Abstract Purpose We assessed the long-term efficacy of renal transplantation in patients with posterior urethral valves. Materials and Methods We reviewed the outcome in 23 patients with posterior urethral valves who underwent renal transplantation since 1979. Results Graft survival was 69 percent at 5 years and 63 percent at 10 years. Seven patients with followup of 7 years of longer had a mean serum creatinine level of 1.5 mg./dl. Three patients (13 percent) demonstrated significant bladder dysfunction postoperatively. Conclusions Renal transplantation into a valve bladder is not associated with an abnormally high rate of failure. Deterioration of graft function secondary to lower urinary tract dysfunction is uncommon, with the majority of patients able to use the unmodified native bladder as a receptacle for the transplanted kidney.