Major urologic complications occurred in 4% of 220 renal homotransplants. In addition, two grafts were lost due to ureteral slough. To keep urologic complications at a minimum, certain criteria have been established. The donor kidney must be removed by a surgeon experienced in transplantation techniques. Haste must be avoided when removing the donor kidney, especially from cadaver donors. Ureteroneocystostomy should be performed rather than pyeloureterostomy, unless the blood supply of the donor ureter appears to be marginal. Good exposure for the ureteral implantation should be provided without unnecessary vesical mobilization. Perfect vesical decompression should be maintained postoperatively. Diagnostic urological procedures should be performed immediately at the first suggestion of malfunction.