Painless Hematuria Research Articles

Painless Visible Haematuria in Adults: An Algorithmic Approach Guiding Management.

There is consensus that visible haematuria may be a sign of serious underlying disease, including malignancy, and warrants a thorough diagnostic evaluation. This is usually undertaken by a combination of clinical examination, cystoscopic evaluation, and urinary tract imaging.A decision support tool has been developed in the form of an algorithmic flow chart as part of a suite of on-line evidence-based and consensus-based guidelines Diagnostic Imaging Pathways (DIP): www.imagingpathways.health.wa.gov.au (Online clinical decision-making tool: Dulku G. Painless Macroscopic Haematuria. Diagnostic Imaging Pathways; September 2015) to provide imaging recommendations for adult patients with unexplained, painless visible haematuria. A literature review, including reference to several international consensus-based expert guidelines, has been employed to develop this tool.The choice of first line imaging method is dependent on the risk stratification into high or low risk for the development of renal and urologic malignancies. Ultrasound is vital in the initial assessment of haematuria particularly in radiation sensitive patients, low-risk patients, and in young men <40 years. Computed tomographic urography (CTU) is a sensitive and specific method for the detection of urothelial malignancy particularly in high-risk patients. Magnetic resonance urography (MRU) provides better contrast resolution than CTU without exposure to ionising radiation or requiring intravenous (IV) contrast administration, making it more suitable for examination of paediatric and pregnant patients and patients with renal impairment. Cystoscopy remains the gold standard in the detection of lower urinary tract (bladder) urothelial tumours.Until randomised clinical trials comparing different diagnostic modalities or strategies prospectively and outcome studies are available, consensus-based practice recommendations similar to ours are nonetheless warranted to reduce the variation in haematuria management.

Adult Wilms’ Tumor with Hypospadias and Cryptorchidism: A Case Report

A 66-year-old patient was seen at the outpatient department with the chief complaints of recent-onset painless gross hematuria, poor appetite and body weight loss. The patient had a history of bilateral orchiectomy for congenital bilateral cryptorchidism. Hypospadias was noted during physical examination. Laboratory assessment revealed hematuria and pyuria. Abdominal ultrasonography and imaging studies showed a left renal mass. Radical nephrectomy was performed on the patient and the pathology report revealed Wilms' tumor (nephroblastoma). The patient underwent chemotherapy after surgery and no tumor recurrence was noted after 8 months of regular follow-up.

Clinical features and management of primary bladder lymphoma

Objective To summarize the clinical experience of primary bladder lymphoma. Methods From September 2012 to May 2019, 8 cases of primary bladder lymphoma treated in our institute were analyzed retrospectively, including 4 males and 4 females. The mean age was 50.5 years old, ranged from 15 to 85. There were 3 cases of localized bladder lymphoma and 5 cases of metastatic bladder lymphoma. Three cases presented with painless gross hematuria primarily and 5 cases suffered from abdominal pain and bloating. Imaging examination showed the bladder tumor or pelvic mass with maximum diameter ranged from 3 to 22 cm, with 11.3 cm on average. Preoperative diagnosis of bladder tumor in 3 cases, and pelvic malignant tumor in 5 cases. Two patients underwent TURBT and 6 cases underwent pelvic mass resection and partial cystectomy. Results Postoperative pathological diagnosis showed 6 cases of diffuse large B-cell lymphoma, 1 case of mucosa-associated lymphoid tissue lymphoma, 1 case of anaplastic large cell lymphoma. Follow-up after surgery ranged 3 to 60 months, with 28.1 months on average. Two patients can not tolerate radiotherapy or chemotherapy for postoperative complications of vesico-vaginal fistula and intestinal fistula, and both were alive at the last follow-up. Six patients underwent CHOP regimen (cyclophosphamide, doxorubicin, vincristine, prednisone), 3 cases were addd with rituximab. Three patients died during the follow-up. One 85-year-old patient died 10 months after surgery. Two cases of metastatic bladder lymphoma died 3 or 6 months after surgery respectively. Three cases were alive after chemotherapy, including 2 young patients undergoing chemotherapy with DICE regime and one patient undergoing pelvic radiotherapy. Conclusion The primary bladder lymphoma has no special clinical symptoms, and TURBT and needle biopsy are critical for the diagnosis, based on the pathological and immunohistochemical examination. The most common pathological type is diffuse large B-cell lymphoma. R-CHOP chemotherapy is recommended, which can be followed by DICE regime for young patients. Metastasis and aging predict poor prognosis. Key words: Lymphoma; Urinary Bladder; Treatment; Prognosis

