During the last 2 decades of the twentieth century, maternal sonography became integrated into routine prenatal care. As a result, numerous anomalies are now detected in the fetus. This practice has had a profound influence on the presentation and natural history of urologic problems in the neonate. In an attempt to reflect the clinical scenario, this article is divided into two main parts: the first includes clinical questions raised by prenatally detected anomalies, abdominal masses, urosepsis, urinary retention, scrotal masses, and abnormal external genitalia; the second part is a discussion of specific anomalies with respect to evaluation and management, including controversies, and optimum timing for referral to a tertiary care center. Our knowledge regarding the pathophysiology and therefore treatment of these conditions is constantly expanding and changing.