Pheochromocytoma is a rare neoplasm, found in 0.1% of all hypertensive patients. Extraadrenal pheochromocytomas occur in 18% of all cases and 1% accurate in the bladder. In this study, we report a case of a vesical pheochromocytoma in a 40-year-old male patient with typical clinical symptoms for 6 years. He related episodes of severe headaches and palpitation with increase of the blood pressure after micturition, which decreased within a few seconds and fatigue afterwards. The patient was evaluated through urinary catecholamine (NE: 263 ug/24 h; E: 14 ug/ 24 h; Dopa: 303 ug/24 h; normal range respectively < 80; < 20 and < 400) and plasma catecholamine level determinations before and after micturition (NE: 1.660-->34.790 pg/ml; E: 55-->231 pg/ml-normal range respectively < 268 and < 75). Magnetic resonance imaging, sonography and 131Iodine-methiliodobenzylguanidine scintigraphy were performed for diagnostic localization. In this case plasma catecholamine level determinations before and after voiding were important to confirm the diagnosis. All imaging techniques were able to disclose the tumor. Typical symptoms, diagnoses and therapy for vesical pheochromocytoma are described and compared to the reports found in the literature.