Presacral cystic schwannomas are rare, difficult to diagnose, and have only been reported in women. We present the first such case in a male patient. It was incidentally diagnosed during an evaluation for renal colic in a 52-year-old man. The presacral lesion was cystic on computed tomography and measured 10 cm in diameter. The appearance on pelvic magnetic resonance imaging was hyperintense on T₂-weighted images and of low to intermediate intensity on T₁-weighted images. Complete excision was achieved without bladder injury. The patient voided without difficulty and was free of local recurrence at 12 months after surgery.