Of 24 renal allograft recipients with urinary extravasation 14 (58%) with ureteral fistulas were selected for percutaneous management in an attempt to obviate secondary operative intervention. The initial procedure in all cases was placement of a percutaneous nephrostomy tube with subsequent internal or internal/external stenting. With a mean followup of 47 months, the percutaneous management proved definitive in 5 patients (36%) and palliative in 1 (7%). The other 8 patients (57%) subsequently required open operative intervention. With this study, we conclude that percutaneous techniques can provide long-term definitive management for at least some transplant ureteral fistulas. However, even in a highly selected group of patients success rates will be limited.