Improvements in imaging and device engineering have led to the rapid development of advanced, minimally invasive techniques in urologic care. While imaging advances have had a major effect in the areas of diagnosis, surgical planning and therapeutic assessment, the focus of this Review is on developments in intraoperative imaging that are currently making an impact in urology and are likely to provide additional opportunities to urologists in the years to come. While previous image-guided urologic procedures have mostly utilized two-dimensional X-ray images, it is expected that new technologies will involve the use of three- and four-dimensional multi-modality imaging, molecular imaging, and robot-assisted image-guidance techniques. Application of these procedures will bring together the complementary disciplines of endourology and interventional radiology in the development of multidisciplinary, cooperative approaches to providing optimal treatments and outcomes for urologic disease.