Survivors of pediatric urologic tumors face unique challenges related to fertility and sexual health, stemming from the disease itself and from multimodal treatment. As a result of improved survival rates, some focus has shifted toward optimizing long-term quality of life, including preservation of reproductive potential and healthy psychosexual development. This chapter reviews the impact of tumor type, treatment modality, and timing on fertility and sexual well-being. Strategies for fertility preservation, risk stratification, and counseling are highlighted, along with guidance on surveillance and multidisciplinary support across the survivorship continuum. By addressing these critical aspects early and consistently, clinicians can help patients navigate reproductive and sexual concerns, promote informed decision-making, and enhance overall life satisfaction after cancer treatment.