Introduction Urological complications are relatively common in patients who have undergone kidney transplantation. Timely diagnosis and proper treatment preserve graft function. The objective is to evaluate the efficacy and safety of endourological interventions used to treat posttransplantation urological complications and lymphocele. From 1989-2002, 700 kidney transplantations were performed at our center. Of these, 30 problems in 28 kidney recipients required endourological interventions, including percutaneous nephrostomy (PCN), percutaneous drainage and transurethral resection of Bladder tumor. Complications were urolithiasis of the kidney and ureter, ureteral stenosis, ureteral obstruction, lymphocele, urinoma and Bladder tumor. 12 patients had lymphocele. All of which we managed by percutaneous drainage along with installation of catheter in the sac for average of 10 days. Only one of the 12 needed open surgery. Nine patients had ureteral stenosis or ureteral obstruction, PCN successfully corrected the creatinine level in 5 patients. Percutaneous antegrade jj stent insertion and ureteral dilatation with ureteroscope led to resolution of ureteral stenosis in 2 patients. PCN also improved urinary leakage in 4 patients. 3 patients developed hydroureteronephrosis secondary to ureteral stone (2 cases) and pelvic stone (1 case), and recovered after PCN + Extracorporeal shock wave lithotripsy in 2 patients and PCN + surgery in other patient. One patient had Hydronephrosis due to pelvic abscess and successfully drained. In one patient transurethral resection of transitional cell carcinoma of Bladder was performed. Sonography was the best tool for diagnosing urological complications. In the most cases, endourological intervention improved the patient’s condition and if followed by surgery, decreased the incidence of morbidity and operative failure. Endourological interventions also improved graft survival.