Superselective Embolization of Bilateral Inferior Vesical Arteries for the Management of Radiation-Induced Hemorrhagic Cystitis Refractory to Conventional Methods

Abstract

Hemorrhagic cystitis (HC) following radiation therapy of pelvic malignancy is a serious and sometimes life-threatening complication. Various methods including bladder irrigation, fulguration, intravesical instillation, oral or systemic agents, hyperbaric oxygen therapy and surgical methods have been proposed to control hematuria. However, there is no consensus on the optimal therapeutic strategy for radiation-induced HC. We recently performed superselective embolization of the bilateral inferior vesical arteries in a patient with radiation-induced HC refractory to conventional treatment methods. This technique is effective for achieving the control of refractory hemorrhage and can be considered an option for the treatment of radiation-induced HC.

Endovascular management of radiation-induced hemorrhagic cystitis

“…[6] Besides surgical treatment, other option is superselective embolization of vesical arteries, which can be done for refractory patients. [34567] We planned to perform superselective embolization of vesical arteries as the patient did not respond to the conservative management. The alternative option in such a situation was cystectomy with reconstruction with ileal conduit.…”

“…[2] Management options include fulguration, intravesical instillation, oral agents, hyperbaric oxygen (HBO) therapy, and surgical treatment. [3] Percutaneous arterial embolization is another minimally invasive and less morbid option for the treatment of radiation-induced HC recalcitrant to conventional techniques. Reported here is our experience with a patient of radiation-induced HC refractory to electrocoagulation and continuous bladder irrigation who was successfully managed with embolization of bilateral vesical arteries.…”