Urogenital tuberculosis is a rare and severe disease since it causes serious consequences. Often, diagnosis may be delayed because of its multiple presentation forms and clinical features. Usually, the recognition is easy to hold, but in certain cases the presentation form can be misleading which can exclude the diagnosis. We present two cases of unusual form of urogenital tuberculosis from which clinical features were taken for a malignant cancer at the beginning. The first case is about a young woman with renal lesions then proceeding to radical nephrectomy. The second case is about a 48 years old patient who had a radical cystectomy to treat an urothelial carcinoma (classified as pT1G3) along with squamous metaplasia (25 %). In both cases, the histologic investigation revealed the presence of a granulomatous reaction with giant cells and caseous necrosis which confirms the diagnosis of tuberculosis. Through the study of these two cases and literature review, we mark the different diagnosis and treatment difficulties handling these unusual presentation forms.