Purpose Blockchain, a novel technology, has changed the way data is stored on the Internet. Its unique inherent feature of maintaining secure and decentralised records, protects it from changes or deletion. Other advantages include system transparency, built-in security and increased autonomy of its users. Blockchain application is well exemplified in cryptocurrencies, governance, security and education. This review aims to assess the current uses of Blockchain in Surgery, and explore potential applications in Urology. Method Systematic literature review and critical appraisal was performed, searching PubMed database for relevant Blockchain papers on Surgery, published in English, between 2003-2024. Results Our search yielded 59 results for Blockchain and Surgery, and only six for Urology. Current application of Blockchain is limited in Surgery and sparse in Urology. Main uses are in secured decentralised dataset across multi-national research centres, and personal health records (patient wallet) in parts of Europe. Conclusion Blockchain is a highly secure technology. Particularly in data decentralisation and immutability (once data entered and stored becomes permanently irreversible). Blockchain has the potential to revolutionise the digital Surgery and Urology, especially in the era of AI. Our proposed utilisations for Blockchain in Urology include: decentralised two-level secured operative consent, ureteric stent tracing, supply chain of BCG, improving electronic medical records and large-scale research, optimising surgery and complication reporting and intraoperative documentation, and universal management of low-risk prostate cancer. Widespread awareness and gradual integration of the technology is required within the healthcare system and to the public.