Uterine prolapse, common in old and multiparous women, has been reported as a rare cause of obstructive uropathy. In this case, the management of a 75-year-old female patient who presented at the outpatient clinic with a history of anuresis and diagnosed with total uterine prolapse, bilateral hydronephrosis, urinary infection and acute renal failure is presented. The renal failure clinical picture regressed with appropriate treatment. However, the patient refused surgery and chose to have a pessary implemented. Four months after dismissal, she was readmitted to the hospital with recurrent renal failure that required dialysis treatment. The patient did not respond to therapy and was placed on a chronic dialysis program with a diagnosis of end-stage renal disease due to posterenal causes.