A 33yrs male patient underwent Renal allogenic Recipient surgery 9 months back,he was fine 2 months back when his creatinine suddenly started showing a increasing trend on USG graft kidney showed hDN,pt had undergone renal transplant 7 yrs bak graft was placed in rt iliac area that time wich eventually went in rejection.

Second time graft was placed on left side n due to increasing creatinine trend MR Pyelogram was done,wich showd lower ureteric narrowing with stricture n a proximal ureteric diverticulum.

So re exploration n uretero native ureterostomy was planned,after opening wound in same layers reached to graft ureter traced upwards,a diverticulum was seen arising from upper part of transplanted ureter,wich was excised n ureter was opened longitudinally upwards,native left ureter was identified after retracting peritoneum as high as possible,after lighting upper most part,native ureter was ligated n cut n split longitudinally for ABT 2 cms n end to side uretero native ureterostomy was done over a 5 by 26 Fr DJ stent, abdominal drain 28 was put wound closed in layers.

Post op recovery was uneventful,drain out put was near 30 ml per day,n creatinine started coming down subsequently n. Became normal on 5 th post op Day pt was discharged on oral soft diet after 10 days.