Clinical Study of Urinary Tract Tumors in Patients with Maintenance Dialysis for End Stage Renal Disease

Introduction: The research in the past ten years shows that the incidence of malignant tumors in dialysis patients is significantly higher than that in normal people. The highest proportion of urinary tumors is one of the main causes of death in patients with end-stage renal disease, and the incidence is gradually increasing. However, the high-risk factors of urinary tract tumors in dialysis patients have not yet been fully elucidated, so exploring this issue is an important issue that the medical community needs to solve. The objectives of this study are to understand the clinical characteristics of maintenance dialysis patients with urinary tract tumors and the influence of related factors on their prognosis.&#x0D; Methods: The clinical data of 22 patients with urinary tract tumors in maintenance dialysis (MHD) from the Affiliated Hospital of Chengde Medical College from January 2013 to June 2018 were retrospectively analyzed. The incidence of urinary tumors and clinical diagnosis and treatment were investigated. And prognosis, analysis of the impact of various relevant factors on the overall survival of patients with dialysis and urinary tumors.&#x0D; Results: The 912 patients with maintenance dialysis, 22 patients had urinary tumors with an incidence of 2.41%. Among them, 13 patients were bladder tumors, 7 patients were renal or ureteral tumors, 1 patient was renal tumor, and 1 patient was prostate cancer. There were 17 cases of intermittent and painless gross hematuria, 2 cases of gross hematuria, 1 case of lumbar pain, 1 case of abdominal pain and dysuria, 1 case of frequent urination and dysuria. Ten patients underwent surgery, and 4 patients died. The postoperative survival of the patients was 12~103 months, with an average of 58.75 months. 12 patients were unable to undergo surgery because of other diseases or economic reasons; in 9 the disease was found during autopsy. The time from tumor to death was 14~38 months, with an average of 24.11 months. The causes of death in 13 death patients: 5 patients were myocardial infarction, 3 patients were heart failure, 3 patients were tumor metastasis, and severe sepsis in 2 patients.&#x0D; Conclusion: There is increased propensity of GU tumors in maintenance dialysis patients. The tumors are of higher grade and demonstrate poor prognosis. Therefore, attention should be paid to the monitoring of urinary tract tumors in maintenance dialysis patients, especially elderly patients without cardiovascular and cerebrovascular complications, because their life expectancy can be longer.

A case report of a young girl with recurrent hematuria: a missed diagnosis - renal nutcracker syndrome

BackgroundNutcracker syndrome is an easily missed cause of hematuria in children. It is characterized by left renal vein entrapment between the abdominal aorta and the superior mesenteric artery causing renal venous hypertension. Intermittent hematuria and orthostatic proteinuria with or without abdominal or flank pain are the common clinical manifestations. Presence of variable non-specific symptoms and non-significant physical findings results in a delayed diagnosis.Case presentationWe present a ten -year -old girl with four episodes of painless gross hematuria and recurrent microscopic hematuria since the age of two years. Doppler ultrasound showed left renal vein compression while 3 D computerized tomography angiography confirmed the diagnosis of an anterior nutcracker. The patient was conservatively treated with nutritional support (pediasure complete formula and high calorie food), iron supplements and followed up, monitored for anemia, hypertension and renal insufficiency.ConclusionNutcracker syndrome is a rare cause of recurrent gross hematuria in children. A high index of suspicion and proper imaging is needed to reach a proper diagnosis and avoid the psychological and financial stress on the family.

Non-functional paraganglioma of urinary bladder managed by transurethral resection.

