Leiomyoma of the epididymis is a rare epididymal benign tumor. We reported a case of primary bilateral epididymal leiomyoma and reviewed the literature. A 36-year-old man presented with right painless intrascrotal mass for 2 years. Physical examination revealed bilateral epididymal nodules. Under scrotal sonographic examination, the masses were hypoechoic and located at the bilateral lower pole of the epididymes. Both cx-fetoprotien (AFP) andβ-human chorionic gonadotropin (hCG) were within normal range. Solid tumors of bilateral epididymal tails with indeterminated characteristics were diagnosed. The tumors were excised without difficulty, and pathology revealed bilateral epididymal leiomyoma.