Urological pathologies are frequent during pregnancy and can have serious consequences on the pregnant woman and fetus health. Urinary tract infection, being the most frequent infection during pregnancy, is a major emergency to deal with because of the risk on the upper tract and negative pregnancy outcome. Distinguishing physiological from pathological hydronephrosis is somehow challenging because of the limitation in diagnostic procedures, ultrasound being the only safe diagnostic exam for the fetus. Medical treatments are to be prescribed following safety profiles. Surgical interventions are relatively safe during pregnancy nowadays. Individualized care and collaborative approach and management between the obstetrical and urological team is primordial to optimize pregnancy outcomes.