Approximately 10% of patients with abdominal trauma have an injury to the urinary tract. The majority of these (80%) are due to blunt trauma, and it is well established that many can be successfully managed nonoperatively. The goals of management of urologic trauma include expeditious and efficient radiologic evaluation, maximum preservation of kidney and urinary tract function, and minimum complications. With these goals in mind, we focus in this article on the management of complex trauma situations involving the urinary tract, including multiple organ system injuries and complex reconstructive cases.