Bladder paraganglioma: a 25-year systematic review unveils the benefits of early diagnosis in reducing surgical complications.

IF 1.6 4区 医学 Q2 SURGERY
Frontiers in Surgery Pub Date : 2025-09-22 eCollection Date: 2025-01-01 DOI:10.3389/fsurg.2025.1657833
Qingqing Liu, Tong Wang, Wenlong Tu, Pengfei Zhou, Xionghui Wu, Huayan Lv
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引用次数: 0

Abstract

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. Two independent reviewers extracted data and performed statistical analyses. 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. 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%, 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 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.

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膀胱副神经节瘤:一项25年的系统回顾揭示了早期诊断在减少手术并发症方面的好处。
背景:膀胱副神经节瘤(BPG)是一种罕见的肿瘤,术前常被误诊。为了提高认识和提高早期发现,我们系统地回顾了过去25年来BPG病例报告的临床表现和治疗方法。我们的目的是找出有助于及时诊断和减少误诊并发症的因素。材料和方法:我们在PubMed检索2000年1月1日至2024年12月31日期间发表的BPG病例报告。两名独立审稿人提取数据并进行统计分析。根据术前诊断将患者分为正确诊断组和误诊组。结果184篇199例,术前诊断BPG 80例(40.2%),误诊119例(59.8%)。儿茶酚胺相关症状在正确诊断组中更为常见(60.0% vs 21.8%, p α-肾上腺素能阻断治疗)。两组在手术入路选择上差异有统计学意义:误诊组有79.0%的患者行经尿道膀胱切除术(TUR),而只有14.3%的患者行膀胱部分切除术;相反,在正确诊断组中,77.5%的患者行部分膀胱切除术,只有15.0%的患者行TUR。正确诊断组术前准备较多(63.7% vs. 0%, p p p p p p p = 0.015)预测正确诊断,而泌尿系统症状(OR = 0.44, p = 0.031)与误诊相关。结论:半数以上的BPG患者术前诊断不准确。儿茶酚胺相关症状与正确诊断密切相关,而泌尿系统症状增加误诊。术前诊断正确的患者更常接受α-肾上腺素能阻断治疗,行膀胱切除术而非经尿道切除术,与误诊患者相比,高血压危象、手术停药和肿瘤残留减少。这些发现强调了在膀胱肿块诊断中进行结构化儿茶酚胺筛查的必要性,并支持了我们的诊断流程,以增强早期BPG的检测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Frontiers in Surgery
Frontiers in Surgery Medicine-Surgery
CiteScore
1.90
自引率
11.10%
发文量
1872
审稿时长
12 weeks
期刊介绍: Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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