Renal oncocytomas (ROs) are benign tumors comprising 16% of renal masses. Due to the overlapping phenotypes seen in RO and chromophobe renal cell carcinoma (RCC) and lack of specific clinical and laboratory characteristics of RO, physicians face a challenge when arriving at a definitive diagnosis of RO. ROs additionally appear indistinct from RCCs on CT scan, contributing further to the difficulty of arriving at a clear diagnosis of RO. This is a case report of a 66-year-old man who presented with flank pain found to be related to bilateral ROs and underwent bilateral partial nephrectomies.ROs are benign small renal masses that often pose a diagnostic challenge since preoperative diagnosis can be difficult to achieve. Given advancements in technology, active surveillance with core renal biopsy is a promising approach to accurately diagnose and manage ROs conservatively. The application of these techniques has wide-reaching implications for patients and physicians by reducing the need for a potentially harmful surgery and creating a cost-effective way to manage a diagnosis.