Renal trauma research has historically focused on parenchymal injuries and the risk of bleeding. However, much less is known about the diagnosis and optimal management of urinary extravasation, which complicates ~30% of high-grade renal injuries. Immediate or delayed ureteral stenting is the most common procedure used to treat collecting system injuries when intervention is needed. However, the lack of evidence-based guidelines leaves the diagnosis and management of urinary extravasation largely dependent upon physicians' experience, initial and follow-up imaging protocols, and the definitions used for grading the injuries. The knowledge gaps in the management of urinary extravasation that need to be addressed include the timing of excretory-phase CT imaging, patterns of clinically significant urinary extravasation, predictors of complications when urinary extravasation occurs, protocols for obtaining and interpreting follow-up imaging, and the role of ureteral stenting and other interventions in management. To improve the management of urinary extravasation after high-grade renal trauma, large, multi-institutional prospective trails assessing different diagnostic and therapeutic protocols are needed.