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Dilatations of the urinary tract are discovered in increasing numbers in intrauterine or postnatal sonographic screening examinations. Only few urinary tract anomalies (e. g. urethral valves) require immediate therapy; however, ureteropelvic stenosis and primary megaureter in particular require a prognostic classification between relevant obstructions needing correction and dilations which do not affect renal function. Ultrasound, diuresis scintigraphy and magnetic resonance imaging (MRI) remain the main pillars of advanced diagnostics despite an increasing number of biomarkers. The prevention of progressive renal parenchymal damage is the main focus of diagnostic and therapeutic strategies, while avoiding unnecessary or unnecessarily stressful interventions.