Posterior pelvic fracture urethral distraction defects (PFUDD) can present formidable challenges in genitourinary reconstruction. Once the acuity of trauma subsides, the patient is often faced with chronic, debilitating genitourinary injuries. Treatment requires an astute diagnostic and technical approach, with definitive repair best accomplished in the hands of experts. A delayed, stepwise approach to repair following the resolution of acute injuries remains a time-tested platform for optimal outcomes. The evaluation, relevant anatomy, and approach to surgical repair are described herein.