Intractable haematuria: long‐term results after selective embolization of the internal iliac arteries

Abstract

simultaneous carcinoma of prostate and bladder, one simultaneous carcinoma of prostate and kidney and one had haemorrhagic cystitis after radiotherapy. RESULTSTAE of the internal iliac arteries produced initial complete control of bleeding in 36 of the 44 patients (82%). At a mean (range) follow-up of 10.5 (1-97) months TAE there was permanent control of bleeding in 19 (43%) patients. A second TAE session was use in five (11%) patients and it was successful in two of them. There were 24 patients (55%) who required a mean of 4 (1-17) transfusion units before embolization; only 13 (30%) required more blood products after TAE. The mean haematocrit level before and after TAE was 27% and 31% ( P < 0001), and the respective haemoglobin level were 8.7 and 10.3 g/dL ( P < 0001). During the follow-up there were no major complications related to TAE; minor complications were post-TAE syndrome in 12 (27%) patients, fever (11%), gluteus pain (14%), nausea (2%), and exterior genital oedema (5%). The 6-and 12-month mortality rates were 66% (29 patients) and 18% (eight), respectively. CONCLUSIONSTAE should be considered as an alternative less-invasive palliative measure and the treatment of choice in these situations. TAE should always be bilateral, the catheter should advance distally to the origin of the superior gluteal artery and the artery embolized with unresorbable particles. Our study confirms the efficacy and safety of TAE in patients with pelvic malignancy, and indicates that this technique should be considered before surgery. The procedure combines the benefits of a minimally invasive approach in decreasing the cost of surgery and operating time, while maintaining low blood loss and analgesia requirement. OBJECTIVETo determine the feasibility and efficacy of transarterial embolization (TAE) in haemorrhagic urological emergencies, and to assess the perioperative morbidity, effect of timing of intervention on the requirement for blood transfusion, and the long-term follow-up.

Unilateral Versus Bilateral Prostatic Arterial Embolization for Lower Urinary Tract Symptoms in Patients with Prostate Enlargement

“…It has proved to be a safe and effective technique to control refractory, lifethreatening bladder, or prostate bleeding. The procedure should be considered the treatment of choice, because it obviates the need for emergency surgery in severely ill patients [11][12][13][14][15][16]. Animal studies have reported that PAE is a safe technique, inducing PV reduction, prostatic infarction, and ablation without sexual dysfunction [17][18][19].…”

Selective bilateral internal iliac artery embolization for controlling refractory hematuria due to the metastatic squamous cell carcinoma of the urinary bladder: a case report

“…[1][2][3] The treatment of BT related hematuria depending on depth of tumor invasion, stage and general appearance ranges from medical to ablation therapy. 2,7,9 However, surgery is not feasible in the later stages of BT and the main purpose of treatment in this stage is palliative therapy to alleviate symptoms by stopping life threatening hematuria.…”

“…[1][2][3] The treatment of BT related hematuria depending on depth of tumor invasion, stage and general appearance ranges from medical to ablation therapy. 2,7,9 However, surgery is not feasible in the later stages of BT and the main purpose of treatment in this stage is palliative therapy to alleviate symptoms by stopping life threatening hematuria. 2,3,5 Transcatheter artery embolization can be a good substitute for highrisk surgical procedures, when we face with hematuria secondary to bladder malignancies, and failed to use routine procedures to stop bleeding.…”

“…[1][2][3][4] Distant (lymphatic and hematogenous) metastases is unusual, 1 and the metastasis of head and neck cutaneous SCC to the urinary bladder has rarely been previously reported in the literature, to the best of our knowledge. The surgery in older subjects with poor health conditions can increase the risk of morbidity and mortality, and also disrupt homeostasis, due to abnormal neovasculatures in the tumor.…”

“…Therefore, because of unfavorable complications, surgery is not acceptable as an appropriate option in patients with higher stages (T4) or metastatic bladder tumors (BTs). 2,3,5,6 Thus, the treatment of choice in most of patients with stage 4 BT is palliative therapy. 7 Embolization, which is a noninvasive procedure with safe features, has recently been used as an efficient method for alleviating of BT-related hematuria, 3,[5][6][7] but its efficacy in patients with bladder SCC is poorly been defined.…”