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Introduction. Fetal lower urinary tract obstruction is a condition that leads to excessive enlargement of the urinary bladder and bilateral obstructive uropathy with irreversible renal pathology in severe cases, thus having a rather reserved prognosis. The most common causes are posterior urethral valves or urethral atresia, and the diagnosis is made by prenatal ultrasound. Materials and method. A 32-year-old patient, known to be 20 weeks pregnant, came for a second-trimester morphological evaluation. The screening ultrasound showed that the abdominal space was mostly occupied by the urinary bladder with a “keyhole” appearance, measuring 6.5 cm in diameter, with the liver and stomach being visible. Intestinal loops could not be seen and, when it came to kidneys, both of them had an abnormal structure, being hyperechoic and with severe ureterohydronephrosis. The ureter was dilated in the pelvis, with a diameter of 13 mm, and the appearance was suggestive for urethral atresia or cloacal dysgenesis. From the morphological evaluation, it was noted that the rest of the fetal structures had a normal ultrasound appearance, the placenta was located anteriorly, with grade I of maturity, the umbilical cord had central insertion, with three vessels, and the amniotic fluid was of normal quantity. Results and conclusions. Regarding the treatment, several options can be taken into consideration, depending on the fetal prognosis, especially when it comes to the renal and pulmonary failure. Percutaneous placement of a vesicoamniotic shunt, fetal cystoscopy or fetal vesicostomy can be considered as a possible treatment. As for the examined patient, the couple was counseled and, due to the renal pathology, the therapeutic abortion was chosen. [ABSTRACT FROM AUTHOR]