Summary

■ Functional extra-adrenal tumors can cause classic paroxysmal hypertension, tachycardia, hypovolemia, and flushing. Non-functioning tumors may only be diagnosed when symptoms from local growth develop, i.e., palpable mass or abdominal pain.

■ Laparoscopy is now used to remove adrenal and extra-adrenal pheochromocytoma, leaving open exploration as a less used option for patients with bulky, invasive tumors or many sites of metastases.

■ Patients must undergo pharmacologic blockade before surgery to avoid the complications of catecholamine excess.

■ A transperitoneal laparoscopic approach to the retroperitoneum similar to that employed during laparoscopic retroperitoneal lymphadenectomy for testicular germ cell tumors is suitable for most extra-adrenal pheochromocytoma.

■ Intraoperatively, a 7.5 MHz flexible laparoscopic ultrasound probe is used to search for other retroperitoneal masses possibly not seen on preoperative imaging or visible inspection.

■ Pheochromocytomas of the bladder are rare, with mostly case reports in the literature. Management of these tumors should parallel the approach to extra-adrenal pheochromocytoma.

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