A 21-year-old British male sustained C-5/C-6 complete tetraplegia in 1998. Since 2006, this patient had been managing his bladder by condom catheter and had no problems. This patient was reviewed in a spinal unit at Regional Spinal Injuries Centre, Southport in November/December 2013. He reported no difficulty in emptying his urinary bladder. An x-ray of the abdomen revealed no urinary tract calcification; urinary bladder was not distended (). Blood test results showed 5.4 mmol/L (2.3–7.5 mmol/L) of urea and 49 μmol/L (0–135 μmol/L) of creatinine. Ultrasound examination of the urinary tract revealed normal kidneys and no hydronephrosis or calculi. The urinary bladder contained 62 mL of urine with moderate wall thickening (). This patient had a well-established bowel regime and was doing all right with his neuropathic bowels and bladder. In 2014, this patient went for an evening out with his friends and had several drinks within a short period of time. He did not take any recreational drugs during partying. Following this social get-together, he felt unwell. The next morning, he noticed swelling of the lower abdomen and passed urine in dribbles. He developed a temperature. He was seen by district nurses and a doctor, who prescribed antibiotics. This patient continued to feel unwell, and he came to the spinal unit 8 days after he went for an evening out with his friends. On clinical examination, it was found that the urinary bladder was distended; bowel sounds were feeble; temperature: 36.4°C; heart rate: 109 bpm; and blood pressure: 90/43 mmHg. An x-ray of abdomen revealed large distended urinary bladder (). Blood tests showed the features of sepsis and acute kidney injury; urea: 19.8 mmol/L (2.3–7.5 mmol/L); creatinine: 172 μmol/L (0–135 μmol/L); potassium: 5.7 mmol/L (3.5–5.2 mmol/L); C-reactive protein: 336.4 mg/L (<5.0 mg/L); white cell count: 18.4×109 (4.0–11.0); and neutrophils: 162×109 (2.0–7.5). A computed tomography scan of the abdomen revealed mildly enlarged and swollen left kidney with some perinephric fluid. No calculi bilaterally and no hydronephrosis. No ureteric or bladder calculi. Urinary bladder was partially filled and trabeculated (). Urethral catheterization led to drainage of 1,400 mL of clear urine. After decompression of the urinary bladder, urethral catheter started draining blood-stained urine. This patient was prescribed Meropenem; intravenous fluids were administered. A sample of urine, which was sent for microbiology, revealed no growth. Methicillin-resistant Staphylococcus aureus was not isolated. The sample of urine sent for cytology showed abundantly mixed inflammatory cells, some red blood cells, squamous epithelial cells, macrophages, and scattered urothelial cells in which there was focal atypia in the form of nuclear enlargement, which was probably reactive in nature. Following drainage of the urinary bladder, blood urea decreased to 9.5 mmol/L (2.3–7.5); creatinine decreased to 62 μmol/L (0–135); and potassium decreased to 3.3 mmol/L (3.5–5.2). A week after instituting bladder drainage by urethral catheter, blood urea decreased further to 5.4 mmol/L (2.3–7.5); creatinine level also decreased to 46 μmol/L (0–135); C- reactive protein decreased to 31.4 mg/L (<5.0); and white blood cell count decreased to 9.8×109 (4.0–11.0). Seventeen days after urethral catheterization and decompression of urinary bladder, catheter-free trial was given. But this patient could not pass urine; therefore, indwelling urethral catheter drainage was reestablished.