Post-transplant hydronephrosis is a common surgical complication after kidney transplantation and a major cause of chronic failure of the transplanted kidney, which affects the functional survival of the transplanted kidney. Appropriate selection of treatment options has a direct relationship to prognosis. The predominant etiology is ureteral bladder anastomotic obstruction. This is followed by inflammatory ureteral scar adhesions or overgrown twisted ureteral adhesions. Spermatic cord or oval ligament compression and ureteral calculi are also seen as causes. Minimally invasive nephroscopy or flexible cystoscopy used to treat hydronephrosis after renal transplantation can save some patients from surgery and is easily accepted by patients. Unfortunately, most post-transplant hydronephrosis is due to mechanical ureteral obstruction, often caused by anastomotic stenosis or inflammatory scar adhesions or compression by uncircumcised spermatic or oval ligaments, and these minimally invasive treatments are simply not available in most cases. Alternatively, recurrent recurrences occur even after dilatation of the placement obstruction site. In some cases, the ureter was damaged during the treatment and still had to be treated by surgical methods. Only 3 of our 17 cases were successfully treated with minimally invasive retrograde cannulation. Therefore, surgical treatment is still the most reliable and effective method. However, the choice of surgical method is worth exploring and studying. Transepithelial bladder flap formation with transplant pelvic ureteral anastomosis and ureteral bladder reanastomosis, which interferes with the transplanted kidney, has many surgical complications, such as wound infection, urinary leakage, anastomotic stenosis, ureteral reflux, etc., and is not ideal for the long-term prognosis of the transplanted kidney. Some scholars believe that reanastomosis of the autologous ureter with the hydronephrosis pelvis or ureter is a transabdominal procedure, which will cause increased abdominal complications and will lead to serious consequences once intra-abdominal urinary fistula is formed, so they failed to boldly choose this postoperative procedure. Satisfactory clinical results have been reported with autologous ureteral repair of ureteral complications of transplanted kidneys, and it is considered practical and feasible to choose autologous pelvic ureter for urinary tract reconstruction. We achieved excellent results in 7 of 17 cases, and no surgical complications occurred in 1 case. The most difficult point in transabdominal autologous ureteral and transplant pelvic ureteral anastomosis is to find the hydronephrosis pelvis or ureter. Because the cases selected for this group generally have significant hydronephrosis with a medial or posterior bias of the renal hilum, it is generally not difficult to find them during intraoperative patient search. The location of the hydronephrosis pelvis and ureter was determined from the imaging data, and finger strokes were used to determine the location of the renal artery and to avoid injury. After confirming the location of the hydronephrosis pelvis or ureter with a fine needle puncture, a small incision of about 0.5-0.8 cm is made and the ureter is anastomosed with the autologous ureter. The position of the anastomosis is judged well before freeing the autologous ureter, and do not free too much. When freeing the autologous ureter, pay attention to preserving more periureteral tissues and blood vessels. During the anastomosis, a double-din catheter was placed as a stent, with one end placed in the renal pelvis and one end placed in the bladder. The catheter is removed via cystoscopy 2 to 4 weeks after surgery. For post-transplantation hydronephrosis of the transplanted kidney, treatment should first be tried by minimally invasive routes such as cystoscopy for tube expansion and internal drainage. If this is not successful, surgical treatment should be considered. Transabdominal transplant pelvic ureter and autologous ureter reanastomosis, which is less disturbing to the kidney and has fewer postoperative complications, can be the preferred choice for open surgery to treat hydronephrosis in the transplanted kidney. With the development of laparoscopic technology, laparoscopic reanastomosis of the transplanted pelvic ureter with the autologous ureter (transabdominal) has become a great possibility and is expected to achieve good results. However, the choice of this procedure is not suitable for hydronephrosis in transplanted kidneys with outward facing hilum.