Congenital obstructive uropathies are the leading cause of chronic kidney disease in children and the most common cause of renal failure requiring kidney transplantation at that age. They make up a group of a whole spectrum of kidney diseases that can occur due to impaired urine flow in any part of the urinary system. The changes found in these kidneys include extracellular substance proliferation, loss of tubular cells and a decrease in the number of nephrons. Their effect on the development, growth and function of the kidneys depends on the time of onset of obstruction, its severity and duration. Dilatation of the fetal renal pelvis on prenatal ultrasound is often the first sign leading to suspicion of congenital obstructive uropathy, and the main such diseases detected after birth are ureteropelvic junction stenosis, primary vesicoureteral reflux, megaureter, duplex kidneys and ureters, and posterior urethral valve. This paper presents the diagnosis, treatment, prognosis and long-term outcomes of congenital obstructive uropathy. Determining the significance of the obstruction for the renal function and the possibility of progression of the kidney injury are decisive factors in treatment planning. Candidates for surgical treatment of upper urinary tract obstruction must be carefully selected, and the risk of the procedure itself must be balanced with the severity of the obstructive kidney injury. Surgical correction of lower urinary tract obstruction is mostly performed in the early postnatal period, and fetal procedures may be indicated in strictly selected cases if performed in experienced medical centers. Optimal outcomes of treatment of congenital obstructive uropathy require continuity of their treatment and supervision lasting from prenatal discovery, through the neonatal period and childhood to well into adulthood.