Sprouting of bladder nerves into cystoplastic cecal segment in the rat

Incorporation of bowel into the bladder (enterocystoplasty) has been widely used to increase bladder capacity. It has been reported by others that the response of smooth muscle from the cystoplastic segment of the intestine shifts from that of the intestine (relaxation to α-agonists and ATP) to that of the bladder (contraction to α-agonists and ATP). This suggests a functional integration of the intestinal muscle into the bladder; the mechanisms are unknown. The aims of the present study were (1) to elucidate if there are signs of bladder nerves sprouting across the anastomosis into the intestinal segment, and (2) to study what happens with the intrinsic innervation of the intestinal segment. As a model, we used cecocystoplasty in rats. The bladder was opened and a patch of cecum with intact vascular supply was anastomosed to the bladder. After two to 11 months the rats were sacrificed and the bladders mounted as wholemounts and stained for acetylcholinesterase-containing nerves, or embedded in paraffin for histology. A pronounced degeneration of the myenteric plexus was found in the cecal segments. In some areas, this had proceeded to the extent that the ganglia were isolated ovoid lumps of cells with no apparent connection to other ganglia. Areas lacking ganglia and nerve trunks but still with muscle could be found in all specimens. Abundant axon bundles were demonstrated sprouting from the cut bladder nerves close to the anastomosis. The bundles spread out in a fan-like pattern or were organized as fewer thicker nerves. There were many nerve bundles entering the cecal segment where they branched and the diameter decreased till they no longer became visible. Some nerves reached surviving lumps of myenteric ganglion cells. The results show that the bladder nerves sprout into the anastomosed cecal segment. It is reasonable to assume that these nerves are responsible for the changes in receptor pharmacological properties of the cecal smooth muscle towards that of bladder muscle. Received: 30 October 1998 / Accepted: 18 May 1999     

Cystometrical evaluation of acute and chronic overdistension in the rat urinary bladder

The urodynamic effects of an experimental, partial infravesical outlet obstruction in rats were studied and compared with the effects in sham-operated controls, and in animals that had undergone 24 h of total outlet obstruction. The animals were studied up to 42 days after surgery. Bladder weight increased with time in the partially obstructed group to reach a final value of 6 times that of the control. In water loading experiments micturition volume was unaffected by sham operation. In the partially obstructed bladders it decreased initially but normalized with time. In the group that had undergone 24 h of total obstruction micturition volume also decreased initially but then became significantly higher than in the controls. In cystometry experiments the partially obstructed bladders developed a considerable residual urine and increased threshold and micturition pressures. Detrusor instability was present already after 10 days. Also in the cystometry experiments the bladders that had been totally obstructed for 24 h had increased micturition volumes. Residual volume was only slightly affected by atropine in the control and partially obstructed bladders but increased 7-fold in rats in which the bladder had been totally obstructed for 24 h 42 days previously. We conclude that there is a close relationship between bladder weight, residual volume and micturition pressure in the partially obstructed bladder, and that 24 h of total obstruction results in disturbances of bladder function that might be related to denervation phenomena previously reported by others. Received: 19 February 1997 / Accepted: 18 September 1997     

Effect of acute distension on cholinergic innervation of the rat urinary bladder

Summary The effect of short-term urinary bladder distension on its cholinergic innervation was studied in Sprague-Dawley rats. Distension was induced for 3 h by forced diuresis and balloon outlet obstruction, and whole thick biopsy specimens were taken from the dome and lateral side of the anterior body 2, 7 and 21 days afterwards. The acetylcholinesterase (AChE) method was used to demonstrate the cholinergic nerves in the distended bladder wall. Cholinergic hypoinnervation was observed 7 days after the distension, persisting up to 21 days, although AChE-reactive nerves were then observed to be more numerous. The distribution of hypoinnervation was uneven, being more marked in the lateral side of the anterior body than in the dome. The distribution of AChE-reactive nerves varied even in the same biopsies, with areas of total hypoinnervation occurring next to areas of slightly diminished innervation. This was especially true 21 days after cholinergic innervation, which may in turn explain the prolonged voiding difficulties often seen after catheterization of an overdistended bladder in a patient with urinary retention. The short-lasting effect of bladder dilatation therapy used to treat detrusor instability or interstitial cystitis may be due to the fairly rapid regeneration of cholinergic innervation.     