ABSTRACTPurpose As a rare bladder tumor, paraganglioma of the urinary bladder (PUB) is frequently misdiagnosed as bladder cancer, particularly for the non-functional type. To date, transurethral resection remains a controversial treatment for non-functional PUB. This study aimed to identify the clinical features, pathological characteristics, prognosis, and safe/effective treatment of non-functional PUB using transurethral resection of the bladder tumor (TURBT).Materials and Methods The clinical records, radiological data, pathological characteristics and follow-up times were retrospectively reviewed in 10 patients with clinically and pathologically proven non-functional PUB in our hospital from January 2008 to November 2016. All patients underwent TURBT treatment.Results The incidence of non-functional PUB in patients with bladder cancer was 0.17%. The mean age at diagnosis was 44.5 ± 13.6 years (range, 29-70 years), and the patient population had a female: male ratio of 3: 2. No patients had excess catecholamine (CA) whilst four patients had painless hematuria. All neoplasms were completely resected via TURBT. The majority of samples were positive for immunohistochemical markers including chromogranin A (CgA) and Synaptophysin (Syn), but were negative for cytokeratins (CKs). Only a single recurrence was observed from the mean follow-up period of 36.4 ± 24.8 months.Conclusion Complete TURBT is a safe and efficient treatment that serves both diagnostic and therapeutic purposes. Histopathological and immunohistochemistry examinations are mandatory for diagnostic confirmation. Long-term follow-up is recommended for patients with non-functional PUB.

Dupilumab-Associated Acquired Hemophilia A in an Elderly Male With Severe Eczema

This is a case of an 80-year-old Caucasian male with no personal or family history of coagulopathy, who was admitted for new onset painless hematuria followed by skin and significant deep soft tissue hemorrhage, with resultant anemia requiring blood transfusions. The hematuria started 1 week after he received an initial dose of subcutaneous injection of dupilumab for the treatment of refractory eczema. Few days later, he had spontaneous bruising on the tongue, anterior neck, right arm and entire left lower extremity in the absence of trauma and strenuous physical activity. His hemoglobin dropped to 7.2 g/dL from a baseline of 15.0 g/dL. Laboratory tests revealed a prolonged partial thromboplastin time, reduced factor VIII activity, and presence of factor VIII inhibitors. Three units of packed red blood cells were transfused and oral prednisone 1 mg/kg daily was initiated. His hemoglobin stabilized. No further bleeding was noted and the ecchymoses gradually resolved. J Med Cases. 2019;10(7):206-208 doi: https://doi.org/10.14740/jmc3336

Episodic Hematuria in a Young Boy - Do Not Miss Familial Idiopathic Hypercalciuria

Familial hypercalcemia is an important cause of episodic hematuria in children and can lead to nephrolithiasis if untreated. Elucidation of proper family history and screening of family members can help in clinching the diagnosis. An 8-year-old boy presented with episodic painless hematuria for 3 years, with a history of small renal stones in parents, which was managed conservatively. Ultrasound showed concretions in the renal pelvis, and urinalysis revealed hypercalciuria in the absence of renal tubular acidosis in index case as well as parents. He was started on thiazides, oral citrate supplementation, and adequate hydration, following which he became asymptomatic.

Renal artery pseudoaneurysm after open partial nephrectomy for renal cell carcinoma

Renal artery pseudoaneurysm is a well-described complication of open and laparoscopic partial nephrectomy. Delayed bleeding from a renal artery pseudoaneurysm is rare after open partial nephrectomy. Here, we present a 75-year-old man who, 14 days after undergoing an open right partial nephrectomy for an endophytic 4.5 cm tumor, developed painless macroscopic hematuria. Prompt computer tomography angiography imaging, followed by therapeutic angio-embolization of segmental renal artery with coils, treated the pseudoaneurysm successfully. Renal artery pseudoaneurysm can be treated rapidly, effectively, and with minimal patient morbidity via percutaneous renal artery embolization.

Seronegative atypical anti-glomerular basement membrane crescentic glomerulonephritis

A 46-year-old female presented with a chief complaint of fatigue and intermittent painless gross hematuria for one month. The patient was fluid overloaded on physical examination and noted to be in acute renal failure with a serum creatinine of 10.8 mg/dL. The patient was emergently started on hemodialysis. Serologies were negative for antinuclear antibody (ANA), anti-neutrophilic cytoplasmic antibody (ANCA), and anti-glomerular basement membrane (anti-GBM) antibody. However, renal biopsy revealed 90% glomerular involvement by temporally heterogeneous crescents ranging from cellular to fibrous. Immunofluorescence studies revealed strong, linear glomerular capillary wall staining for immunoglobulin G (IgG). Although the patient was treated with pulse dose steroids and cyclophosphamide, the patient ultimately developed infectious complications from immunosuppression, and treatment was terminated. This case highlights the atypical presentation of anti-GBM disease diagnosed based on renal biopsy with negative serologies. Although rare, the possibility of atypical anti-GBM antibodies which are not detected by standard commercial assays should be considered in such cases.

