Successful treatment of severe hemorrhagic cystitis with selective vesical artery embolization

Selective embolization of the internal iliac arteries for the treatment of severe hemorrhagic cystitis following hematopoietic SCT

“…29,30 In the present study, we report our management of selective embolization of the internal iliac arteries in 10 patients with severe HC after HSCT.…”

Embolização vesical superseletiva para tratamento de hematúria maciça por cistite actínica

“…2 Hematuria secondary to actinic cystitis is often associated with bleeding fed by several different vessels, as in the case described here, but if it appears that only one of the vesical arteries is involved, contralateral embolization can be conducted at a later date to reduce the risk of necrosis of the bladder. 4,6 Since there are few reports in the literature, there is no consensus on the ideal interval between embolizations or on whether this strategy really does afford protection from necrosis of the bladder. Additionally, the majority of authors recommend simultaneous bilateral embolization for severe hematuria.…”

“…1,2 In patients who are already weakened by intense bleeding and whose general health is compromised by advanced cancer, complex surgical procedures such as ligature of the hypogastric arteries, urinary shunts 4 and radical cystectomy with or without construction of a neobladder, are associated with high morbidity and mortality rates. 4,6 In cases in which the cause of bleeding has not yet been identified and pulsating hemorrhage is detected during cystoscopy, angiotomography or arteriography can be used to facilitate diagnosis. 5 Of the two, arteriography provides more precise details of pelvic vascularization.…”

“…5 In many patients, severe hematuria cannot be controlled by conservative measures such as irrigation of the bladder, instillation of formalin, silver nitrate, estrogen, epidermal growth factor, increase of intravesical hydrostatic pressure or hyperbaric oxygen therapy, or using endoscopic procedures with electrocoagulation, laser or argon hemostasis. [1][2][3][4]6 Cystectomy is not always an option since these patients often have a high surgical risk. 1,2,4 Arterial embolization is a safe, minimally invasive option that can be used to control hematuria caused by bladder hemorrhage.…”

“…[1][2][3][4]6 Cystectomy is not always an option since these patients often have a high surgical risk. 1,2,4 Arterial embolization is a safe, minimally invasive option that can be used to control hematuria caused by bladder hemorrhage. 1,5 …”