Changes in neuropeptide y tissue concentration in the wall of the rat urinary bladder after acute distension

Neuropeptide Y (NPY) is known to be associated with the adrenergic system. The relationship among the late micturition disorders following acute urinary distension, the adrenergic system and NPY was investigated. A total of 90 rats were included in the study of which 30 acted as the control group. Acute urinary distension was created in 60 rats. The NPY concentration within their bladders was assessed by the use of radioimmunoassay (RIA) at 3 h after distension and subsequently on days 2, 7 and 21, then the third and sixth months. The NPY concentrations assessed in the third and sixth months were compared with the control group in the same age group. By means of the RIA method, a substantial decline of NPY concentration was observed at 2 days after distension, while the concentration started to increase after day 7 (P=0.003). This increase continued until the twenty first day (P=0.004). However, a significant decline was maintained when compared to the concentration before distension. In the third and sixth months, a significant decline were observed in the NPY concentration in comparison to the control group (P=0.004 and P=0.005, respectively). Early and late micturition disorders experienced after acute urinary distension may be the result of adrenergic denervation which may be related to NPY.     

Denervation and outlet obstruction induce a net synthesis of contractile and cytoskeletal proteins in the urinary bladder of the male rat

The concentrations of the contractile proteins actin and myosin and the cytoskeletal protein desmin were determined in urinary bladders from normal rats, and from rats with bladder outlet obstruction or denervation. Ten days of obstruction or total denervation by bilateral removal of the pelvic ganglia resulted in an almost fourfold increase in bladder weight. Actin and myosin concentrations did not change significantly. The total amount of actin was 1624±235 g in the control bladder. In the obstructed and denervated bladders it increased significantly to 6277±648 g and 7671±835 g, respectively. The desmin/actin ratio was 0.237±0.012 in the control bladders, and increased significantly to 0.369±0.015 in the obstructed and 0.343±0.022 in the denervated bladders. Partial denervation by removal of the pelvic ganglion on one side only increased bladder weight by 52%, but did not increase the desmin/actin ratio. The content of actin in such bladders increased by 82%. Both obstruction (which increases the functional load of the detrusor muscle cells) and denervation (which produces bladder paralysis) are known to induce hypertrophy of the detrusor smooth muscle cells. The study shows that the desmin/actin ratio and the total amount of contractile proteins increase in response to the hypertrophy as such, and not to the work performed by the smooth muscle cells, and that the nerves have no trophic influence on the growth response. Also, even a limited lesion of the bladder innervation is associated with growth and a net increase in the amount of contractile proteins.     

Effect of distension on adrenergic innervation of the rat urinary bladder

Summary The effect of distension on adrenergic innervation was investigated in the rat urinary bladder. Bladders were distended for 3 h by forced diuresis and ballon obstruction, and specimens were taken from the bladder dome, body and neck for the demonstration of glyoxylic acid-induced fluorescence of catecholamines. Depletion of catecholamines started after 10 h and was almost complete after 2 days. The fluorescence had recovered part way after 5–7 days and was practically normal after 21 days. Small, intensely fluorescent (SIF) cells in the ganglia continued to leak catecholamines throughout the 21-day study period. The primary clinical success of distension therapy for the treatment of unstable bladder may be at least partly due to a reversible disturbance in the function of the adrenergic nerves, which have an excitatory alpha-adrenergic dominance in such cases, but the persistent leakage from SIF cells raises the question of whether distension causes prolonged disturbances in bladder function.     

Effect of doxazosin on rat urinary bladder function after partial outlet obstruction

