<p>Urological disorders encompass a broad spectrum of medical conditions that affect the kidneys, ureters, bladder, and urethra. Among these, urinary tract infections, kidney stones, renal dysfunction, and urological malignancies are commonly observed, each exhibiting distinct pathophysiological mechanisms. Due to their diverse etiologies and heterogeneous nature, strategies for prevention and treatment must be tailored to the specific characteristics of each disease. Lactylation, a recently recognized post-translational modification, arises from excessive lactate accumulation. This biochemical alteration occurs in histones, where it influences gene transcription, and in non-histone proteins, where it modulates their functional properties. Recent research indicates that lactylation significantly contributes to the development of various urological diseases by affecting key biological processes such as inflammation, angiogenesis, lipid metabolism, and fibrosis. Given its involvement in these pathological pathways, precise regulation of lactylation presents a promising avenue for both prognostic evaluation and therapeutic intervention in urological disorders. This review offers a thorough examination of lactylation, exploring its biological functions and mechanistic roles in urological diseases. In particular, it underscores the impact of lactylation on disease initiation and progression while providing novel insights into its therapeutic and preventive potential. By clarifying the role of lactylation in urological pathology, this analysis aims to support future scientific inquiries and clinical advancements in this expanding field.</p>