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Management of a ureteric stricture post ureteroileal anastomosis of a renal transplant. A 58-year-old woman with a prior radical cystectomy and ileal conduit underwent a living-related donor renal transplant for end-stage renal disease secondary to autoimmune glomerulonephritis. She subsequently developed an ischaemic stricture of the transplant ureter. A successful ureteropyelostomy was performed with the native right ureter anastomosed to the pelvis of the renal transplant. She presented to the emergency department 18 months later feeling unwell and with raised inflammatory markers. Imaging demonstrated a large soft tissue mass over the right psoas muscle and hydronephrosis of the native right kidney. A nephrostomy and nephrostogram of the native right kidney diagnosed a urine leak from the native right kidney and she underwent an open right native nephrectomy. She recovered well postoperatively and continues to have excellent graft function. Renal transplantation in an abnormal urinary tract carries a high risk of complications. A multidisciplinary team approach is essential in offering the most appropriate treatment and ensuring good graft function is preserved.