Minimally Invasive Approach of Bladder Paraganglioma: Case Report and Review of Literature

Case Report

Austin J Clin Case Rep. 2014;1(7): 1034.

Minimally Invasive Approach of Bladder Paraganglioma: Case Report and Review of Literature

Matthias Beysens1, Bruno Lapauw2, Pieter-Jan Gykiere3, Sven Dekeyzer4, Nicolaas Lumen1 and Karel Decaestecker1*

1Department of Urology, University Hospital Ghent, Belgium

2Department of Endocrinology, University Hospital Ghent, Belgium

3Department of Nuclear Medicine, University Hospital Ghent, Belgium

4Department of Radiology, University Hospital Ghent, Belgium

*Corresponding author: Karel Decaestecker, Department of Urology, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium.

Received: July 10, 2014; Accepted: Aug 05, 2014; Published: Aug 07, 2014


Purpose: Paraganglioma of the bladder is a rare neoplasm that usually presents with hypertension, headache and dizziness after micturition.

Case Presentation: We present the case of a 22-year-old man with typical symptoms of bladder paraganglioma.

We performed the first robot-assisted laparoscopic tumorectomy without opening of the bladder mucosa. Additionally, we give an overview of the literature on minimally invasive approaches for bladder paraganglioma.

Conclusions: This article gives an overview of the symptoms, diagnostic tools and surgical treatment of bladder paraganglioma. It is a rare neoplasm that, however it has a typical presentation, can be easily missed based on patient history alone.

Keywords: Bladder paraganglioma; Pheochromocytoma; Minimally invasive surgical procedure


Pheochromocytoma is a neuro-endocrine tumor that usually develops in the adrenal medulla. Extra-adrenal pheochromocytomas, also called paragangliomas (which account for 5% to 10% of pheochromocytomas), are most often found in the retroperitoneum, thorax and urinary bladder [1].

In the bladder wall it originates from the sympathetic plexus of the detrusor muscle. Bladder paragangliomas are extremely rare and constitute less than 0,05% of bladder tumors [2].

Typical symptoms are headache, palpitations, sweating, blurred vision and hypertension, all related to the act of micturition [1].

Diagnosis of a paraganglioma can be made in almost all patients with the demonstration of elevated measurements of plasma fractionated metanephrines and/or urinary plasma fractionated metanephrines and catecholamine’s (measured on a 24-hour urine collection).

Nuclear imaging in combination with computer tomography (CT) or magnetic resonance imaging (MRI) may be required to localize and fully delineate the extent of the disease.

Standard treatment is open partial or radical cystectomy. Minimal approaches are reported, but only in case reports.

We give a literature overview of all minimal-invasive cases and report the first case of a robot-assisted laparoscopic tumorectomy without opening the bladder.

Case Presentation

A 22-year-old man was referred to our urological department with complaints of severe headache, palpitations and dizziness after micturition occurring for 2 months. His complaints were initially this severe, that he even refused to micturate and a transurethral catheter was placed in another hospital. His medical history and physical examination were completely normal. He had no urinary tract symptoms and no hematuria.

A 24-hour urine collection was performed and revealed an elevated amount of norepinephrine, together with elevated normetanephrine levels on a plasma sample, suggesting a paraganglioma.


On ultrasonography, a 2x3-cm, slightly hypoechogenic mass was seen embedded in the left detrusor wall (Figure 1). On cystoscopy, the same mass was seen lying under the mucosa in the left side of the bladder (Figure 2). The lesion was estimated to be 5 cms away from the ureteral orifices.