Case report and literature review: key clinical management points and prognostic analysis of paraganglioma of the urinary bladder.

OBJECTIVE

To investigate the clinical characteristics, diagnostic approach, perioperative management, and key considerations in surgical decision-making for functional bladder paraganglioma.

METHODS

We conducted a retrospective analysis of the clinical data of a patient with pathologically confirmed bladder paraganglioma and discussed the findings in the context of relevant domestic and international literature.

RESULTS

The patient was a 50-year-old man who presented with frequent urination, urinary urgency, and dysuria for more than 2 months, accompanied by paroxysmal hypertension during urination with a peak blood pressure of 205/120 mmHg. Diagnostic transurethral resection of the bladder tumor was performed at another hospital, and postoperative pathology indicated paraganglioma. Upon admission to our hospital, further testing revealed markedly elevated plasma levels of norepinephrine and methoxy norepinephrine. Contrast-enhanced pelvic MRI revealed a mass on the right bladder wall involving the right ureteral orifice, accompanied by right-sided hydronephrosis and suspicious pelvic lymph nodes. After multidisciplinary discussion and thorough preoperative preparation including α-receptor blockade and volume expansion, the patient underwent radical cystectomy with bilateral pelvic lymphadenectomy and ileal neobladder reconstruction. Postoperative pathology confirmed bladder paraganglioma invading the full thickness of the bladder detrusor muscle (deep muscular layer) with a Ki-67 index of approximately 8%, and no lymph node metastasis was observed in 18 examined lymph nodes (7 left pelvic and 11 right pelvic). During the 5-month postoperative follow-up, no obvious recurrence or metastasis was detected.

CONCLUSION

Urination-related paroxysmal hypertension is the pathognomonic sign of functional bladder paraganglioma. Preoperative catecholamine metabolite testing combined with pelvic contrast-enhanced MRI forms the core diagnostic system. Multidisciplinary collaboration-based perioperative management and individualized surgical resection are the keys to improving prognosis, and lifelong follow-up is mandatory for all patients.