Patients with skeletal metastases from all sites are increasing in number as the treatment protocols for primary tumors improve survival of patients with cancer. While diagnosis and follow-up of the patient with urologic skeletal metastasis continue to become more sophisticated with new MRI techniques and the advent of positron emission tomography, the goal of orthopedic treatment remains the same: pain relief and maintenance of mobility. This paper describes the pathogenesis of metastasis followed by strategies currently available for accurately diagnosing, treating, and following the patient with skeletal metastases secondary to urologic malignancy.