{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:05:23Z","timestamp":1792598723510,"version":"4.5.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>We searched PubMed for BPG case reports published between January 1, 2000, and December 31, 2024. Two independent reviewers extracted data and performed statistical analyses. Patients were categorized into two groups based on preoperative diagnosis: correctly diagnosed and misdiagnosed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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%, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), whereas urinary symptoms were more prevalent in the misdiagnosed group (57.1% vs. 28.7%, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). None of the misdiagnosed patients received preoperative <jats:italic>\u03b1<\/jats:italic>-adrenergic blockade therapy. There were significant differences in surgical approach selection between the two groups: 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%, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), and lower incidences of intraoperative hypertensive crisis (17.5% vs. 40.3%, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), discontinued surgeries (0% vs. 26.9%, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), residual tumors (2.5% vs. 37.8%, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), and reoperations (12.5% vs. 41.2%, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). Catecholamine-related symptoms (OR\u2009=\u20093.98, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001) and hypertension (OR\u2009=\u20092.52, <jats:italic>p<\/jats:italic>\u2009=\u20090.015) predicted correct diagnosis while urinary symptoms (OR\u2009=\u20090.44, <jats:italic>p<\/jats:italic>\u2009=\u20090.031) were associated with misdiagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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 <jats:italic>\u03b1<\/jats:italic>-adrenergic blockade and underwent cystectomy rather than transurethral resection, 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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1657833","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T05:28:30Z","timestamp":1758518910000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Bladder paraganglioma: a 25-year systematic review unveils the benefits of early diagnosis in reducing surgical complications"],"prefix":"10.3389","volume":"12","author":[{"given":"Qingqing","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenlong","family":"Tu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengfei","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xionghui","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huayan","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e2251","DOI":"10.1210\/clinem\/dgaa965","article-title":"Incidence and clinical presentation of pheochromocytoma and sympathetic paraganglioma: a population-based study","volume":"106","author":"Ebbehoj","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B2","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1016\/s0022-5347(17)55898-x","article-title":"Malignant pheochromocytoma of the bladder","volume":"123","author":"Das","year":"1980","journal-title":"J Urol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/1471-2490-13-22","article-title":"Pheochromocytoma of the urinary bladder: a systematic review of the contemporary literature","volume":"13","author":"Beilan","year":"2013","journal-title":"BMC Urol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"198","DOI":"10.4103\/0971-3026.155879","article-title":"Concurrent nonfunctional paraganglioma of the retroperitoneum and urinary bladder: a case report with literature review","volume":"25","author":"Sherwani","year":"2015","journal-title":"Indian J Radiol Imaging"},{"key":"B5","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1016\/j.eprac.2023.07.027","article-title":"Diagnosis and management of pheochromocytomas and paragangliomas: a guide for the clinician","volume":"29","author":"Sharma","year":"2023","journal-title":"Endocr Pract"},{"key":"B6","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1016\/s0302-2838(03)00416-0","article-title":"Malignant non-urothelial neoplasms of the urinary bladder: a review","volume":"44","author":"Dahm","year":"2003","journal-title":"Eur Urol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1092260","DOI":"10.3389\/fcvm.2022.1092260","article-title":"Case report: partial cystectomy for pheochromocytoma of the urinary bladder: a case report and review of literature","volume":"9","author":"Hu","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1002\/iju5.12580","article-title":"Bladder paraganglioma: a case of acute respiratory distress syndrome triggered by large bladder tumor transurethral resection with mild symptoms and atypical imaging","volume":"6","author":"Takahashi","year":"2023","journal-title":"IJU Case Rep"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2545","DOI":"10.1007\/s40618-021-01649-7","article-title":"Protocol for presurgical and anesthetic management of pheochromocytomas and sympathetic paragangliomas: a multidisciplinary