BACKGROUND Renal autotransplantation is an established therapy in cases of renal vascular lesions, tumors of the kidney and ureter, complex ureteral lesions, and kidney trauma. It has been a significant technical innovation, aiding the urologist in his great effort to preserve renal function by conserving renal tissue. We report our experience with autotransplantation in 4 patients. The indications, techniques, and results of renal autotransplantation in relation to our own experience are discussed. METHODS The patients included 3 women and one man. The average age of the patients was 35 years old, with a range from 20 to 54 years. One patient had Takayasu's arteritis, the second had Nutcracker syndrome with flank pain and hematuria, the third a complicated long ureter stricture, and the fourth patient a renal artery saccular aneurysm. RESULTS The average operation time was 7 hours (4.5 to 8.5 hours), and the cold ischemia time was about 88 minutes (45 to 150 minutes). Three of the autografts resumed normal renal perfusion, and in the fourth patient the renal autograft was lost due to vascular thrombosis. CONCLUSIONS Renal autotransplantation is a feasible method for the surgical treatment of renal and ureteral lesions. To avoid postoperative ureteral sloughing and subsequent urinary fistulas, the ureter can be left intact to preserve the ureter blood supply. However, in the case of a complicated vascular reconstruction procedure, it appears to be appropriate to divide the ureter and have the kidney completely free, thus avoiding back-flow perfusion from the intrinsic and intercommunicating blood supply in the ureteral wall, which may result in vascular thrombosis and subsequent autograft failure.