Superselective embolization of bladder arteries in the treatment of intractable bladder haemorrhage

Abstract

Bladder hemorrhage following radiation therapy is a serious complication in patients undergoing this treatment. Several methods have been proposed to control this particular situation; however, results have been far from satisfactory, with the exception of drastic measures such as hypogastric artery ligation and radical cystectomy. We recently used a method of superselective embolization of the bladder arteries which enabled us to control severe intractable bleeding in a patient submitted to bladder irradiation for a transitional cell infiltrating carcinoma. Compared to selective embolization and other methods, the advantages of superselective embolization are a lower recurrence rate concerning bleeding, fewer side-effects and the possibility of using adaptable embospheres (150-1000 micron) which, on account of their marked plasticity, offer better occlusion of the vessels. For these reasons, superselective embolization of the bladder arteries should be considered as the treatment of choice in intractable bladder hemorrhage.

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

“…Non surgical techniques used to manage haematuria in this setting include irrigation with silver nitrate or formalin, aminocaproic acid treatment, and the application of intravesical hydrostatic pressure. However success rates using these methods are variable and may necessitate a general anaesthetic (5,6). These patients are often not suitable for more radical surgical options such as hypogastric artery ligation, urinary diversion or cystectomy.…”

Superselective Embolization of Bilateral Inferior Vesical Arteries for the Management of Radiation-Induced Hemorrhagic Cystitis Refractory to Conventional Methods

“…Embolizations of the entire internal iliac artery or arteries to treat radiation-induced HC were reported with successful results; however, serious complications following embolization of the bilateral internal arteries have been reported (5,7,8). Superselective vesical artery embolization has been used as a therapeutic strategy of HC secondary to radiation therapy, trauma, and tumors without ischemic complications (5,6,9,10). The patient in this study showed gradual decline of hematuria after superselective embolization of bilateral inferior vesical arteries and eventual stoppage of hematuria without ischemic complications.…”

“…Superior vesical arteries were preserved to prevent ischemic complications, such as bladder necrosis. Superselective embolization of inferior vesical arteries can also prevent ischemic complications, such as gluteal pain or necrosis, genital injury, or tissue necrosis (5,6). Embolizations of the entire internal iliac artery or arteries to treat radiation-induced HC were reported with successful results; however, serious complications following embolization of the bilateral internal arteries have been reported (5,7,8).…”

“…However, no standard treatment methods are currently established (1)(2)(3)(4). Percutaneous arterial embolotherapy can be a minimally invasive and less morbid option for the treatment of radiation-induced HC refractory to conventional treatment methods (5,6). We report our experience of a patient with radiation-induced HC refractory to electrocoagulation and continuous bladder irrigation who was successfully managed with embolization of both inferior vesical arteries superselectively.…”

“…The patient did not experience serious recurrent gross hematuria during the 6-month follow-up period and is doing well, although he showed a small amount of gross hematuria and clot passage without clinical significance. However, longer follow-up periods are required with a larger patient number to establish the long-term efficacy of the superselective embolization of vesical arteries in patients with radiation-induced HC refractory to other treatment modalities (5,6). Surgical treatment, including urinary diversion with or without cystectomy, has been used, but it would be considered a last resort because of high morbidity and mortality (3).…”