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Objective: High-pressure balloon pneumatic dilatation for the treatment of primary obstructive megaureter (POM) was initially described under cystoscopic and radiological control. However, some groups use cystoscopic control only, in an attempt to avoid the ionizing radiation associated with the procedure., Materials and Methods: A retrospective study of POM patients treated with pneumatic dilatation in our unit from 2008 to 2021 was carried out. Success rates, complications, and follow-up were compared between two groups -dilatation under cystoscopic control alone (CS) vs. dilatation under radiological control only (RX)., Results: 23 patients -9 CS and 14 RX- underwent surgery. Both groups were demographically comparable. Mean hospital stay was significantly shorter in the CS group (1 vs. 2 days; p =  0.009). Operating time was longer in the RX group (78 vs. 30 min; p =  0.001). Ureterovesical junction (UVJ) dilatation was successful in 100% of CS vs. 79% of RX cases; RR: 3.87 (0.51-26.99). Postoperative complications were similar in both groups; RR: 3.87 (0.51-26.99). Double J stent migration occurred in one case in both groups; RR: 0.64 (0.05-9.03). In the long-term, treatment success rate was higher in the CS group (100% vs. 71%); RR: 3.87 (0.51-26.99)., Conclusion: POM pneumatic dilatation under cystoscopic control alone is faster, without increasing the risk of complications. Based on our experience, we suggest ionizing radiation be removed, since we consider it to be unnecessary.