BACKGROUND: We present a case of COVID-19-positive pediatric patient for urgent urological surgery by spinal anesthesia to avoid aerosolizing procedure. CASE PRESENTATION: A 12-year-old, COVID-19-positive boy presented for urgent wound incision and drainage at the circumcision site. Our anesthetic plan consisted of spinal anesthesia with sedation. He was transported from the COVID-19 isolation floor to the negative pressure operating room. He was placed in lateral decubitus position and oxygen was delivered through facemask. Under sedation, spinal anesthesia was achieved at first attempt. The patient maintained spontaneous ventilation without airway intervention. Patient was recovered in the operation room then transported back to the floor. CONCLUSION: Spinal anesthesia is a safe alternative to general endotracheal anesthesia for many pediatric urology procedures. Effective team communication and preparation are keys when caring COVID-19-positive patient in perioperative setting to avoid minimize the risk to healthcare providers.