Genitourinary diseases significantly affect the quality of life of elderly individuals in Europe, yet comprehensive studies on their burden remain limited. This study used Global Burden of Disease (GBD) 2021 data to analyze the burden of genitourinary diseases in adults aged 55 and older in Europe from 1990 to 2021, with projections to 2030 to inform policy development.Using GBD 2021 data, we assessed the burden of genitourinary diseases in European adults aged 55 and older, analyzing incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) rates. Associations with socioeconomic indicators, including the Socio-Demographic Index (SDI) and Human Development Index (HDI), were analyzed using Spearman's correlation. Temporal trends were examined through Estimated Annual Percentage Change (EAPC) and Autoregressive Integrated Moving Average (ARIMA) models.In 2021, Europe emerged as the region with the highest proportion of elderly populations globally. Among European nations, the Russian Federation reported the highest incidence rates of certain genitourinary diseases, including urinary tract infections (UTI) and interstitial nephritis (IN) at 10,188.73 (95% UI 8,549.59 to 11,914.66), urolithiasis at 8,538.61 (95% UI 6,976.70 to 10,315.88), and benign prostatic hyperplasia (BPH) at 1,377.63 (95% UI 1,040.48 to 1,702.85) per 100,000 population. Greece exhibited the highest DALYs, mortality, and YLLs rates related to chronic kidney disease (CKD). Notable gender and age disparities were evident, with males generally bearing a heavier burden across the majority of genitourinary disorders, except for UTI and IN, where females, particularly those aged 55-64, demonstrated a higher incidence. Socioeconomic factors also impacted these burdens, with higher Human Development Index (HDI) scores associated with increased mortality (R = 0.50, P < 0.001) and YLDs (R = 0.37, P = 0.014). Projections indicated that the burden of genitourinary diseases would continue to rise across most European countries over the next decade, while countries like Poland and Iceland were expected to experience declines.Genitourinary diseases are increasingly burdening Europe's aging population. Addressing regional, gender, and socioeconomic disparities is critical for developing effective, age-sensitive healthcare policies and strengthening healthcare systems.Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.