an inter- and multidisciplinary approach. The ability to perform and interpret US imaging correctly has become an integral part of clinical practice in uro-andrology, but intra- and interobserver variability is a well-known limitation. These recommendations will help to improve terminology, reliability, and reproducibility in uro-andrological US scanning.