Hypoxia induced by partial outlet obstruction is believed to play a major role in both the hypertrophic and degenerative effects of partial outlet obstruction. Doxazosin (dox) is a clinically effective alpha-adrenergic antagonist used in the treatment of symptomatic benign prostatic hyperplasia (BPH). Although the major therapeutic effect of the agent is believed to occur on the smooth muscle components of the prostate by reducing prostatic urethral resistance and thus improving emptying, dox may have part of its clinical action via effects mediated by other actions, including via spinal alpha-adrenergic receptors or direct effects on the bladder, possibly via inhibition of vascular alpha receptors. The specific aim of the current study was to determine whether dox pretreatment on rats affects blood flow to the bladder and reduces the level of bladder dysfunction induced by partial outlet obstruction. In part 1, eight rats were separated into two groups of four rats each. Group 1 received oral administration of dox (30 mg/kg) for 4 weeks; group 2 received vehicle (5% dimethyl sulfoxide). After 4 weeks of treatment, blood flow studies were performed using fluorescent microspheres and the bladders excised, frozen, and submitted to Interactive Medical Technologies (IMT) for blood flow analysis. In part 2, 32 adult male rats were separated into four groups of eight rats each. Groups 1 and 2 received oral administration of dox (30 mg/kg) for 4 weeks, groups 3 and 4 received vehicle (5% dimethyl sulfoxide). At 4 weeks, the rats in groups 1 and 3 received partial outlet obstructions and treatment continued for an additional 2 weeks. After 6 weeks of treatment (total), each rat was anesthetized, the bladder excised, weighed, and isolated strips mounted and contractility studies performed. 1) Four weeks pretreatment of rats with dox increased blood flow to the bladder in both the control and obstructed groups. 2) Partial outlet obstruction induced a mild decrease in blood flow. 3) The magnitude of the increased bladder weight in the vehicle-treated obstructed group was significantly greater than in the dox-treated obstructed group. 4) Partial outlet obstruction resulted in significant decreases in the contractile response to field stimulation in both treated and non-treated rats. The magnitude of the decreased response was significantly greater in the non-treated rats. 5) The response to potassium chloride was significantly reduced by partial outlet obstruction in the vehicle-treated group but not in the dox-treated group. 6) The time to maximal tension was significantly increased in response to carbachol, adenosine triphosphate, and potassium chloride. However, the magnitude of the increase was significantly greater for the vehicle-treated obstructed groups stimulated by potassium chloride than for the dox-treated groups. Dox treatment of rats increased blood flow to the bladder and reduced the severity of the response to partial outlet obstruction. These beneficial effects would be due to pharmacological effects on alpha-adrenergic systems outside those present in the prostate. These include effects on blood flow to the bladder, effects on the micturition centers of the central nervous system, spinal reflexes, and alpha-adrenergic receptors in the urethra and bladder.     

Lactate dehydrogenase activity and isoform distribution in the rat pelvic ganglion: effects of diabetes and bladder outlet obstruction

We have previously shown that the intramural motor nerves in the rat bladder can function in anoxic conditions. The present study aims to explore the distribution and activity of lactate dehydrogenase (LDH), the key enzyme for ATP generation in anoxia. The activity and isoform distribution pattern of LDH was studied in pelvic ganglia from male and female rats. A histochemical investigation showed that the LDH activity was intense in the ganglion cells, and weak in the other tissue components (nerve bundles, connective tissue). The male pelvic ganglion weighed 55% more than the female pelvic ganglion, the enzyme activity per unit ganglion weight was 60% higher and the total LDH activity was 155% higher. The isoform distribution was similar, with M4 being dominant isoform, followed by M3H. Infravesical outlet obstruction in the female rat induced a threefold increase in ganglion weight, and the total LDH activity increased twofold. In this hypertrophic female ganglion a decreased relative amount of M4, and an increased amount of MH3, was found. Diabetes in the male rat had no effect on ganglion weight or its contents and isoform distribution of LDH.     

3H-thymidine uptake by the rat urinary bladder after partial outflow obstruction

Partial outflow obstruction induces marked changes in detrusor contractile function and morphology. One common finding in all experimental animal models of outflow obstruction is a significant increase in bladder mass. It is not clear which tissue compartments undergo hypertrophy, hyperplasia, or both. The present study was designed to evaluate the time-related changes in ³H-thymidine uptake and distribution within each tissue compartment induced by partial outflow obstruction using autoradiography. Partial outlet obstruction in rats induced a mild 2-fold increase in mass over a 14 day period. DNA synthesis increased significantly at 1 day following surgery, and remained increased through 7 days. DNA synthesis returned to control levels by 14 days. Distribution studies (using autoradiography) demonstrated a marked increase in the number of labelled urothelium cells at 1 and 3 days after obstruction. Sham surgery also initiated an increase in the number of labelled cells in the urothelium at 1 day. Although both sham and obstructive surgeries induced substantial increases in the labelling of cells within the connective tissue components, the magnitude of the increase in labelled connective tissue cells of the obstructed bladders was greater than that of the sham group. The number of labelled smooth muscle cells of the obstructed bladder increased significantly at 3, 5, and 7 days. However, there were no changes in smooth muscle incorporation of ³H-thymidine by the sham groups. In conclusion, partial outflow obstruction induced time-dependent increases in bladder wall proliferation. The urothelium and connective tissue were the compartments first affected, followed by smooth muscle. © 1994 Wiley-Liss, Inc.     

