Renal transplantation is an established method for improving both quality of life and patient survival for those with end stage renal disease. Early allograft function may be compromised by several factors including vascular thrombosis, rejection, infection, as well as obstruction. Ureteral obstruction complicates approximately 10% of renal transplants , most often related to ischemic strictures at the ureteroneocystostomy . Early post-operative obstruction, usually diagnosed after worsening allograft function and concordant hydronephrosis seen on imaging, is most commonly treated with percutaneous nephrostomy. In the context of ureteral stent placement, limited literature exists regarding methods for identifying the source of obstructive uropathy early in the post-transplantation setting. Here we describe our experience with a renal transplant patient with declining graft function and evidence of hydronephrosis despite an appropriately positioned ureteral stent.