Genitourinary trauma usually occurs in the setting of multisystem trauma, accounting for approximately 10% of all emergency department admissions. Timely evaluation and management of the trauma patient have the potential to minimize urologic morbidity and mortality. New imaging modalities and a growing emphasis on nonoperative expectant management of both upper and lower urinary tract injuries have changed the field of urologic trauma. Concomitant injury to both the upper and the lower urinary tract is rare, but careful evaluation is critical to identify these devastating injuries.