Abstract
PurposeTo evaluate the feasibility, safety and long-term efficacy of super-selective trans-catheter arterial embolization for the management of intractable bladder bleeding.Materials and methodsThe records of 20 patients with intractable haematuria referred urgently for selective arterial embolization after failed conventional therapy, between 2013 and 2018, were retrospectively analyzed. Primary outcomes were technical (cessation of extravasation and/or stasis of flow within the target vessel) and clinical (bleeding control) success. Secondary outcomes included complication and re-intervention rates.ResultsTechnical success was 90% (18/20 cases), as in 2 cases, embolization was not feasible. Super-selective embolization of the vesical arteries was feasible in 15/18 cases (83.3%). Selective proximal occlusion of the anterior division of the internal iliac artery was performed in two cases (11%) and embolization of the anterior division after coil blockage of the posterior division was performed in one case (5%). Bilateral and unilateral embolization was performed in 10 and 8 cases, respectively. Peri-procedural mortality rate was 5% (1/18 patients). One possible procedure-related death occurred due to myocardial infarction ten days following non-target embolization of the buttocks and the anterior abdominal wall. Mean time follow up was 35 ± 15 months. Bleeding reoccurred in three patients (16.6%), all successfully managed (one conservatively and two with further embolization). Clinical success was 85% (17/20 cases). During follow up 11 more patients died, due to underlying conditions not related to bleeding or the procedure.ConclusionsSuper-selective angiographic embolization is feasible, safe and effective to control refractory, life threatening bladder bleeding and should be considered as a first line treatment, as to obviate the need for emergency surgery.
Highlights
Intractable haematuria is a severe, life-threatening condition
Super-selective embolization of the vesical arteries was feasible in 15/18 cases (83.3%)
Selective proximal occlusion of the anterior division of the internal iliac artery was performed in two cases (11%) and embolization of the anterior division after coil blockage of the posterior division was performed in one case (5%)
Summary
Intractable haematuria is a severe, life-threatening condition. It may have a host of causes such as an underlying malignancy mainly prostate and bladder cancer, inflammatory causes or radiation and drug induced cystitis (Ghahestani and Shakhssalim 2009). Most cases of bladder and prostate haematuria are managed conservatively by irrigation with formalin, silver nitrate or alum solution, intra-vesical hydrostatic pressure, hyperbaric oxygen or endoscopic diathermy. Over the past decade percutaneous, trans-catheter, arterial embolization has been proposed as an attractive, minimal invasive, alternative treatment for patients suffering from bladder haematuria not responding to conventional, noninvasive treatment. (Loffroy et al 2014) We sought to assess the feasibility, safety and long-term efficacy of super-selective, trans-catheter, embolization of the vesical arteries for the management of intractable bladder haematuria in our institution Data regarding the safety and efficacy of the method remain scarce. (Loffroy et al 2014) We sought to assess the feasibility, safety and long-term efficacy of super-selective, trans-catheter, embolization of the vesical arteries for the management of intractable bladder haematuria in our institution
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