Podium 01
排尿後劇烈頭痛-膀胱副神經節瘤病例報告
任駿逸、劉惠瑛
高雄長庚紀念醫院 泌尿科
Post-micturition headache associated with bladder paraganglioma -A case report
Chun-Yi Jen, Hui-Ying Liu
Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Abstract:
A 11-year-7-month-old girl has underlying disease of focal stenosis over right middle cerebral artery and left anterior cerebral artery, and focal paroxysmal sharp wave on EEG, controlled with anti-epileptic medications. The patient suffered from headache after micturition for several months and was admitted for further evaluation and management. The headache characteristics was sudden onset after micturition, dull pain, over posterior occiput area, and last for 2-3 minutes. Paroxysmal hypertension was also observed. Renal sonography and CT of abdomen demonstrated an avidly enhanced lesion over the left lower pelvis, abutting the wall of urinary bladder. The laboratory exam revealed elevated normetanephrine in blood, elevated VMA and norepinephrine in 24-HR urine. Under the impression of extra-adrenal pheochromocytoma, we suggest surgical intervention.
She underwent robotic-assisted laparoscopic surgery with Davinci Xi for excision of left pelvic tumor. The tumor was identified with abundant blood supply, located between bladder and internal iliac vessels. Pelvic tumor excision with partial cystectomy was done with tumor capsule intact. The final pathology report showed a sympathetic paraganglioma. There is no more post-micturition headache after the operation, and no elevated blood pressure.