Pelvic lipomatosis is defined as a condition characterized by the diffuse proliferation of normal mature fatty tissue in the perirectal and perivesical region. We report a case of a 40-year-old, obese male who presented with marked lower urinary tract symptoms. Imaging studies and blood tests revealed bilateral hydroureteronephrosis and right non-excretory kidney with deranged renal function. Diagnosis of the pelvic lipomatosis was established on the basis of clinical and radiological findings. The patient was successfully managed by simple cystectomy and ileal conduit.After 6 years of follow-up, the patient is doing well with normal renal parameters.A 40-year-old, obese, normotensive, euglycemic patient presented in 2005 with increased frequency, urgency, urge incontinence, nocturnal enuresis, straining to void, and poor stream for 15 years. Symptoms had aggravated over the last year (2004). There was a history of low backache and erectile dysfunction for the last 6 months. His bowel function was normal and there was no edema of the lower limbs.