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

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Abstract

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.

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Abbreviations

TCC:

Transitional cell carcinoma

TURBT:

Transurethral resection of bladder tumor

HC:

Hemorrhagic cystitis

TA:

Takayasu’s arteritis

IV:

Intravenous

IIA:

Internal iliac artery

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Authors and Affiliations

  1. Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA, 19104, USA

    Suyash Mohan

  2. Department of Radiology, University of Texas Medical Branch, Galveston, TX, 77555-0709, USA

    Manoj Kathuria

  3. Department of Urology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareily Road, Lucknow, Uttar Pradesh, 226014, India

    Deepak Dubey

  4. Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareily Road, Lucknow, Uttar Pradesh, 226014, India

    Sunil Kumar, Rajendra V. Phadke & Sanjay S. Baijal

Authors
  1. Suyash Mohan
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  2. Sunil Kumar
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  3. Deepak Dubey
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  4. Rajendra V. Phadke
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  5. Sanjay S. Baijal
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  6. Manoj Kathuria
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Contributions

SM data collection, manuscript writing. SK protocol/project development, manuscript editing. DD data collection, manuscript editing. RVP protocol/project development, manuscript editing. SSB data collection, manuscript editing. MK protocol/project development, data collection, manuscript editing.

Corresponding author

Correspondence to Suyash Mohan.

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Conflicts of interest

All the authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Additional information

Part of this study was presented as a scientific poster at 31st Annual Scientific Meeting of Society of Interventional Radiology (SIR), Toronto, Canada, March 30th to April 04th, 2006.

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Mohan, S., Kumar, S., Dubey, D. et al. Superselective vesical artery embolization in the management of intractable hematuria secondary to hemorrhagic cystitis. World J Urol 37, 2175–2182 (2019). https://doi.org/10.1007/s00345-018-2604-0

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  • DOI: https://doi.org/10.1007/s00345-018-2604-0

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