This paper reviews current concepts and controversies in regard to the classification, clinical findings, imaging techniques, and management of upper urinary tract trauma. The impact of CT, and especially spiral CT, in differentiating significant from nonsignificant renal trauma is reviewed. The controversy in regard to the correct approach to the management of any significant renal trauma (i.e., conservative vs. aggressive therapy) as well as the differences in opinion as to the appropriate treatment between blunt and penetrating trauma are also reviewed.