Category: Robotic Surgery: Lower Tract - Malignant

VS18-1 - Management of Bladder Paraganglioma with Combination Cystoscopic and Robotic Approach

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

Twenty-eight patients with an average age of 27 ± 15.6 years at symptom onset presented to the NIH from 2000 to 2017 with urinary bladder paragangliomas (UBPGLs). All but one of these patients received surgical treatment, with 3 of these patients undergoing combined robotic assisted partial cystectomy (RAPC) with intraoperative cystoscopy. Here, we describe the management of a recent patient with a UBPGL who underwent a RAPC with intraoperative cystoscopy. 


Methods : This is a 29 year-old, Caucasian male who initially presented to the NIH in June 2017 for evaluation of a possible pheochromocytoma. He self-referred to the NIH as his grandmother had a history of Succinate Dehydrogenase Complex Iron Sulfur Subunit B (SDHB) mutation and metastatic pheochromocytoma. These symptoms included increased frequency of migraine headaches to three to four days per week from prior frequency of one time per month, with migraine headaches preceded by generalized weakness and paresthesias, ear fullness, photophobia, palpitations and nausea. During these episodes, his blood pressure was found to be severely elevated [(190-220)/(90-100)]. Between the episodes, his blood pressure was within normal range (120s/80s). His lab studies were found to be significant for elevated catecholamine and metanephrine values. MRI of his pelvis showed a focal, solid, enhancing lesion along the mucosal aspect of the right bladder wall which exhibited intermediate signal on T2 imaging and was 2.4 cm in largest diameter. He also received an FDG/PET scan which showed a 2.4 x 1.2 cm FDG avid soft tissue mass arising from the mucosal surface of the right anterolateral wall of the bladder. In addition, he had genetic testing which was positive for an SDHB mutation. He was initiated on 10 mg phenoxybenzamine daily after his first visit to the to NIH and has been titrated up to 10 mg t.i.d. He was counseled and consented for RAPC with intraoperative cystoscopy.


Results : The tumor was resected in its entirety with minimal removal of normal bladder tissue and the patient’s blood pressure was well controlled throughout the surgery. He was discharged on post-op day 3, after cystogram confirmed the absence of bladder leakage. Two- week follow up showed symptom resolution and normalization of lab values.


Conclusions :

RAPC is feasible with use of intraoperative cystoscopy and can result in minimal removal of normal bladder tissue.

Gustavo E. Pena-La Grave

Research Fellow
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health
bethesda, Maryland

Gustavo E. Pena La-Grave

Research Follow
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health
Bethesda, Maryland

Dr Pena-LaGrave, Gustavo MD Clinical Fellow at NIH (National Cancer Institute) NCI ( National Cancer Institute) UOB ( Urological Oncology Branch) Bethesda Md.
Medical School at Escuela de Medicina José María Vargas, Ccs Venezuela
Surgical Residency Washington Hospital Center, DC PGY1-2
Unaccredited Fellowship of oncologic urology at Mount Sinai Miami Beach 2 years
Surgical Residency PGY-2 Westchester Medical Center, NY
Trauma and Surgical Critical Care Fellowship Westchester Medical Center, NY
Clinical Fellow at NIH, NCI UOB Bethesda

Jonathan Bloom

Research Fellow
National Cancer Institute
Bethesda, Maryland

Graham Hale

MRSP Research Scholar
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health
Bethesda, Maryland

Samuel Gold

MRSP Research Scholar
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health
Bethesda, Maryland

Piyush Agarwal

Head, Bladder Cancer Section
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health
Bethesda, Maryland

kareem Ryan