Bladder Paraganglioma: A 25-Year Systematic Review Unveils the Benefits of Early Diagnosis in Reducing Surgical Complications

Qingqing Liu^1,2Tong Wang³Wenlong Tu^1,2Pengfei Zhou^1,4Xionghui Wu^1,4Huayan Lv^1,2*

• ¹Zhejiang University School of Medicine, Hangzhou, China
• ²Department of Anesthesiology, Jinhua Municipal Central Hospital, Jinhua, China
• ³Department of Biology, Duke University, Durham, United States
• ⁴Department of Urology, Jinhua Municipal Central Hospital, Jinhua, China

Background: Bladder paraganglioma (BPG) is a rare tumor frequently misdiagnosed before surgery. To raise awareness and improve early detection, we systematically reviewed clinical manifestations and treatment approaches reported in BPG case reports over the past 25 years. We aimed to identify factors that could facilitate timely diagnosis and reduce complications from misdiagnosis. Materials and methods: We searched PubMed for BPG case reports published between January 1, 2000, and December 31, 2024. Patients were categorized into two groups based on preoperative diagnosis: correctly diagnosed and misdiagnosed. Results: A total of 199 cases from 184 articles were included, with eighty patients (40.2%) preoperatively diagnosed with BPG and 119 (59.8%) misdiagnosed. Catecholamine-related symptoms were significantly more common in the correctly diagnosed group (60.0% vs. 21.8%, p < 0.001), whereas urinary symptoms were more prevalent in the misdiagnosed group (57.1% vs. 28.7%, p < 0.001). None of the misdiagnosed patients received preoperative α-adrenergic blockade therapy. 79.0% of patients in the misdiagnosed group underwent transurethral resection (TUR), while only 14.3% received partial cystectomy; conversely, in the correctly diagnosed group, 77.5% of patients underwent partial cystectomy, and only 15.0% underwent TUR. The correctly diagnosed group had more preoperative preparation (63.7% vs. 0%, p < 0.001), and lower incidences of intraoperative hypertensive crisis (17.5% vs. 40.3%, p < 0.001), discontinued surgeries (0% vs. 26.9%, p < 0.001), residual tumors (2.5% vs. 37.8%, p < 0.001), and reoperations (12.5% vs. 41.2%, p < 0.001). Catecholamine-related symptoms (OR = 3.98, p < 0.001) and hypertension (OR = 2.52, p = 0.015) predicted correct diagnosis while urinary symptoms (OR = 0.44, p = 0.031) were associated with misdiagnosis. Conclusion: More than half of BPG patients lack accurate preoperative diagnoses. Catecholamine-related symptoms were strongly associated with correct diagnosis, while urinary symptoms increased misdiagnosis. Patients with preoperative correct diagnosis more frequently received α-adrenergic blockade and underwent cystectomy rather, with reduced hypertensive crises, surgery discontinuation, and residual tumors compared with those misdiagnosed. These findings highlight the need for structured catecholamine screening in bladder mass diagnostics and support our diagnostic flowchart to enhance early BPG detection.