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Objective: The objective of this study is to identify variables associated with clinical outcomes after urologic transfers before and during the COVID pandemic. Methods: After IRB approval, a retrospective chart review was performed on adult patients transferred to our institution from 01/01/2018 to 12/31/2019 ("pre‐COVID") and from 01/02/2020 to 12/31/2022 ("COVID"). We identified demographics, origin hospitals, ICD‐10 pre‐ and post‐transfer diagnoses, distance of transfer, and post‐transfer CPT codes. Results: During the study period, our adult urology service accepted 160 transfers with a mean patient age of 71 years. A total of 49/160 (30%) of subjects made up the "pre‐COVID" cohort and 111/160 (70%) made up the "COVID" cohort. There were 11/111 (10%) transfers of >100 miles in the COVID period but 0/49 in the pre‐COVID period (p = 0.02). Patients from the COVID period waited on average 1.2 days longer for a procedure after transfer compared to pre‐COVID period (p = 0.03). The time until a patient's surgical procedure after transfer was a significant predictor of length of stay > 5 days (OR 1.91, CI 1.43 – 2.58, p < 0.01). Different diagnosis upon re‐evaluation after transfer was associated with a decreased rate of subsequent readmission (OR 0.30, CI 0.09–0.97, p = 0.05). Conclusions: Long‐distance transfer, even >100 miles (which we termed "mega‐transfers"), was a new pandemic‐related phenomenon at our institution. Delays in definitive care and changes in diagnoses after transfer were associated with readmission and length of stay. Our findings illustrate the importance of inter‐institutional communication, diagnostic accuracy, and post discharge planning when managing transfer patients. [ABSTRACT FROM AUTHOR]