Renal autotransplantation has become the treatment of choice for selected patients with difficult urological problems such as extensive ureteral loss, complicated renovascular disease, renal malignancy requiring nephron-sparing surgery, the loin pain-hematuria syndrome, and severe renal trauma. This approach offers specific advantages in each of these categories, including the option to carry out extracorporeal repair of the kidney if necessary. This is also often the only available technique for achieving reconstruction and salvage of the involved kidney. The long-term results with renal autotransplantation are excellent and support its continued application in appropriate clinical conditions.