Ultrasonography is now well established as an accurate, noninvasive means of evaluating the genitourinary tract in patients of all age groups. Ease, speed, and portability of real-time have made ultra-sonography one of the most readily accessible imaging procedures. Most authorities concede that it is best utilized as a complement to other imaging modalities. This article describes and illustrates the many pathologic processes involving the upper genitourinary tract that can be accurately diagnosed utilizing real-time ultrasonography.