Urinary tract infection (UTI) is a major cause of morbidity and mortality in renal transplant recipients. The effect of intravesically applied antibiotic solution in the prevention of infectious complications of renal transplantation is still controversial. The aim of this study was to evaluate the efficacy of intravesical amikacin for the prophylaxis of the post transplant UTI within the first three months after kidney transplantation. In a prospective, randomized controlled trial, two hundred consecutive renal transplant recipients were randomly allocated to two 100 study groups. The bladder was filled preoperatively with saline solution containing amikacin (1 gr in adults or 30 mg/kg in children) in the test group, and with saline solution only in the controls. Patients were followed up for three months after the transplantation. Post operative urinary tract infection was defined based on a urine culture with a bacterial count of 100,000 CFU per mL of urine, or a positive nitrate test. Factors such as gender, age, the underlying kidney disease, receiving the first graft or subsequent retransplantation, and the source of graft (living-related, unrelated, or deceased donor) were analysed. The overall incidence of UTI was significantly lower in the test group (25% vs. 49%; p=0.0007). In addition, male patients, adults, first kidney graft recipients, patients with ESRD due to glomerulonephritis, having renal transplantation for the first time, or those patients from the test group receiving a living-related graft have significantly lower episodes of UTI than their control counterparts (p<0.05). Ecoli was the most common organism causing UTI (28.9%). In conclusion, the addition of amikacin to the bladder irrigation fluid could have significant effects on the overall incidence of UTI in the first three months after the kidney transplantation.