An 85-year-old man presented with 5 days of abdominal pain and worsening mental status. On exam, he had a suprapubic mass. Labs showed elevated creatinine. A renal ultrasound found right hydronephrosis. Inserting a Foley catheter drained 2500cc of urine and resolved the mass. He was diagnosed with urinary retention from an enlarged prostate and treated with catheterization, hydration, and medications for his prostate and urinary symptoms.