The prime objective of this study was to assess the benefits and practicalities of an investigation protocol to identify, follow-up and investigate fetal uropathies in a manner to maximize efficiency. Over a one-year-period, antenatal ultrasound examinations were performed on 4268 consecutive pregnancies. Eighty fetuses had renal tract dilatation; these were followed up postnatally according to the protocol; 17 had significant structural abnormalities requiring further follow-up. Hospital attendances were estimated to have been reduced by approximately 66% through the use of the protocol. The protocol for investigation and management of these patients is presented. The system implemented worked very smoothly and the subsequent findings and implications are discussed.