Superselective vesical artery embolization in the management of intractable hematuria secondary to hemorrhagic cystitis

• Published in: World journal of urology 2019-10, Vol.37 (10), p.2175-2182
• Main Authors: Mohan, Suyash, Kumar, Sunil, Dubey, Deepak, Phadke, Rajendra V., Baijal, Sanjay S., Kathuria, Manoj
• Format: Article
• Language: English
• Subjects: Arteries; Bladder; Bladder cancer; Catheterization; Cervix; Cyclophosphamide; Cystitis; Cystitis - complications; Disease management; Embolization; Embolization, Therapeutic - methods; Female; Hematuria; Hematuria - etiology; Hematuria - therapy; Hemorrhage; Hemorrhage - complications; Hemorrhagic cystitis; Humans; Male; Medical records; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Oncology; Original Article; Patients; Pelvis; Radiation therapy; Retrospective Studies; Surgery; Transitional cell carcinoma; Urinary bladder; Urinary Bladder - blood supply; Urology; Veins & arteries
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-018-2604-0

Purpose To evaluate the efficacy and outcome of superselective vesical arterial embolization in the management of severe intractable hematuria secondary to hemorrhagic cystitis. Materials and methods We retrospectively reviewed the medical records of nine patients with severe intractable hematuria treated with superselective vesical artery embolization at our institution between March 2003 and February 2015. There were six males and three females with a mean age of 56.1 years. Seven patients had transitional cell carcinoma (TCC) of urinary bladder and had undergone transurethral resection of bladder tumor and pelvic radiotherapy. One patient had synchronous renal pelvis and bladder TCC. One patient had aortoarteritis and was receiving cyclophosphamide therapy and another patient had carcinoma cervix post-pelvic radiotherapy. Following the failure of conservative management, superselective vesical artery catheterization and embolization was performed with 300–500-μ PVA particles in all patients. Coil embolization of inferior gluteal artery followed by particle embolization of vesical arteries was done in one patient in whom superior, inferior vesical and inferior gluteal arteries were arising as a trifurcation. Results The technical success rate was 100% with complete cessation of hematuria within 48 h in all patients. No significant complications were noted, except for post-embolization syndrome in one patient, which improved on symptomatic treatment. During a mean follow-up period of 14.45 months (ranging from 3–28 months), one patient had mild recurrent hematuria (at 2 months) which resolved spontaneously. Conclusions Superselective vesical artery embolization is a safe and effective procedure in controlling intractable life-threatening hematuria in a select group of patients who have failed conventional treatment protocols. This procedure may be considered as the treatment of choice since it usually obviates the need for emergency surgery in these severely ill patients.