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A 66-year-old man with symptomatic hypertensive episodes was found to have a 9-mm adrenal mass and elevated metanephrine levels. He was scheduled for an adrenalectomy for suspected pheochromocytoma. Subsequent workup revealed a large bladder mass which was found to be a paraganglioma. There is no consensus on what should be considered the standard management of primary bladder paraganglioma, including surgical technique, assessment of malignancy, and appropriate follow-up, owing to the rarity of the diagnosis.