To determine the incidence of, indications for and sequelae of temporary vascular occlusion in the management of renal trauma the records of 90 patients with 92 renal injuries were reviewed. Patients who required temporary vascular occlusion were compared to patients with similar injuries who also required renal surgery but not vascular occlusion. Only 11 of 92 renal injuries (12 per cent) required temporary vascular occlusion for reconstruction and control of renal bleeding. Neither the type nor the extent of renal and associated injury was a significant predictor of the need for occlusion. Renal injuries associated with large or expanding retroperitoneal hematomas were more likely to require temporary vascular occlusion than injuries without such associated hematomas. Temporary vascular occlusion was not associated with an increase in postoperative azotemia or mortality. The procedure is safe and effective, and allows for confident inspection and reconstruction of the kidney in patients who otherwise would be at high risk for nephrectomy.