Abstract: Epididymal tuberculosis (tuberculous epididymitis) is a common type of extrapulmonary tuberculosis (EPTB) in the male urogenital system, characterized by a complex pathogenesis and numerous challenges in diagnosis and treatment, which can also affect male fertility. In recent years, significant progress has been made in the diagnosis and treatment of epididymal tuberculosis with the advancement of medical technology. This paper systematically reviews its pathogenesis and epidemiological characteristics, summarizes the application of traditional and emerging diagnostic techniques, analyzes the current status and breakthroughs in pharmacological treatment, surgical treatment and integrated traditional Chinese and Western medicine treatment, and explores clinical challenges and future research directions. The aim is to provide a comprehensive reference for clinical practice and a framework for relevant basic research.