In this article, we briefly summarize the technological differences between conventional energy-integrating detector computed tomography and photon-counting computed tomography (PCCT). With an eye on genitourinary (GU) applications, we discuss current literature on the development and optimization of clinical PCCT protocols, including the selection of kilovoltage peaks, ultra-high-resolution mode, and generation of spectral data sets such as virtual non-contrast series. Then, we review the current literature regarding applications in the GU system, including the differentiation of benign renal cysts from renal masses, the characterization of adrenal masses without the use of follow-up imaging, and the improved detection of renal stones.