Current role of transcatheter arterial embolization for bladder and prostate hemorrhage

Abstract

Intractable hematuria from the bladder or the prostate can be life-threatening and its management remains a difficult clinical problem. Severe bleeding can arise as a result of radiation cystitis, bladder carcinoma, cyclophosphamide-induced cystitis, severe infection, transurethral resection of the prostate and prostate cancer. When irrigation of the bladder through a three-way catheter and fulguration of the bleeding lesions fail to stop the hematuria, a life-threatening situation can develop, when blood transfusion fails to keep pace with the rate of blood loss. Patients with massive uncontrollable hematuria are often elderly and unfit for cystectomy as a treatment. Many urologists have had to manage this difficult problem, and several different treatments have been attempted and described, with varying degrees of success. Transcatheter arterial embolization of the vesical or prostatic arteries is occasionally indicated in these patients when all other measures have failed. There is limited published experience with this procedure, but success in 90% of patients is reported when the vesical or prostatic arteries can be identified. The aim of this review is to describe the current place of transcatheter arterial embolization in the management of severe bladder or prostate bleeding after failed conservative therapy, and to review its efficacy and morbidity.

Spontaneous soft tissue hematomas

“…Although arterial embolization is extensively used in the treatment of external hemorrhage (hemoptysis, postpartum hemorrhages, polytrauma), it is less often proposed for SMH [24][25][26]. It has the advantage of being less invasive and selective [12].…”

Current management of radiation cystitis: a review and practical guide to clinical management

“…Long‐term resolution of haematuria ranges from 70% to 81% after a median follow‐up of 16–18 months. Loffroy et al found that embolization can be selected to treat any cause of intractable haematuria (including radiation cystitis) as complete resolution occurs in 92.6–100% of patients. Notably, depending on the selectivity of embolization, ischaemic complications occur in 10–62.5% of patients and may include skin or bladder necrosis, gluteal paresis, Brown–Sequard syndrome, and perineal or buttock pain.…”

Hemostastic embolization in oncology

“…Macroscopic hematuria, which is classically painless and occurs at the end of voiding, is the presenting symptom of bladder cancer in almost 80% of cases [65] and can also occur during the natural history of the disease after its initial stages. The causes of hematuria in this situation are multiple and often interlinked: primary tumor bleed, radiation or chemical cystitis, severe infection or the co-existence of other pelvic cancers [66].…”