Somatic Mutations Profile of a Young Patient With Metastatic Urothelial Carcinoma Reveals Mutations in Genes Involved in Ion Channels

Background: Urothelial carcinoma is the most common malignancy of the bladder and is primarily considered as a disease of the elderly. Studies that address bladder tumor occurrence in young age groups are rare.Case Presentation: A 19-year-old male presented with a gross total painless hematuria. A histology after biopsy revealed a high-grade transitional cell carcinoma with lymph node metastasis. The patient succumbed to the disease on day 72 of the treatment. Here, we used whole-exome sequencing of a paired tumor-normal sample to identify the somatic mutations and the possible targets of treatment.Result: We predicted eight potential driver mutations (TP53 p.V157L, RB1 c.1498+1G>T, MED23 p.L1127P, CTNND1 p.S713C, NSD1 p.P2212A, MED17 p.G556V, DPYD p.Q814K, and SPEN p.S1078*). In addition, we predicted deleterious mutations in genes involved in the ion channels (CACNA1S p.E1581K, CACNG1 p.P71T, CACNG8 p.G404W, GRIN2B p.A1096T, KCNC1 p.G16V, KCNH4 p.E874K, KCNK9 p.R131S, P2RX7 p.A296D, and SCN8A p.R558H).Conclusions: Most likely, mutations in genes involved in ion channels may be responsible for the aggressive behavior of a tumor. Ion channels are the second largest class of drug targets, and may thus serve as a putative potential therapeutic target in advanced stage urothelial carcinoma.

Diagnosis and Management of a De Novo Urothelial Carcinoma in a Kidney Allograft: A Case Report

IntroductionFollowing renal transplantation, the incidence of malignancies is 3–5 times higher than that of healthy individuals. Among other type of cancers, the risk of urological tumors is also elevated. However, only a few cases of de novo transitional cell carcinomas occurring in renal allografts have been reported. Case reportA 63-year-old tertiary transplanted male patient was urgently hospitalized for a painless macroscopic hematuria. Ultrasonography revealed pyelectasis and a hematoma in the renal pelvis. A percutaneous nephrostomy tube was inserted. An anterograde pyelography was performed later, where a filling defect was still observable in the location of the previously reported hypoechoic mass. Contrast-enhanced ultrasonography showed enhancement of the lesion. An ultrasound-guided percutaneous biopsy was performed. The histologic evaluation revealed a high-grade transitional cell carcinoma. A whole-body staging computed tomography scan did not show signs of metastatic disease. The renal allograft was surgically removed. No disease progression was observed during the 21-month follow-up period. ConclusionsPainless hematuria and asymptomatic hydronephrosis occurring after kidney transplantation should raise the possibility of urothelial carcinoma in the kidney graft. Contrast-enhanced ultrasound should be considered as a first-line diagnostic modality because it is easily accessible and does not raise concerns about nephrotoxicity or radiation burden.

The bleeding obvious – a case of male endometriosis

Case: A 54-year-old male presented with painless haematuria. His background included hypertension, diabetes mellitus and obesity. Cystoscopy showed an atypical lesion at the base of the bladder. A transurethral resection was performed.

Urethral cavernous hemangioma: a highly misdiagnosed disease (a case report of two patients and literature review)

BackgroundDiagnosis of urethral cavernous hemangioma (UCH) is very rare. It can be easy to misdiagnose and mistreat due to its atypical clinical manifestations and a lack of relevant knowledge. The study is to explore the diagnosis, differential diagnosis, and treatment of UCH.Case presentationThe first patient was a 15-year-old male, who was admitted to the hospital for more than 1 year with repeated hematuria. UCH was diagnosed by cystoscope biopsy, and cured with local injection of pingyangmycin. The second patient was a 49-year-old male, who was admitted for repeated painless gross hematuria and intermittent urethral bleeding after penile erection for more than 20 years. The case had been misdiagnosed as seminal vesiculitis, urethritis, or prostatitis, for over 20 years, until it was diagnosed as UCH by MR examination of the penis. It was treated by injection of pingyangmycin into the hemangioma’s lumen and base. A small incision in the ventral penile area was separated from the location of the hemangioma, which was injected with pingyangmycin again. A biopsy of resected tissue further confirmed the diagnosis of UCH.ConclusionsUCH is an easily misdiagnosed disease. Intermittent painless hematuria is important characteristic of UCH. Local injection of pingyangmycin is a good option for treatment of UCH.

