Abstract Complications leading to urinary extravasation developed in four of thirty-three renal transplant recipients. The management of these patients was facilitated by the use of temporary nephrostomy drainage, resulting in a functioning kidney and survival in all cases. The advantages of nephrostomy in transplantation, as described, are as follows: fistulas and extravasations, dangerous in the immunosuppressed patient, can be converted to situations of controlled urinary drainage; the success of reoperative surgery of the urinary tract can be secured by total urinary diversion accomplished by nephrostomy; and excellent postoperative radiologic studies of urinary tract disease can easily be performed by nephrostogram. We believe that these cases demonstrate the value of the much maligned nephrostomy in the transplanted patient, converting the potentially fatal complications of urinary leakage and obstruction to more easily manageable problems.