Abstract Leiomyosarcoma of the bladder is a rare malignancy, generally affecting elderly males. It has significant associated morbidity and mortality and there is a lack of literature regarding this aggressive tumour. This article reports the case of a bladder leiomyosarcoma in a 35-year-old Caucasian male who was successfully treated. Management involves a combination of chemotherapy, radiotherapy and surgical resection. Radical cystectomy with wide resection margins is considered as the gold-standard but has several implications on patient quality of life. More conservative surgical approaches are arising with similar outcomes and improved quality of life. The aim of this article is to highlight the important features of bladder leiomyosarcoma and its possible incidence in younger patients. This article also aims to accentuate the several treatment options and the current gold-standards in care.