The influence of pelvic nerve transection on the neuromuscular system of the canine urinary bladder

Summary We previously reported that bladder overdistension led to denervation and subsequent supersensitivity of the detrusor muscle to acctylcholine. Therefore, to exclude the influence of bladder overdistension, we produced a low-pressure bladder in female mongrel dogs using an indwelling urethral catheter, and performed pelvic neurectomy (decentralization). We examined the effects of decentralization on the neuromuscular system of the bladder. The contraction response levels of bladder strips in dogs 1 and 2 weeks after neurectomy was low, and significantly different from that of bladder strips in the control group. The doseresponse curves of dogs 4 and 8 weeks after neurectomy showed a shift to the left when compared to those of the control group, indicating a significant increase in sensitivity of the bladder strips. Many cholinergic terminal and varicosity profiles had a normal ultrastructure in all of the groups subjected to neurectomy, while some had degenerating profiles representing clear axoplasm without any recognizable organelles. Microphotographs of bladders obtained from dogs with spontaneous catheter loss showed degenerating axons, which were observed more frequently than in bladders kept empty with indwelling urethral catheters. Micturition in the dogs with spontaneous catheter loss was achieved by overflow incontinence without catheterization. These findings suggest that post-synaptic nerve degeneration may be augmented by impairment of micturition, followed by decentralization. Our observations also suggest that post-synaptic nerve degeneration (denervation) plays an important role in the increased sensitivity of the detrusor muscle to acetylcholine in the parasympathetically decentralized urinary bladder, whether denervation is due to trans-synaptic degeneration or impairment of micturition.     

The effects of organ resection on rat urinary bladder carcinogenesis

The effect of unilateral nephrectomy, orchiectomy or partial hepatectomy on the growth of chemically induced rat bladder tumors was investigated. Male F344 rats were treated with 0.05% N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) for 5 weeks, and surgical resection of one of these organs was performed 2 weeks after the completion of BBN administration. Histological evaluation of the bladder 24 weeks after the start of the experiment revealed that unilateral nephrectomy and orchiectomy significantly increased the numbers of preneoplastic and neoplastic lesions as compared with the corresponding sham-operated groups. Partial hepatectomy also enhanced tumor growth, although not significantly. Immunohistochemical studies examining the effect of organ resection on normal bladder urothelium showed that BrdU immunostaining of urothelial cells significantly increased 7 days after unilateral nephrectomy or orchiectomy, while BrdU incorporation was minimum after partial hepatectomy or sham operation. C-met expression in the bladder urothelium was evident following unilateral nephrectomy or partial hepatectomy, while increased immunoreactivity of androgen receptor was noted following unilateral orchiectomy. Further study is needed to determine the exact mechanism of the bladder tumor growth-enhancing effect associated with organ restriction. Received: 12 July 2000 / Accepted: 23 February 2001     

多沙唑嗪对兔膀胱出口部分梗阻致膀胱顺应性减低的影响

目的 探讨多沙唑嗪对兔膀胱出口部分梗阻后膀胱顺应性改变的影响.方法 成年雄性新西兰兔40只随机分为4组,每组10只,A组为假手术对照组,B组为膀胱出口部分梗阻组,C组为膀胱出口部分梗阻后口服多沙唑嗪组,D组为假手术后给予多沙唑嗪组.各组于14周行尿动力学检测,检测完成后处死并留取膀胱标本,行膀胱称重.结果 4组膀胱标本质量分别为(3.2±0.9)、(14.1±2.3)、(5.0±2.0)、(2.9±0.5)g;B、C组均高于A、D组,B组高于C组,差异均有统计学意义(P＜0.01);A、D组间比较差异无统计学意义(P＞0.05).4组逼尿肌漏尿点压分别为(10.2±2.5)、(18.8±6.1)、(13.5±4.7)、(11.6±3.6)cm H2O(1 cm H2O=0.098 kPa),B组高于A、D组,差异有统计学意义(P＜0.01),且高于C组,差异有统计学意义(P＜0.05);A、C、D组间差异无统计学意义(P＞0.05).膀胱顺应性分别为(2.86±0.56)、(1.22±0.39)、(4.25±2.19)、(2.90±0.53)ml/cm H2O,B组与A、D组相比明显下降,差异有统计学意义(P＜0.01);C组高于A、D组,差异有统计学意义(P＜0.05);A、D组间差异无统计学意义(P＞0.05).结论膀胱出口部分梗阻后早期应用多沙唑嗪治疗能够延迟梗阻对膀胱顺应性的损害,保护膀胱储尿功能.

