CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S26
DOI: 10.1055/s-0041-1730717

Selective Vesical Artery Embolization in Management of Lower Urinary Tract Hemorrhage on Top of Locally Advanced Urinary Bladder Tumors

Essam Hashem
Ain Shams University Hospitals, Cairo, Egypt
Karim Abdeltawab
Ain Shams University Hospitals, Cairo, Egypt
› Author Affiliations

Background: Causes of lower urinary tract hemorrhage are diverse. Locally advanced urinary bladder (UB) tumors are among the important causes, especially postirradiation therapy. If not properly managed, it may lead to serious morbidity and mortality. Vesical artery embolization may be a safe and effective minimally invasive method for bleeding control. Methods: In the period between January 2015 and November 2017 at Ain Shams University Hospitals, 12 patients (mean age of 68 years), with known locally advanced UB malignancy presenting with gross hematuria, underwent transarterial embolization after failure to achieve hemostasis using conservative measures. Clinical success was defined as stabilization of vital data of the patient and obviation of conventional invasive surgical management. Permanent embolization particles (300–500 μ) were used as the embolic agent of choice in all cases. Results: Bleeding was angiographically identified in two patients. In the other ten patients, no definite bleeders could be identified, and thus, empirical bilateral vesical artery embolization was performed. Clinical success was achieved in nine patients (75%), and this included the two patients with angiographically identified bleeding source. Surgical management was required in the remaining three patients, due to postembolization rebleeding. No significant periprocedural complications were encountered. Conclusion: In our limited sample size, transcatheter embolization is shown to be a safe and effective treatment option in management of gross hematuria due to locally advanced UB malignancy. Angiographic identification of the bleeding source is thought to yield higher clinical success rates. We recommend undertaking further studies with larger sample size to consolidate our results as well as stratification by tumor type and whether bleeding source is identified or not. This stratification process may improve patient selection criteria for the procedure.

Publication History

Article published online:
11 May 2021

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