Objective To investigate the treatment of urinary tract obstruction after kidney transplantation, and to introduce the novel ‘antegrade percutaneous urinary tract throughout guidance technique’ with guide wire in selected patients. Methods 43 cases of renal transplantation patients due to urinary tract obstruction (ureteral stenosis and hydronephrosis in 24 cases, urinary calculi with or not ureteral stenosis in 19 cases) received endourological treatment. Retrograde pathway was tried firstly, if failed, antegrade pathway was adopted with ‘antegrade percutaneous urinary tract throughout guidance technique’, 18 Fr percutaneous tract was established if necessary, endoscopy was needed in antegrade or combine with retrograde pathway. Results Of the 43 patients, 9 (20.9 %) patients were managed directly through the retrograde ureteroscopy, 28 (65.1 %) patients were managed with anterograde percutaneous technique in 18 Fr tract, 6 (14.0 %) patients were treated with ‘antegrade percutaneous urinary tract throughout guidance technique’. Operation time was (72.0 ± 16.0) (45～95) minutes. Postoperative stone clearance rate of 89.5 % (17/19). Of 32 cases with ureteral stricture, 6 (6/32, 18.8 %) cases were cured after one time of dilation and JJ stent indwelling for 2 months, 18 (56.3%) cases with stable hydronephrosis after 2-3 times of dilation and JJ stent indwelling, 5 cases (15.6 %) needed long-term repeated stent indwelling for drainage, 3 (9.4%) cases required nephrostomy tube drainage. Conclusion Minimally invasive treatment of urinary tract obstruction after renal transplantation is effective. Antegrade percutaneous urinary tract throughout guidance technique provided a powerful guarantee for retrograde operation and avoided the bleeding risk following percutaneous renal surgery, when combined with flexible ureteroscopy, urinary calculi in patients with kidney transplantation can be effectively managed with little trauma.