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Introduction: A nomogram for predicting the diagnosis of lower urinary tract obstruction (LUTO) based on an antenatal ultrasound index generated from a Bayesian Meta‐regression analysis has been in development and noted with superior diagnostic accuracy compared to the keyhole sign (KHS). We aim to assess the accuracy of the nomogram in expanded diagnostic utilization to predict LUTO. Methodology: The validation of the nomogram for expanded diagnostic utilization was based on data from a prospective institutional antenatal clinic database between January 2020 and June 2022. Diagnostic accuracy indices were determined for confirmed postnatal diagnosis of LUTO or prune belly syndrome (PBS). Receiver operating characteristics (ROC) curves were generated to compare the area under the curve (AUC) of the nomogram versus KHS. Results: Based on 84 male fetuses with antenatal ultrasound of moderate‐severe hydronephrosis (PUV n = 15, PBS n = 4), the KHS had 26.3% (95%CI 9.1–51.2) sensitivity and 100% (95%CI 94.4%–100%) specificity, with 14 false‐negatives. The nomogram showed a 84.2 (95%CI 60.4%–96.6%) sensitivity and 95.4 (95%CI 87.1%–99%) specificity with three false‐positives. The nomogram also had a superior AUC compared to KHS (0.98 vs. 0.63). Conclusion: The nomogram can be used as a valuable tool to trigger further postnatal screening and provide individualized risk assessments to families during prenatal counseling. Key points: What's already known about the topic?When fetuses with LUTO do not exhibit all of the classic prenatal ultrasound features, the diagnosis is often missed, resulting in infants being born outside high‐risk fetal centers. There are serious implications including early presentation in the neonatal period with infections and urosepsis and already compromised kidney function What does this study add?This work reports a tool for the early, and accurate prediction of LUTO using fetal ultrasound features. This nomogram allows for personalized risk stratification based on individual ultrasound features, which will improve the long‐term outcomes of children with LUTO [ABSTRACT FROM AUTHOR]