*Purpose: The purpose of this study was to determine differences in outcomes of urine leak treatment modalities post kidney transplantation comparing results of foley catheter, interventional radiology and surgical intervention.

*Methods: We conducted a retrospective cohort study of consecutive adult kidney transplants from 2012-2017 and identified patients with a urine leak within one-year post-op, grouped by treatment modality. The difference in continuous variables across compared groups was assessed using one-way analysis of variance and for binary outcomes using chi-square test. Time-to-event outcomes were analyzed using the Cox-proportional hazards method.

*Results: We analyzed 1,308 adult kidney transplants and identified 36 cases of ureteral leaks. The three treatment modalities for urine leaks demonstrated no difference in length of stay, delayed graft function, transplant admission medical complications, transplant admission surgical complications, readmissions, 1-year medical complications, 1-year surgical complications, resolution of urine leaks, graft survival, and or patient survival. There was a significant difference in the number of days to diagnosis of a leak by treatment type (p<.001).

*Conclusions: While the standard of care for treatment of urine leaks post kidney transplant varies, there is no difference in patient or graft survival outcomes based on the use of foley catheter, interventional radiology or surgical intervention. These findings suggest provider preference can dictate the decision making without significant consequence to patients.

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