Between January 1977 and March 1988, 10 of 892 renal transplant recipients formed urinary tract calculi posttransplantation. The presenting symptoms were predominantly those of azotemia due to obstruction and/ or hematuria. Factors predisposing to stone formation included a reconstructive urologic procedure at the time of transplantation (n=4) or a surgical complication (n=4), necessitating the placement of a ureteral stent and/or nephrostomy tube, secondary hyperparathyroid-ism (n=5), hyperuricosuria (n=4), and hypercalciuria (n=1). Four patients passed their stones spontaneously; 1 patient underwent ureterolithotomy, 3 patients underwent endourologic stone extraction, 1 patient was treated with a combination of surgical and endourologic procedures, and 1 patient underwent extracorporeal shock wave lithotripsy as monotherapy. While the management of these patients can be challenging, awareness of predisposing factors, proper application of all currently available urologic techniques, and attention to certain guidelines of management can aid in minimizing morbidity from this rare urologic complication of renal transplantation.