Selective Vesical Arteries Embolization in the Management of Lower Urinary Tract Hemorrhage on Top of Inoperable Urinary Bladder Tumors

Objectives: Lower urinary tract hemorrhage is relatively rare compared to renal causes all over the world and in Egypt as well. Causes are diverse most important causes are urinary bladder (UB) tumors, especially post-irradiation therapy, trauma, and very rarely prostatic tumors. Vesical arteries embolization can be very effective if local measures failed to stop bleeding. Methods: In the period between January 2015 and October 2019, 18 patients consisting of 16 males and 2 females (mean age 63 years) with known inoperable UB malignancy presenting with cross hematuria underwent transarterial embolization in Ain Shams University Hospitals after failure to achieve hemostasis after conservative and local treatments. Clinical success was defined as stabilization of vital data of the patient and obviation cystectomy. Polyvinyl alcohol (PVA) particles 300–500 μ were used as embolic agents in all the patients. Results: Bleeder could be identified angiographically in six patients only. In 12 patients, no definite bleeder could be identified, so bilateral vesical embolization was done empirically. Clinical success rate was 72% (13 patients, including the six patients with angiographically identified bleeder). Surgical palliative cystectomy was needed in three patients after rebleeding postembolization. No major procedural-related complications were recorded. Conclusion: In our limited number of cases, transcatheter embolization is a feasible treatment option in the management of hematuria due to UB malignancy with low rates of complications. Angiographic identification of the bleeding source was associated with higher clinical success rates.

Publication History

Article published online:
26 April 2021