approach","volume":"44","author":"Araujo-Castro","year":"2021","journal-title":"J Endocrinol Invest"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2811","DOI":"10.1210\/clinem\/dgac427","article-title":"Presentation, management, and outcomes of urinary bladder paraganglioma: results from a multicenter study","volume":"107","author":"Yu","year":"2022","journal-title":"J Clin Endocrinol Metab"},{"key":"B11","doi-asserted-by":"publisher","first-page":"W65","DOI":"10.7326\/0003-4819-151-4-200908180-00136","article-title":"The prisma statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration","volume":"151","author":"Liberati","year":"2009","journal-title":"Ann Intern Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1007\/s12022-017-9484-5","article-title":"Update on adrenal tumours in 2017 world health organization (Who) of endocrine tumours","volume":"28","author":"Lam","year":"2017","journal-title":"Endocr Pathol"},{"key":"B13","first-page":"507","article-title":"Bladder cancer: diagnosis and treatment","volume":"96","author":"DeGeorge","year":"2017","journal-title":"Am Fam Physician"},{"key":"B14","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1002\/iju5.12185","article-title":"Paraganglioma of the urinary bladder: case report and literature review","volume":"3","author":"Kurose","year":"2020","journal-title":"IJU Case Rep"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.3892\/etm.2013.1242","article-title":"Unsuspected paraganglioma of the urinary bladder with intraoperative hypertensive crises: a case report","volume":"6","author":"Li","year":"2013","journal-title":"Exp Ther Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"bvab073","DOI":"10.1210\/jendso\/bvab073","article-title":"Clinical presentation and perioperative management of pheochromocytomas and paragangliomas: a 4-decade experience","volume":"5","author":"Uslar","year":"2021","journal-title":"J Endocr Soc"},{"key":"B17","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/j.ijcard.2017.07.014","article-title":"Pheochromocytoma as a reversible cause of cardiomyopathy: analysis and review of the literature","volume":"249","author":"Zhang","year":"2017","journal-title":"Int J Cardiol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.47391\/jpma.10839","article-title":"Pheochromocytoma-induced congestive heart failure and hypertension in a 21- year-old man-a case report","volume":"74","author":"Chen","year":"2024","journal-title":"J Pak Med Assoc"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2807","DOI":"10.1007\/s00345-022-04166-1","article-title":"Bladder paraganglioma: basic characteristics and new perspectives on perioperative management","volume":"40","author":"Cai","year":"2022","journal-title":"World J Urol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1007\/s00345-021-03851-x","article-title":"Differences in clinical presentation and management between pre- and postsurgical diagnoses of urinary bladder paraganglioma: is there clinical relevance? A systematic review","volume":"40","author":"Li","year":"2022","journal-title":"World J Urol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1007\/s11701-016-0573-0","article-title":"Bladder paraganglioma: safe and feasible management with robot assisted surgery","volume":"10","author":"Bishnoi","year":"2016","journal-title":"J Robot Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"101953","DOI":"10.1016\/j.beem.2024.101953","article-title":"Update on clinical characteristics in the evaluation of phaeochromocytoma and paraganglioma","volume":"38","author":"Berends","year":"2024","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"B23","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1016\/s2213-8587(23)00038-4","article-title":"Clinical consensus guideline on the management of phaeochromocytoma and paraganglioma in patients harbouring germline Sdhd pathogenic variants","volume":"11","author":"Ta\u00efeb","year":"2023","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.1097\/hjh.0000000000002438","article-title":"Genetics, diagnosis, management and future directions of research of phaeochromocytoma and paraganglioma: a position statement and consensus of the working group on endocrine hypertension of the European society of hypertension","volume":"38","author":"Lenders","year":"2020","journal-title":"J Hypertens"},{"key":"B25","doi-asserted-by":"publisher","first-page":"101938","DOI":"10.1016\/j.beem.2024.101938","article-title":"Overview of recent guidelines and consensus statements on initial screening and management of phaeochromocytoma and paraganglioma in sdhx pathogenic variant carriers and patients","volume":"39","author":"Lussey-Lepoutre","year":"2025","journal-title":"Best Pract Res Clin Endocrinol Metab"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1657833\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T05:28:30Z","timestamp":1758518910000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1657833\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,22]]},"references-count":25,"alternative-id":["10.3389\/fsurg.2025.1657833"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1657833","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,22]]},"article-number":"1657833"}}