This chapter reviews the evidence for or against the use of prophylactic antibiotics in four commonly performed urological procedures. A first systematic literature search is conducted in PubMed using the Mesh search terms “antibiotic prophylaxis” and “ureteroscopy”. A second systematic literature search is conducted in PubMed using the search terms “antibiotic prophylaxis”, “antimicrobial prophylaxis”, and “extracorporeal shock‐wave lithotripsy”. A third systematic literature search is conducted in PubMed using the mesh terms “antibiotic prophylaxis”, “prostate”, and “biopsy”. A fourth systematic literature search is conducted in PubMed using the search terms “antibiotic prophylaxis”, “antimicrobial prophylaxis”, “transurethral resection” and “prostate”. Many areas of antibiotic prophylaxis research would benefit from high‐quality randomized controlled trials (RCTs) and systematic reviews of higher methodological rigor. Guidelines should adopt a transparent method to consider the quality of the evidence base for each clinical question using judgment and clinical understanding.