We report two cases of bladder leiomyosarcoma diagnosed by histology. Total segmental cystectomy was performed in both cases because of the scant progressive nature of the disease. A follow up of 11 and 6 years, respectively, revealed no tumor recurrence or metastasis. The choice of performing a conservative or radical surgical procedure in the treatment of this tumor type should depend on the endoscopic findings as well as tumor grade and stage.