ABSTRACT Introduction Urinary tract infections (UTIs) occur commonly following kidney transplant and are associated with significant morbidity. Some providers perform intra‐operative antibiotic bladder irrigation at the time of ureteroneocystostomy, although practice varies widely among surgeons. As a result, this study was performed to assess outcomes following a single intravesical gentamicin injection for the prevention of UTIs. Methods This was a retrospective cohort study of adult patients who underwent a first isolated kidney transplant between January 2018 and January 2023. Outcomes were compared between patients who received bladder irrigation with a single dose of gentamicin and controls who did not receive antibiotic irrigation. The primary end point was the incidence of culture‐confirmed UTI within 3‐months of transplant. Key secondary endpoints included delayed allograft function and serum creatinine at 3‐months. Results A total of 764 patients were included in the study analysis (gentamicin = 406 vs. control = 358). At 3 months, the incidence of UTIs was 18.2% in the gentamicin group compared to 13.1% in the control group ( p = 0.05). A higher incidence of BK viremia >10,000 copies/mL was also observed in the gentamicin group compared with control patients (5.9% vs. 2.5%; p = 0.02). After multivariable regression analysis older age, female sex, early rejection, longer dialysis vintage, and urinary catheter duration were all found to be positively correlated with the incidence of UTIs. Conclusion Among kidney transplant recipients, bladder irrigation with gentamicin was not found to reduce the incidence of UTIs at 3 months. Additional studies should explore a possible association between antibiotic bladder irrigation and subsequent BK viremia.