Bladder paraganglioma: basic characteristics and new perspectives on perioperative management

Area of Science:

• Uro-oncology
• Endocrinology
• Surgical Oncology

Background:

• Paraganglioma and pheochromocytoma are rare neuroendocrine tumors associated with severe metabolic and cardiovascular complications.
• Bladder paragangliomas (PGLs) are exceptionally rare, presenting diagnostic and management challenges due to imprecise clinical guidelines.

Purpose of the Study:

• To characterize the clinical presentation, surgical management, and outcomes of bladder paragangliomas.
• To highlight the perioperative considerations and potential complications associated with bladder PGL.

Main Methods:

• Retrospective review of 20 patients diagnosed with bladder PGL at Sun Yat-sen University Cancer Center.
• Analysis of clinical data, including presentations, surgical therapies (transurethral resection, partial cystectomy), and patient outcomes.
• Evaluation of intraoperative hemodynamic events and postoperative troponin I levels.

Main Results:

• The study included 20 patients (10 male, 10 female) with a median age of 47.5 years.
• 65% of patients were asymptomatic, with PGL detected incidentally.
• 65% of patients experienced significant intraoperative blood pressure fluctuations despite alpha-blocker use in two cases. Postoperative troponin I was elevated in all tested patients. 88.9% survived without recurrence after a median follow-up of 51 months.

Conclusions:

• Bladder PGLs can be misdiagnosed as urothelial carcinoma, and hemodynamic instability during surgery is a significant challenge.
• Postoperative troponin I monitoring is advised for all bladder PGL patients, irrespective of symptoms, to identify cardiac complications.