A 79-year-old man, who had a left-sided radical nephrectomy 28 years ago as a result of renal cell carcinoma, is presented with urinary retention for six months. Renal ultrasound revealed the right kidney to be 13.6 cm, normal echogenicity without hydronephrosis, and a mildly distended bladder. Urodynamic testing indicated obstruction. The patient returned one month later with gross hematuria. Computed tomography (CT) scan of the abdomen and pelvis revealed an intraluminal 3.7*3.2 cm mass on the right side of the urinary bladder and a 1.7 cm lytic lesion in the left acetabulum, which was suspicious for metastatic disease. Furthermore, the right kidney demonstrated subcentimeter hypodense lesions. Magnetic resonance imaging (MRI) of the visceral pelvis showed an enhancing 2.5 cm lesion in the left superior acetabular region with disruption of the medial cortex that was consistent with metastatic disease. A transurethral resection of the bladder removed a 4.2*3.5*0.6 cm single fragment of aggregate soft, tan-brown colored bladder tissue. The pathological diagnosis of a fragment of the partially necrotic bladder tumor was consistent with Fuhrman grade 2 clear cell renal cell carcinoma. Bone scan showed negative findings. However, positron emission tomography computed tomography scan with fluorodeoxyglucose (PET-CT FDG) of the skull base to thighs revealed scattered hypermetabolic lytic osseous lesions in the left acetabulum, a lytic lesion in the 1st left rib, a hypermetabolic 4.4 cm right para-aortic retroperitoneal lesion, numerous subcentimeter scattered lungs nodules, and a 17 mm right thyroid nodule. Furthermore, an MRI of the abdomen revealed multiple hypoenhancing masses in the right kidney which were suspicious for renal neoplasm associated with metastatic disease. The MRI also showed a tumor thrombus in the right renal vein and inferior vena cava, and pulmonary nodules. At first, the patient decided not to undergo any systemic treatment plan as he desired to pursue the situation through a holistic approach. A few weeks later, however, the patient agreed to start chemotherapy. He was given sunitinib 12.5 mg which was later increased to 25 mg. However, he was unable to tolerate the increased sunitinib dosage due to gross hematuria. Consequently, the patient was given nivolumab through a Port-a-Cath and has remained in stable condition for over two years.