Genitourinary injury occurs in approximately 10% of abdominal trauma cases, with renal injury being most common, followed by urinary bladder (UB) injury. Most acute traumatic renal injuries (80–90%) are a result of blunt trauma. Though less common, penetrating renal injuries are often more severe. Ureteral injury usually occurs as a result of penetrating trauma, most frequently ballistic insults, and is usually accompanied by other intra-abdominal injuries. UB injuries are relatively uncommon, most of which are a result blunt trauma (60–85%), as compared to penetrating trauma (15–40%). Pubic rami fractures and diastasis of the pubic symphysis also have a high correlation with UB injury. Hematuria, though the most common indicator of injury to the genitourinary tract, is not a reliable predictor and is not always present. Additionally, the presence of hematuria does not indicate the site of injury, which may be anywhere along the genitourinary tract. Imaging is routinely used in the diagnosis and grading of genitourinary injuries and may involve a combination of standard trauma protocol CECT, followed by delayed-phase CT imaging, CT cystogram, and/or retrograde urethrography (RUG), depending on the site(s) of suspected injury. Determination and stratification of injury severity by imaging at initial presentation often directs management without the need for laparotomy in most patients. Familiarity with commonly used grading systems, including the American Association for the Surgery of Trauma (AAST) grading scales and radiology-based grading scales, is key in relating important findings to clinical providers.