Painless Gross Hematuria: A New Presentation of Primitive Neuroectodermal Tumor of the Prostate

Introduction: Primitive neuroectodermal tumor (PNET) is a very rare type of prostate sarcoma that mostly occurs in young adults, and it is associated with a poor prognosis. Case Presentation: A 37-year-old male was admitted with intermittent painless gross hematuria from 1 month prior to admission. Cystosocopy, abdominopelvic computed tomography scan (ACTS), and magnetic resonance imaging (MRI) revealed huge prostate. All tumor markers were negative and pathology findings of trans-rectal ultrasonographic biopsy (TRUS Bx) and trans-urethral resection of prostate (TURP) were consistent with severely inflamed prostatic urethra with no evidence of malignancy. The patient underwent radical prostatectomy. Histopathology of the specimens showed malignant neoplasm of small round and oval cells suggestive of PNET. Immunohistochemistry (IHC) study results on CD99 were positive. Conclusions: We report a rare uncommon case of prostate PNET presented by intermittent painless gross hematuria. As the prognosis is very poor, medical staff should pay enough attention to the differential diagnosis, choosing the best treatment and subjects close follow-up.

A Quest for Accuracy: Evaluation of The Paris System in Diagnosis of Urothelial Carcinomas.

Introduction:Urine cytology is an important screening tool of patients for urothelial carcinoma (UC) and follow-up of patients with treated disease. Ease of procurement, cost-effectiveness, and lower turnaround time are the major advantages.Objective:To compare current system of reporting (CSR) at our institute with The Paris System (TPS) and analyze utility of urine cytology based on TPS reporting in correlation with urine culture and histopathology.Materials and Methods:One-year retrospective study of 90 cases was undertaken wherein cases presenting with painless hematuria and clinically suspicious of UC were included. Urine cytology slides were reviewed and reported with TPS guidelines. These findings were correlated with histopathological diagnosis and urine culture as indicated. Statistical analysis was done using SPSS 17 software.Results:With TPS guidelines, 11.1% and 5.6% cases were reported as high-grade UC (HGUC) and low-grade urothelial neoplasm (LGUN), respectively. Suspicious for HGUC category included 17.8% of cases. The rate of reporting “atypical urothelial cells (AUC)” was significantly lower (11.1%) with TPS on comparison with CSR (16.7%). Histopathological correlation of positive predictive value for HGUC was better (100%) on using TPS when compared with CSR (64.3%). Among 11 cases with microbial growth on urine culture, 9.1% were reported as atypical. Sensitivity and accuracy of TPS in detecting UC were 83.3% and 86.52%, respectively. Both were higher when compared with CSR.Conclusion:In comparison to CSR, criteria of TPS limit the AUC category and enhance the sensitivity and accuracy of detecting HGUC. Adopting TPS for urinary cytology will ensure uniformity and accuracy of HGUC diagnosis.

Comparison of bladder ultrasonographic and rigid cystoscopic findings in patients with hematuria.

Background:Bladder cancer ranks ninth in world-wide cancer incidence and is 2.5-4 times more common in men, and painless gross hematuria is its typical clinical symptom. Cystoscopy is used to evaluate the cause of hematuria in bladder while the use and reliability of ultrasonography is questionable for this purpose. Therefore, the aim of this study was to compare abdominal ultrasonography and rigid cystoscopy in the diagnosis of bladder tumors in Babol Shahid Beheshti Hospital.Methods:In this cross-sectional study, 60 patients who were candidate for cystoscopy referred to Babol Shahid Beheshti Hospital in Iran in 2017-2018. In this study, rigid cystoscope was used to view the bladder after doing sonography. The numbers, demographic information (age, gender and residence) and clinical characteristics (indication of cystoscopy, history of chronic disease, sonographic and cystoscopic results) of patients were recorded in the checklist.Results:The mean age of patients (37 (61.7%)=males) was 58.65±14.26 (19-85) years and 48 (80%) of them were >50 years old. The sensitivity and specificity of sonography was 71.43 (95% CI: 29.4, 96.33) and 96.23% (95% CI: 87.02, 99.54) in detecting bladder tumors, respectively. The negative predictive and positive predictive values in sonography were 96.23 (95% CI: 88.76, 98.8) and 71.43% (95% CI: 37.25, 91.33) respectively.Conclusion:The results of this study indicate that since sonography has high negative predictive values in evaluating hematuria; therefore it can be replaced with rigid cystoscopy for patients with lower risk of malignancy.