Abstract：

Objective To explore the effect of doxazosin on rabbit bladder compliance after partial bladder outlet obstruction. Methods A total of 40 male New Zealand white rabbits were randomized into 4 groups, with 10 rabbits in each group. Partial bladder outlet obstruction was established in groups B and C, while groups A and D underwent the same operation but without partial bladder outlet obstruction. On the day after the operation, groups C and D received oral administration of doxazosin. After 14 weeks, urodynamic examinations were carried out in all groups, and the bladder was weighted after cystectomy. Results Bladder weight was (3.2±0.9) g in group A, (14.1±2.3) g in group B, (5.0±2.0) in group C,and (2.9±0.5) g in group D. The bladder weight in groups B and C increased significantly compared to groups A and D (P＜0.01), group B increased significantly over group C (P＜0.01), and there was no significant difference between groups A and D (P＞0.05).The detrusor leak point pressure was (10.2±2.5) cm H2O in group A, (18.8±6.1) cm H2O in group B, (13.5±4.7) cm H2O in group C,and (11.6±3.6) cm H2O in group D. The detrusor leak point pressure in group B was significantly higher than group A, group D (P＜0.01) and group C (P＜0.05). There was no significant difference between group A, group C and group D (P＞0.05). The bladder compliance was (2.86±0.56) ml/cm H2O in group A, (1.22±0.39) ml/cm H2O in group B, (4.25±2.19) ml/cm H2O in group C,and (2.90±0.53) ml/cm H2O in group D. The bladder compliance was significantly decreased in group B compared to groups A and D (P＜0.01). Bladder compliance in group C was significantly higher than in groups A and D (P＜0.05), and there was no significant difference between group A and group D (P＞0.05). Conclusion Early use of doxazosin can delay the occurrence of lower bladder compliance after partial bladder outlet obstruction, thus protecting the storage function of bladder.     

The effect of acute denervation on the microcirculation of skeletal muscle: rat cremaster model

Although tissue is denervated during replantation of a severed part, tissue transfer, or muscle transplantation, there are few studies concerning the effects of acute denervation on muscle microcirculation. We have described a surgical procedure that totally denervates the rat cremaster muscle. Histological examination of the denervated tissue has given convincing evidence of nerve degeneration and skeletal muscle atrophy, accompanied by electrophysiological evidence of total denervation. The diameters of each component of the microcirculation were measured before and after denervation. Arterioles and arteries ranging in size from 10 to 70 microns in diameter were found to increase significantly in size immediately after acute denervation. Larger arteries and veins did not undergo significant diametrical increases. These findings suggest that total acute denervation significantly increases the diameter of small arteries and arterioles, thereby decreasing the resistance in the arterial bed and increasing blood flow. Since this phenomenon is of limited duration (20 min), it would appear to be ineffective in enhancing reperfusion and oxygenation at the time of reattachment of amputated parts or during vascularized tissue transfers, until methods of prolonging it for several hours or more are found.     

Ultra-structural morphological abnormalities of the urinary bladder in streptozotocin-induced diabetic female rats

The objective of this study was to evaluate the ultra-structural changes in the urinary bladder of diabetic rats in relation to disease duration since the morphological bases of diabetes-induced bladder dysfunction are poorly understood. Urinary bladders were examined chronologically by electron microscopy in a female Wistar-rat model of streptozotocin-induced diabetes mellitus and compared to control samples. Numerous dark mitochondria with swollen cristae and electron lucent, large, calcified and degenerated mitochondria were observed first in the urothelium. Intraepithelial capillaries surrounded by thick collagen were also present. Gap junctions between myocytes were interrupted or extensively widened with reduced mitochondria and caveolae. Collagen accumulation, degenerated nerve fibres and myelin bodies were seen between myocytes with increased collagen content and frequent mast cells, phagocytes and lymphocyte aggregates in the stroma. All ultra-structural lesions became augmented with longer duration of diabetes. Diabetes induces time-dependent pathologic changes in the urinary bladder of rats that might account for bladder dysfunction.     

