Current role of transcatheter arterial embolization for bladder and prostate hemorrhage

• Published in: Diagnostic and interventional imaging 2014-11, Vol.95 (11), p.1027-1034
• Main Authors: Loffroy, R, Pottecher, P, Cherblanc, V, Favelier, S, Estivalet, L, Koutlidis, N, Moulin, M, Cercueil, J.P, Cormier, L, Krausé, D
• Format: Article
• Language: English
• Subjects: Angiography; Angiography - methods; Embolization, Therapeutic - methods; Female; Hematuria - diagnostic imaging; Hematuria - etiology; Hematuria - therapy; Hemorrhage; Hemorrhage - diagnostic imaging; Hemorrhage - etiology; Hemorrhage - therapy; Humans; Male; Prostate; Prostate - blood supply; Prostatic Diseases - diagnostic imaging; Prostatic Diseases - etiology; Prostatic Diseases - therapy; Radiology; Therapeutic embolization; Treatment Outcome; Urinary bladder; Urinary Bladder - blood supply; Urinary Bladder Diseases - diagnostic imaging; Urinary Bladder Diseases - etiology; Urinary Bladder Diseases - therapy
• ISSN: 2211-5684; 2211-5684
• DOI: 10.1016/j.diii.2014.03.008

Abstract Intractable hematuria from the bladder or the prostate can be life-threatening and its management remains a difficult clinical problem. Severe bleeding can arise as a result of radiation cystitis, bladder carcinoma, cyclophosphamide-induced cystitis, severe infection, transurethral resection of the prostate and prostate cancer. When irrigation of the bladder through a three-way catheter and fulguration of the bleeding lesions fail to stop the hematuria, a life-threatening situation can develop, when blood transfusion fails to keep pace with the rate of blood loss. Patients with massive uncontrollable hematuria are often elderly and unfit for cystectomy as a treatment. Many urologists have had to manage this difficult problem, and several different treatments have been attempted and described, with varying degrees of success. Transcatheter arterial embolization of the vesical or prostatic arteries is occasionally indicated in these patients when all other measures have failed. There is limited published experience with this procedure, but success in 90% of patients is reported when the vesical or prostatic arteries can be identified. The aim of this review is to describe the current place of transcatheter arterial embolization in the management of severe bladder or prostate bleeding after failed conservative therapy, and to review its efficacy and morbidity.