The urinary and genital tracts are affected by more anomalies than any other organ systems. Very few of these abnormalities require urgent neonatal intervention, but recognition of clinical findings is important for directing appropriate evaluation and management. This article addresses renal, bladder, and genital abnormalities noted in newborns. Neonatal management of exstrophy/epispadias complex, prune belly syndrome, and myelomeningocele is discussed. The differential diagnoses of abdominal masses and introital masses are presented.