Operative exploration is required in 5% to 10% of cases Absolute indications for renal exploration are life-threatening hemorrhage believed to be from renal injury, renal pedicle avulsion and expanding, pulsatile or uncontained retroperitoneal hematoma Relative indications include incomplete radiographic staging with concurrent traumatic injuries that require repair/exploration, extensive devitalized renal parenchyma, vascular injury, and significant urinary extravasation Attempts to preserve the kidney are more likely to succeed in patients with grade IV injuries Children with grade V injuries frequently require nephrectomy In patients with vascular injuries, chances of renal salvage are improved if renal parenchyma is minimally disrupted and revascularization is achieved within a few hours of the injury Penetrating renal injuries have traditionally been managed with operative intervention Compared with blunt trauma, far less literature is available in support of nonoperative treatment after penetrating trauma In addition, many recommendations are extrapolated from data on adult patient populations Careful selection of hemodynamically stable patients who can tolerate CT staging may identify a cohort of children who can be safely treated conservatively Indications for renal exploration are similar to those for injuries caused by blunt trauma Patients with penetrating trauma have a higher need for surgical intervention Short-term complications of renal trauma include delayed hemorrhage, urinary extravasation, abscess formation, and ureteral obstruction secondary to clot formation Drainage with a ureteral stent or percutaneous nephrostomy may be considered in cases of ongoing urinary extravasation Long-term complications include compromised renal function, hypertension, and arteriovenous fistula Chronic hypertension develops in a period ranging from days to 32 years, which is why patients with a history of renal trauma should undergo long-term yearly blood pressure monitoring URETER Goal of Treatment Ureteral injuries are uncommon in children and are often missed on initial evaluation As the ureters are well protected in the retroperitoneum, significant concomitant injuries are usually present The goal of emergency evaluation is to recognize the clinical scenarios in which ureteral trauma is possible so as to allow high suspicion for these injuries and prompt operative intervention These injuries occur in less than 1% of all genitourinary traumas