Superselective vesical artery embolization for intractable bladder hemorrhage related to pelvic malignancy

Abstract

Background Intractable bladder hemorrhage from pelvic malignancy can be potentially life-threatening and its management can be a challenging clinical problem. Purpose To evaluate safety, efficacy, and clinical outcome of superselective vesical artery embolization for the control of intractable bladder hemorrhage from pelvic malignancy. Material and Methods Between January 2010 and September 2018, 20 patients underwent superselective vesical artery embolization for intractable hematuria secondary to pelvic malignancy arising from or invading the bladder. Treatment details and clinical outcomes were obtained. Results There were 12 men and 8 women (mean age = 77 years). Bilateral embolization was performed in 10 patients and unilateral approach in 10 patients. Two patients died within four days after embolization due to underlying heart failure and systemic metastasis, respectively. The remaining 18 patients had a follow-up of >30 days. Bleeding was controlled after the first embolization in 17/18 patients and after a repeat embolization in the remaining one patient. The mean follow-up period of 18 patients was 10.6 months (range = 1–77 months). Late recurrent hemorrhage (≥ 30 days after embolization) was reported in 6 (33.3%) patients. Five of these six patients underwent repeat embolization. There were no major complications related to embolization. Conclusion Palliative superselective vesical artery embolization is a feasible, effective, and safe procedure to control intractable hematuria in patients with pelvic malignancy.

Selective arterial embolization for severe refractory hematuria of the urinary tract: a useful intervention to keep in mind

“…5 There's been described a high success rate in specific procedures such as SAE of prostatic arteries, with low morbility compared to conventional surgical management. [5][6][7] In our cohort of patients described in this paper, the success rate was lower compared to the success reported in the literature (52.3% vs 43-100%), this can be due to the selection of patients in this study, with a high variety of aetiologies of urinary tract bleeding. 7 On the other hand, we had a low complication rate, and no post embolization syndrome was noted.…”

“…[5][6][7] In our cohort of patients described in this paper, the success rate was lower compared to the success reported in the literature (52.3% vs 43-100%), this can be due to the selection of patients in this study, with a high variety of aetiologies of urinary tract bleeding. 7 On the other hand, we had a low complication rate, and no post embolization syndrome was noted. Unfortunately, 3 patients required radical surgical treatment as management of RH.…”