The future of air travel may seem uncertain at the present time, but up until the COVID-19 pandemic, approximately 44,000 inflight medical emergencies occurred annually, averaging 1 in 604 flights. Some of you will have heard the heart-sink announcement “if there is a doctor on board please identify yourself” and wondered what you will have to deal with. Using a database from a ground-based medical support centre, 1368 (1%) out of 138,612 in-flight emergencies between 2015 and 2017 were identified to be urological in nature. Bearing in mind the limitations of this data, consequent to the potential inaccuracies of reporting a diagnosis by a crew member and those that are not reported at all (surprisingly only 34% of all incidents have in-flight medical reports recorded), 30% of these urological emergencies were urinary retention, 21% flank pain, 35% lower urinary tract symptoms / suspected urinary tract infection, 9% visible haematuria, 3% testicular pain, and 1% catheter-related problems. Catheters were available in 92% of on-board medical kits but this varies between airlines. In-flight emergencies may potentially increase morbidity consequent to limitations imposed by availability of on-board medical supplies, limited space, crew training and the distance to the nearest airport. The majority of emergencies are outside the day-to-day practice of urology, usually involving conditions such as syncope, respiratory symptoms (perhaps more often in the near future), nausea and vomiting and consequently requires a broad knowledge managing these.