Ileal incorporation into the urinary tract of renal recipients is indicated for different pre-and post-transplant urologic disorders. The aim of this study is to evaluate the pre- and post-transplant indications, employed surgical techniques, as well as the impact upon long-term graft function and survival in these patients. Between Mar. 1976 and Jan. 2003, a total of 1500 consecutive live-donor renal transplants were performed at a single institution. Thirteen patients (0.9%) had history of ileal incorporation into their urinary tracts. There were 6 patients (group I) with pre-transplant ileal loop conduit or bladder augmentation. Whereas, post-transplant ileal ureter or ileal bladder substitution were offered for 7 patients (group II). Patients’ characteristics, surgical techniques and impact upon long-term graft function and survival were reviewed. Overall graft survival in patients with ileal incorporation was 92% at 1year, 84% at 5 years and 61% at 10 years compared with 94%, 78% and 54% respectively in the remaining population (p=0.73). In group I ileal incorporation was indicated in five patients with neurogenic bladder and one patient with valve bladder. In group II, Post-transplant ileal substitution was indicated in 3 patients with muscle invasive bladder cancer while ileal ureter was instituted in 4 patients with urologic complications. Patients’ characteristics were comparable in both groups apart from significantly younger patients in group I (P= 0.01).Graft function was 1.2 mg % and 1.7 mg % in group I while it was 1.3 % and 1.5% in group II at 1 and 5 years respectively (p=0.69, p= 0.67) .Similarly, graft survival was comparable between both groups. Ileal incorporation into the urinary tract could be offered for renal failure patients prior to transplantation and for renal recipients whenever indicated without impact upon long-term graft function or survival.