A 38-year-old female gravida 2, para 2, sterilized patient was presented to the hospital with acute urinary retention and severe lower abdominal pain. Clinical and ultrasonographical examination revealed a marked distention of urinary bladder, enlarged uterus with posterior wall fibroid impacted in the pouch of Douglas. Intravenous pyelography revealed a moderate degree of bilateral hydroureter and hydronephrosis. However, the renal function tests were within normal range. Urine examination revealed pyuria and multi-drug resistant Staphylococcus aureus. Total abdominal hysterectomy was resorted after considering the medical and social factors. Histopathological examination revealed intramural leiomyoma, complex hyperplasia of the endometrium and chronic cervicitis. Detecting that the fibroid could contribute to the development of acute urinary retention, cystitis and its appropriate management along with the uneventful recovery of the patient indicated the validity of the approach that would have led to serious renal complications. This paper focuses on the acute complications of the uterine fibroid, multidisciplinary diagnostic approach, and the importance of immediate intervention to prevent subsequent renal damage. © 2010 Elsevier B.V., All rights reserved.