It's not important that title tags should match URLs. Not directy, anyway. Indirectly, via title<->keywords<->URLs, that's a different matter ...
Title tags should contain (note not match, but contain) target keywords, for sure.
So your real question is "Is it important to have keyword rich URLs?" This debate is as old as the hills, and in my own extensive experience it hardly makes a difference. However, Google's Matt Cutts has stated it can help, and is probably one of Google's 200+ ranking signals, so therefore if you were starting from scratch then it might make sense to use keywords in URLs in a limited way. What I definitely would not do is re-do an entire site architecture that was working pretty well, just to get some keyword-rich URLs.
When you say your URLs are "full of cgi crap", I guess that means they are dynamic? i.e. contain lots of query parameter/value pairs (?param1=value1¶m2=value2¶m3 etc.) Such URLs can be harmful, for lots of reasons (mostly to do with duplicate content, thin content, and spider traps) and it's worth addressing these issues. But the problem isn't that your URLs don't contain keywords or match the title tags.