This chapter reviews the clinical, macroscopic, and microscopic features, as well as the differential diagnosis of the most common lesions and tumors seen in a routine surgical pathology. It begins with common congenital anomalies. Benign lesions and mimics of cancer follow including entities such as fibroepithelial polyp, endometriosis, urethral inflammatory polyp, caruncle, urethral diverticulum, ectopic prostatic tissue, and idiopathic retroperitoneal fibrosis. This is followed by a review of neoplasms of the renal pelvis and ureter including benign urothelial neoplasms, flat urothelial lesions with atypia, urothelial carcinoma, squamous cell carcinoma, and adenocarcinoma. A review of common neoplasms of the urethra also includes benign epithelial tumors of the urethra, carcinoma of the urethra, squamous cell carcinoma of the urethra, and adenocarcinoma of the urethra. Applicable ancillary testing modalities including immunohistochemistry and other molecular findings are discussed.