I'm in this same situation. Just got engaged to another 3rd year who I've been dating since college. I'm 100% set on doing urology, she's still not sure what she wants to do (possible Ortho).
It makes things more difficult for sure. That said, I know 2 different guys who were upperclassmen who matched in Urology and ended up in the same city as their significant others. They mainly stuck to big cities with multiple residency programs. Once they matched, they asked their program director to make some calls on their significant others behalf. Apparently it worked in both situations.
I'm pretty paranoid about this, though. Really don't want to get married and then spend 5+ years apart.