Abstract
Haematuria is a common symptom in patients with advanced transitional cell carcinoma of the bladder. We report our experience of selective pelvic embolization using gelfoam as an embolic agent to treat intractable haematuria in these patients. Three male patients aged 66-79 (mean 73.6 years) with inoperable or recurrent transitional cell carcinoma of the bladder underwent selective embolization to treat haematuria over a 9 month period. Initial pathological tumour stages were T2, T3, and T3a. Gelfoam was used as the embolic agent. In all patients extensive vesical neovascularisation was identified without a single focus of active extravasation. Following embolization all patients experienced cessation of haematuria. Mean transfusion requirements were 8.6 units pre-embolization and 0.3 units post-embolization. At follow up of between 6-13 months (mean 10 months) no further episodes of bleeding had been reported. No patient experienced procedure-related complications. Radiologically guided embolization is a safe and effective method for palliating haematuria in patients with transitional cell carcinoma. On the basis of our experience we would recommend gelfoam as the embolic agent of choice.
Highlights
Materials and methodsBladder carcinoma accounts for up to 8% of malignant disease in men and 3% in women, with transitional cell carcinoma (TCC) accounting for 90% [1]
The treatment of choice for TCC of the bladder is transurethral resection or cystectomy depending on tumour stage but many patients have unresectable disease at time of diagnosis
We report our experience of superselective pelvic embolization using gelfoam as an embolic to treat intractable haematuria in three male patients with advanced or recurrent TCC of the bladder
Summary
Materials and methodsBladder carcinoma accounts for up to 8% of malignant disease in men and 3% in women, with transitional cell carcinoma (TCC) accounting for 90% [1]. The treatment of choice for TCC of the bladder is transurethral resection or cystectomy depending on tumour stage but many patients have unresectable disease at time of diagnosis. In these patients, or in those with recurrent disease, haematuria can cause significant morbidity and can occasionally be life threatening. Percutaneous embolization techniques have proven to be effective in the treatment of pelvic haemorrhage in many clinical settings [2, 3] using different embolic materials and improved catheter technology allows superselective catheterisation of bleeding vessels to limit side effects secondary to non-target embolization. We report our experience of superselective pelvic embolization using gelfoam as an embolic to treat intractable haematuria in three male patients with advanced or recurrent TCC of the bladder
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