Selective arterial embolization for control of haematuria secondary to advanced or recurrent transitional cell carcinoma of the bladder

Abstract

Aim: haematuria is a common symptom in patients with advanced transitional cell carcinoma of the bladder. We report our experience of selective pelvic embolization using gelfoam as an embolic agent to treat intractable haematuria in these patients. Methods: Three male patients aged 66-79 (mean 73.6 years) with inoperable or recurrent transitional cell carcinoma of the bladder underwent selective embolization to treat haematuria over a 9 month period. Initial pathological tumour stages were T2, T3, and T3a. Gelfoam was used as the embolic agent. Results: In all patients extensive vesical neovascularisation was identified without a single focus of active extravasation. following embolization all patients experienced cessation of haematuria. Mean transfusion requirements were 8.6 units pre-embolization and 0.3 units post-embolization. At follow up of between 6-13 months (mean 10 months) no further episodes of bleeding had been reported. no patient experienced procedure-related complications. Conclusion: Radiologically guided embolization is a safe and effective method for palliating haematuria in patients with transitional cell carcinoma. on the basis of our experience we would recommend gelfoam as the embolic agent of choice.

Selective embolisation for intractable bladder haemorrhages: A systematic review of the literature

“…The definition of success differed between studies. Some studies defined success as control and no recurrence of haematuria, with the success rate ranging from 43% [10] , [13] up to 100% [1] , [15] , [22] . Korkmaz et al [15] , subdivided the success rate into clinical success, control of haematuria, and technical success.…”

“…Some studies focused on the need for blood transfusion as an indicator of success [22] , whilst others focused on haemoglobin and haematocrit levels [15] . Halpenny et al [22] reported that the mean transfusion requirement was 8.6 units before embolisation and 0.3 units after embolisation.…”

“…Some studies focused on the need for blood transfusion as an indicator of success [22] , whilst others focused on haemoglobin and haematocrit levels [15] . Halpenny et al [22] reported that the mean transfusion requirement was 8.6 units before embolisation and 0.3 units after embolisation. Liguori et al [13] reported that of 24 patients (55%) who required a mean (range) of 4 (1–17) transfusion units before STE; only 13 (30%) required more blood products after STE.…”

Management of refractory haematuria following radiation therapy and recurrent adenocarcinoma of the prostate with fluoroscopic-guided selective pelvic embolization

“…Continuous bladder irrigation and washouts, and multiple blood transfusions are not effective in all cases, and any surgery may be associated with significant morbidity. 2 In patients who have already undergone radical radiotherapy, such as this patient in the form of a permanent prostate brachytherapy, further palliative radiotherapy is not considered beneficial. Angiographic embolization represents an alternative safe and effective means of achieving haemostasis in this population.…”

“…Preliminary studies have demonstrated the short- and medium-term efficacy of selective embolization in controlling refractory vesical haemorrhage secondary to radiation cystitis, 3 prostatic disease, 4 as well as gynaecological 5 and bladder 2 malignancy. Success rates of this treatment modality varied between 75% and 100%, depending on the study.…”