INTRODUCTION: Helical tomotherapy (HT) is an innovative approach to the delivery of intensity-modulated radiation therapy which combines the imaging elements of helical computed tomography (CT) with megavoltage linear accelerator treatment. The purpose of this report is to describe our experience with the clinical implementation of HT for genitourinary malignancies. MATERIALS AND METHODS: All patients treated with a primary genitourinary malignancy were included in this study cohort. Descriptive statistics for various demographic and treatment-related parameters such as patient age, primary site of disease, site of radiotherapy, goal of treatment, dose/fractionation, immobilization and clinical trial enrolment were calculated. RESULTS: A total of 57 patients diagnosed with a primary genitourinary malignancy were treated on the helical tomotherapy unit during the study period. Median age was 69 years (range 45 to 83 years) and 56 (98.2%) patients were male. Prostate cancer was the most frequently treated genitourinary cancer in this cohort of 57 (94.7%) cases. Ten patients (17.5%) were treated with palliative intent, 46 (80.7%) with radical intent (including full dose prostate bed adjuvant/salvage RT), and one (1.8%) patient was treated in a purely adjuvant manner (high risk postop bladder). CONCLUSIONS: HT is a technology that can be utilized in both radical and palliative genitourinary treatment situations in order to deliver precise conformal IMRT therapy with unique localization and critical structure avoidance properties.