Acute presentation of ureteral stump empyema after pretransplant nephrectomy has not been reported so far. We report on a 25-year-old male patient with end-stage renal disease due to congenital vesicoureteral reflux and a longterm history of management of infected kidneys including the last step of pretransplant right native nephrectomy. Within 2 weeks after operation, he presented with clinically visible ureteral stump empyema. Computed tomography and surgical exploration confirmed the diagnosis of a huge retentive stump of obstructive-refluxing megaureter which was excised with a smooth postoperative course. So, ureteral stump empyema may develop after a pretransplant nephrectomy and threaten the transplant process and the patient’s life. Consecutive nephrectomy and ureterectomy procedures to keep the iliac fossa fresh for kidney transplantation do not outweigh the risks of ureteral stump infections. Therefore, simultaneous nephroureterectomy is mandatory in the case of obstructive-refluxing megaureter.