Malignant urological tumours account for a relevant number of patients who develop bone metastasis throughout the course of their disease. Diagnosis of bone metastasis is mostly achieved by imaging studies including plain X-ray, computed tomography or magnetic resonance tomography. Differential diagnosis between benign and malignant processes in the bone can be sometimes challenging so that minimally or open operative biopsy of the bone becomes necessary in rare cases. After diagnosis of bone metastasis medical treatment using bisphosphonates or denosumab should be initiated in order to prevent skeletal complications. Therapeutic goals for symptomatic bone metastasis are the reduction of tumour associated pain and stabilization of the bone. Pathologic fractures are mostly being treated using either minimally invasive or open operative techniques for stabilizing the segment of the bone or spine. In case of accompanying neurologic symptoms immediate intervention and decompression of the neural structures is warranted in order to prevent irreversible neurologic deficits.