Surgeons of the Royal Navy during the Napoleonic and revolutionary wars, between 1793 and 1815, were solely responsible for all health care of the officers, men, and boys of their ships. This paper examines the genitourinary medicine and surgery encountered by the naval surgeons at the time of Nelson. Primary sources are examined to explore the presentation, case mix, and management of genitourinary disease during this period. A general overview is given of the life and work of the Royal Naval surgeons at the end of the 18th century. The documents that were examined contained 39 surgeon’s journals, these were written by 26 surgeons on 13 different ships. The journals contained 446 presentations to the sick list of men with genitourinary symptoms. The presenting symptoms are grouped together under the following headings; venereal disease, penile pathology, scrotal pain and swelling, urinary symptoms and retention, stone disease and trauma. Examination of these journals permits a glimpse of medical life in the Royal Navy during the time of Nelson. The case load and management of genitourinary disease shows the diversity of presentation to these surgeons.