Abstract
Renal transplantation in patients with a defunctionalized lower urinary tract poses surgical challenge. A native cutaneous ureterostomy, although underutilized, may be a viable option in select cases. We report a 28-year-old male with end-stage renal disease secondary to posterior urethral valves, managed with a left cutaneous ureterostomy since infancy. He underwent successful renal transplantation with inverted graft placement in the left iliac fossa to enable ureteral anastomosis to the native ureteric stump. This approach proved safe and effective, with excellent graft function maintained over 3 years.