Ureteral stents, when left in situ in renal transplant patients, are a potential iatrogenic cause of graft compromise and graft failure. Such patients may present with acute renal failure, recurrent urinary tract infections, hematuria, and dysuria. We present a case report of a renal transplant patient with a heavily encrusted forgotten stent. We employed a simultaneous approach, using percutaneous nephrostolithotomy and cystolithalapaxy, for complete removal of the encrusted stent and associated stones. A MEDLINE literature review was then performed to identify and analyze similar cases in which a forgotten stent in a renal allograft was removed. Our experience and that found in the medical literature suggest that removal of forgotten stents can be achieved safely and effectively with proper endourological techniques. We also reviewed the current status of ureteral stent design in terms of attempts to preclude this problem. Ureteral stent design is still in a state of evolution with a focus on creating stents of new materials, and stents with new coatings, that may prevent encrustation.