Purpose <p>With simulation-based training becoming increasingly common, identifying experiences that enhance surgical aptitude has become a growing area of research. However, data specific to urology remains limited. Video game exposure may enhance visuomotor and cognitive skills relevant to urological procedures. This study aimed to compare ureteroscopic performance between gaming and non-gaming students and to evaluate associations between gaming habits and task performance.</p> Methods <p>In this prospective study, undergraduates with no prior ureteroscopic experience completed a demographics and gaming history questionnaire, played one tablet- and one smartphone-based game, then performed diagnostic ureteroscopic and stone extraction tasks on a bench model, with completion times and game high scores recorded.</p> Results <p>A total of 160 students were included. Gamers, defined as playing &gt; 3&#xa0;h/week at the peak of their gaming history, outperformed non-gamers in both ureteroscopic (<i>p</i> &lt; 0.01) and video game tasks (<i>p</i> &lt; 0.01). Ureteroscopic performance correlated with years of gaming experience (<i>p</i> = 0.001) and peak weekly gaming hours (<i>p</i> = 0.002), regardless of gamer status. Current gaming time showed no correlation. Hand dominance had no significant effect, while male participants outperformed females in all tasks (<i>p</i> &lt; 0.04), irrespective of gaming status.</p> Conclusion <p>Prior video game exposure was associated with superior baseline ureteroscopic performance. These findings suggest video gaming may support psychomotor skill development relevant to urology. Further research should define the transferable skills involved and identify additional life experiences influencing ureteroscopic aptitude. Integrating these insights into surgical training could enhance skill acquisition and help identify individuals with greater innate aptitude for urological specialization.</p>