Ureteral strictures in transplanted renal units are initially managed by balloon dilation and indwelling stents. When endourologic management fails, ureteroneocystostomy or pyeloureteral anastomosis to the native ureter is the treatment of choice. Nevertheless, such procedures are not always successful. We present what we believe to be the first two North American cases of silicone-polyester artificial ureters (pyelovesical bypass graft) after failed endourologic or open management of ureteral strictures after renal transplantation. After 12 and 15 months of follow-up, the renal function was stable, with no evidence of obstruction. Long-term follow-up is needed to monitor the rate of late encrustation and obstruction.