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Acute urinary retention (AUR) is not an uncommon finding in urologic practices. AUR is most often secondary to outflow obstructions, mechanical, and/or dynamic factors, but can also be caused by trauma, medication, neurologic disease or infection. Regardless of the cause, the priority is to decompress the bladder and determine the cause to prevent future occurrences. As evidenced in this unusual case, at times, the etiology is not readily or easily determined. This case affords the reader an opportunity to review several urologic diagnoses, as well as less frequently occurring phenomena of penetrating genitourinary trauma and subsequent sequelae.