Paroxysmal hypertension associated with urination

Abstract

We herein reported 2 rare cases of urinary bladder paraganglioma presenting with severe postmicturition syndrome and paroxysmal hypertension, in the absence of hematuria. Biochemical tests of plasma catecholamines after symptoms' onset and determinations of metanephrines in plasma or urine can assist in screening for paragangliomas but can also be falsely negative due to multiple factors such as small tumor size, preanalytical procedures, and concomitant medications. Imaging tests are required to identify the location and size of the tumor, with thorax, abdomen, and pelvis CT scans recommended. Functional imaging examinations including MIBG, octreotide scintigraphy, and positron emission tomography are needed to identify additional lesions and their function via whole-body exploration. Diagnostic accuracy of different functional imaging examinations highly depends on the type and location of tumors and requires further investigation. Genetic tests are valuable for prediction of increased risk of malignancy in affected individuals and their relatives. Surgery after sufficient adrenergic blockage remains the mainstream treatment for localized tumors with generally optimistic outcomes. Longterm follow-up is necessary to monitor tumor recurrence.