Postmicturition syndrome: a neglected syndrome dangerous for the bladder and the heart

Postmicturition syndrome refers to symptoms caused by overdistension of the bladder or micturition. Bladder paraganglioma is a rare neuroendocrine neoplasm, which arises from the chromaffin tissue of the sympathetic nervous system embedded in the muscle layer of the bladder wall. Clinical presentation of catecholamine-secreting paragangliomas may mimic that of hyperfunctioning adrenal pheochromocytoma. Typical symptoms such as sweating, palpitations, headache, nausea, hypertension, or flushing are due to catecholamine release and are related to micturition or bladder overdistension. We herein report the case of a 22-year-old woman admitted to the Emergency Department because of cranial trauma secondary to a car accident. She referred history of micturition-related headache, nausea, sweating, and increase in blood pressure since she was 13 years old. The neurological investigation was normal. No urogenital tract investigation was performed and, on admission, blood pressure was 190/125 mmHg. During hospitalization, abdominal ultrasonography, performed to rule out secondary hypertension, unexpectedly showed a large vascular soft tissue mass in the bladder wall, compatible with a paraganglioma. Twenty-four hours of urinalysis of catecholamines revealed high values of urine metanephrines. Abdominal magnetic resonance imaging and histopathological evaluation of the surgical specimen, following resection of the bladder lesion, confirmed the diagnosis. Our case underlines the importance not to underestimate symptoms compatible with postmicturition syndrome, especially in young patients, to make early diagnosis of bladder paraganglioma.