Pediatric urology was required due to the wide range of complex illnesses that can be difficult to detect and treat. In 1983, pediatric urology made its way to West Virginia. In the state of West Virginia, which spans 24,038 square miles, there were two pediatric urologists. The utilization of telemedicine to reach out to more people across the state, as well as evaluating its efficacy from patient-centric cost analysis and diagnosis concordance standpoint. For patients in rural areas, it was both cost and time effective. The patients who came in for pediatric urological consultation from outside telemedicine “referral centers” in Martinsburg, Parkersburg, and Wheeling were evaluated. The purpose of the consultation, the geographic driving distance, the drive time, and the travel cost saved from the telemedicine consultation were all considered. Between August 2018 and April 2020, 92 patients were treated outside of approved telemedicine sites. The average travel time and distance saved by using telemedicine consultation were 4 hours and 46 minutes and 299.8 miles, respectively. The average cost of saved fuel per patient was $173.88. Undescended testis, recurrent urinary tract infection, and nocturnal enuresis were the reasons for the consultation. Only two (8.7%) of the 23 patients scheduled for surgery had a diagnosis that did not match their operating room evaluation. The excellent diagnosis concordance rate (91.3%) demonstrates that telemedicine could be used to evaluate a well-trained practice.