Central cholinergic mechanisms in L-DOPA induced hyperactive urinary bladder of the rat

Summary The involvement of central and peripheral cholinergic structures in the mediation of a centrally induced hyperactive urinary bladder response to L-2,3-dihydroxyphenylalanine (L-DOPA), after peripheral decarboxylase inhibition, registered by a cystometric procedure, has been analysed pharmacologically in anaesthetised rats. The urinary bladder response to L-DOPA was unchanged after blockade of cholinergic receptors with methylscopolamine, diminished after atropine and totally inhibited after hexamethonium. In addition, activation of muscarinic receptors in the pontine-mesencephalic brain region with oxotremorine after methylsopolamine pretreatment generates a hyperactive urinary bladder response, mediation of which seems to be independent of endogenous catecholamine stores. It is suggested that cholinergic receptors in the pontine-mesencephalic brain region are of importance for regulation of urinary bladder function in the rat. Furthermore, the bladder hyperactivity induced by L-DOPA might be propagated via muscarinic receptors in this brain area, and mediated peripherally via cholinergic receptors in the autonomic ganglia, but in the bladder detrusor via non-cholinergic receptors.     

肠膀胱重建术后尿路结石的微创治疗(附4例报告)

目的：探讨肠膀胱重建术后尿路结石的微创治疗效果。方法：报告4例膀胱癌膀胱全切肠代膀胱术术后并发尿路结石患者的临床资料。结果：1例行经皮肾穿刺肾盂输尿管造影定位下体外冲击波碎石术，结石粉碎并排至结肠膀胱；1例行经皮肾镜碎石术；另2例行经尿道输尿管镜下钬激光碎石术，结石粉碎并取出。结论：肠膀胱重建术后尿结石的发生与尿路感染和手术操作等因素有关，对可控膀胱术后上尿路结石可实施经皮肾镜取石术或尿路造影定位下ESWL治疗，原位回肠代膀胱术后尿路结石可实施腔内碎石治疗。     

Hemangiopericytoma arising from the wall of the urinary bladder

Hemangiopericytoma (HPC) arising from within the urinary bladder is exceptionally rare. A 45-year-old man having the symptoms of left groin pain, vague suprapubic discomfort and frequency was admitted to our clinic. Pelvic tomography revealed a tumor in the bladder wall measuring 4 × 3 cm and was not clearly distinct from the lower abdominal wall. Partial cystectomy was performed and the histopathological examination confirmed the hemangiopericytoma. Three thousand rad exterior beam irradiation was performed after operation. Partial cystectomy and adjuvant radiotherapy may be a simple and effective alternative operation for the patient with HPC.     

女性控尿机制的研究及其在原位新膀胱术中的应用

近10多年来,随着对女性人体盆腔和尿道局部解剖学的深入研究,临床泌尿外科医师对膀胱颈、尿道、横纹括约肌、尿道支持组织及这些结构的神经支配在女性控尿中的作用有了新的认识,指导和推动了原位新膀胱术在女性患者中的应用,提高了临床效果和患者生活质量。本文就有关女性控尿机制及其在原位新膀胱术中的应用进展作一介绍。     

Bacterial infection and acid mucopolysaccharides in epithelium of rat urinary bladder

Summary The distribution of acid mucopolysaccharides in bladder epithelium was studied by colloidal iron staining in experimental cystitis of rats. In normal bladders the staining was mainly confined to the superficial (luminal) layer, but observed uniformly in all layers of epithelium in cystitis. Enzyme digestion (hyaluronidase, heparitinase, chondroitinase AC, chondroitinase ABC) disclosed the existence of hyaluronic acid, heparan sulphate and dermatan sulphate in the bladder epithelium. The possible roles of these mucopolysaccharides glycosaminogycans) were discussed.     

Malignant paraganglioma of the urinary bladder. A case report

Paraganglioma (pheochromocytoma) is probably the most fascinating of alltumors as it can present with a wide range of clinical manifestations.Paraganglioma of the urinary bladder is one of the rare tumors andconstitute less than 10% of all bladder tumors. The common presentationof paraganglioma of the urinary bladder is painless haematura, headache,palpitation and anxiety. Malignancy is uncommon and no histological featureis characteristic of malignancy. Invasion of adjacent organs or metastasisto the lymph nodes is the only criteria to suggest malignancy. In thepresence of proven metastasis radical cystectomy with pelviclymphadenectomy is recommended. In the present case the tumor wasarising from anterior wall of the bladder away from the bladder neck andthat in a large capacity bladder it was possible to get a wide margin forpartial cystectomy along with bilateral pelvic lymphadenectomy withoutviolating the oncological principles. At a follow up of two years there is noevidence of recurrence of tumor.