Bilateral nephrectomy is indicated prior to transplantation for selected patients with endstage renal disease. Bilateral posterior surgical incisions have been used to perform this operation upon 45 patients. Postoperatively, there were no deaths, and a single minor complication occurred. These results were compared with 331 transperitoneal bilateral nephrectomies performed at this institution. The posterior surgical approach has proved superior in permitting bilateral nephrectomy to be performed with a more rapid recovery period for the patient and with diminished morbidity.