Urinary bladder distention is a rarely reported cause of iliac vein compression. We report a case of bilateral lower extremity and scrotal edema resulting from marked bladder distention. The bladder was readily palpable and a 4,100 cm3 postvoid residual urine volume was found. No other cause of lower extremity and scrotal edema was found. The patient improved after bladder drainage and transurethral prostatectomy (TURP) for moderate benign prostatic hypertrophy.