Abstract: Pyroptosis is a form of programmed cell death that differs from classical apoptosis and passive necrosis. It plays a crucial role in activating innate immune responses, driving local inflammatory reactions, regulating immune cell activation and infiltration, and remodeling the tumor immune microenvironment. In recent years, the role of pyroptosis in the initiation, progression, and treatment response of urological tumors has garnered increasing attention. Current studies have demonstrated that pyroptosis exhibits dual regulatory effects in various tumors: on the one hand, it exerts anti-tumor effects by inducing lytic death of tumor cells; on the other hand, under specific microenvironmental conditions, the chronic inflammatory response mediated by pyroptosis may promote immune escape, thereby driving tumor progression. This review systematically summarized the similarities and differences in the molecular mechanisms of pyroptosis in three common urological tumors, namely renal cell carcinoma, bladder cancer, and prostate cancer. It also summarized the regulatory networks and potential therapeutic targets during tumor initiation and progression. Furthermore, it elucidated the research progress on enhancing the efficacy of immune checkpoint inhibitors by modulating pyroptosis pathways, aiming to provide novel strategies and theoretical foundations for the precise treatment of urological.