Management of urinary lithiasis in solitary kidney patients is difficult. There are also difficulties in management of patients with ectopic kidneys. Kidney transplanted patients, however, have both problems. We reviewed articles in this matter to find the best approach for management of such cases. We reviewed articles submitted in MEDLINE from 1996 till 2007 for Incidence etiology and management of uroloithiasis in transplanted kidneys. Then we reviewed results and conclusions of these articles and risks and benefits of each approach. Results: 51000 transplanted kidneys in 50 articles reviewed. Incidence of uroloithiasis was very variable (average 1.7%) and in the United States it was 104/100000 annually in one report. Location of stones according to frequency was kidney, ureteral and bladder respectively. There are several treatment modalities as follows: medical treatment for small stones, watchful waiting for small non symptomatic patients, treatment of stones at donor kidney, treatment for patients with anuria or hydronephrosis with any kind of diversion and treatment for elective patients. For stones at donor graft SWL is recommended before donation and bench surgery is the other modality. For elective patients SWL is first line treatment at most centers. PCNL is the second line treatment modality and flexible ureteroscopy and insitu lithotripsy by pneumatic or Holmium laser was the last modality. Open surgery is rarely indicated.