Synchronous invasive urothelial cell carcinoma of the bladder with chronic myeloid leukemia

Incident of bladder carcinoma synchronous with CML was about 0.45% and its treatment became a challenge. We reported a case of invasive urothelial cell carcinoma with chronic myeloid leukemia (CML) in a 55-years-old man. The patient suffered painless gross hematuria from the first time. Patient complained of weight drop drastically and often accompanied by intermittent fever. The result of bone marrow biopsy was chronic phase CML, while the results of abdominal ultrasound and abdominal Multislice Computerized Tomography without contrast were a bladder mass. The patient underwent TUR-BT and therapy with imatinib. The pathology result showed that an Invasive Urothelial Cell Carcinoma of bladder. Our report concluded an uncommon case of Invasive Urothelial Cell Carcinoma of bladder and CML.

Giant bladder calculus in a male patient with chronic alcoholic liver disease

Introduction: Giant bladder calculus in recent urologic practice is uncommon. Bladder calculi have been known to grow to significant sizes in delayed presentations. They may be associated with chronic liver disease. Literature search revealed few studies suggesting a link between chronic liver disease and urolithiasis. Case Report: A 23-year-old man presented to us with 17 year history of frequency, urgency, weak stream, feeling of incomplete emptying of the bladder, strangury, total painless hematuria and yellowness of the eyes of same duration. He also had a history of ingestion of alcohol for the past 10 years. On examination, he was pale and icteric. Abdominal examination revealed hepatomegaly and a hard non-tender suprapubic mass. Other systems were essentially normal. Urinalysis revealed triple phosphate crystals but his urine culture was negative. He had deranged renal and liver function tests. Serum calcium was low, 4.8 mg/dL, phosphorus was 13.93 mg/dL. He was nonreactive to Hepatitis B and C. Ultrasonography revealed an enlarged liver measuring 18 cm, echogenic foci with posterior acoustic shadowing in both kidneys, dilatation of both pelvicalyceal systems with a solid echogenic mass occupying the whole of the bladder lumen. Plain abdominal X-ray revealed a huge radio opaque mass measuring 10 cmx6 cm, occupying the pelvic region and radio opaque masses measuring 2 cm x 2 cm in both kidneys. A diagnosis of urolithiasis (huge bladder calculus and nephrolithiasis) with chronic alcoholic liver disease was made. He had open cystolithotomy under spinal anaesthesia. No obstructive lesion was seen. The calculus measured 12cm x 9cm x 6cm, weighed 1.5 kg and was adherent to the bladder mucosa. The calculus was removed and he was placed on continuous bladder drainage for 10 days, following which the catheter was removed. He has been on regular follow up in the outpatient clinic since discharge. He has no lower urinary tract symptoms but jaundice is still present. Conclusion: Giant bladder calculus is rare and should be considered in patients with long standing lower urinary tract symptoms and strangury. There may be an association between chronic liver disease and bladder calculus.

Paraganglioma of the Urinary Bladder

Urinary bladder paragangliomas are rare with a reported incidence of &lt;1% of bladder tumors. We presented a case of a urinary bladder paraganglioma in a 26-year-old male who presented with a painless gross hematuria and hypertensive crisis occurring during his trans-urethral resection. Our diagnosis was based upon patient’s history, abdominal-pelvic computed tomography scan, which revealed a left-sided bladder wall mass 2.26 X 4.4 X 3.28 cm that was obstructing the left distal ureter and causing significant left severe hydroureter and hydronephrosis. Preoperative preparation was done with beta blocker and alpha blocker two weeks prior to surgery. The patient underwent an open surgical partial cystectomy, left nephroureterectomy and, complete external and internal iliac lymphadenectomy. Gross pathological examination of the mass revealed a 3x4.5x4 cm growth originating from the wall of the urinary bladder. Microscopic examination revealed nests invaded into muscularis propria of the urinary bladder, with no evidence of distant metastasis. Immunohistochemical studies showed positive tumor cells staining for chromogranin and synaptophysin while S100 highlighted the surrounding sustentacular cells. During the first 3-month post-operative follow-up period, the patient’s blood pressure was stabilized and the symptoms gradually subsided. Urinary bladder paragangliomas should be considered among the differential diagnosis of bladder tumors.