Acute urinary retention is the most common urological emergency and is defined as the inability to voluntarily empty the bladder when it is full, accompanied by a strong urge to urinate and pain. General and abdominal symptoms may also occur. It appears predominantly in older men due to prostate enlargement (PE). Women are less frequently affected, with neurological disorders and gynecological causes prevalently in their cases. Rapid diagnosis and immediate initiation of therapy are necessary in cases of acute urinary retention. Sonographic examination offers a simple, noninvasive, reproducible, and cost-effective method for emergency assessment of the bladder and upper urinary tract. Immediate and complete decompression of the bladder is the desired goal; in this case, transurethral catheter insertion is the first therapeutic choice in both men and women. Alternatively, a suprapubic approach can be chosen, which is associated with a higher risk of complications due to intra-abdominal injuries.