Transarterial Embolization in the Management of Intractable Haemorrhage

Abstract

<b><i>Introduction:</i></b> The purpose of this study was to evaluate the effectiveness and long-term results of selective transarterial iliac embolization (STIE) in patients with intractable bladder haemorrhage (IBH). <b><i>Methods:</i></b> Twenty-five patients with a median age of 84 (range 65–94) years underwent STIE because of IBH between 2002 and 2020. The median follow-up time was 3 (mean 13.9) months. Patients were treated because of bleeding bladder or prostate cancer, radiation-induced haemorrhagic cystitis, and other conditions. Success was defined as technical success (feasibility to embolize bilateral hypogastric arteries or neoplastic arteries) and as clinical success (absence of further or additional therapy). <b><i>Results:</i></b> Twenty-five patients with a median age of 84 years with a median hospital stay of 7 days were embolized at our institution. In total, 60% required additional therapy. Only 20% had minor complications, but no complication major was seen; 60% needed an additional therapy because of continuous bleeding. Our 30-day, 90-day, 6-month, and 12-month mortality rates were 28, 44, 64, and 76%, respectively. <b><i>Conclusions:</i></b> STIE in IBH is a safe, well-tolerated, and feasible procedure for palliating haematuria patients in poor general condition. Major complications are very rarely seen. However, patients often need additional therapy after STIE.

Selective arterial embolization for severe refractory hematuria of the urinary tract: a useful intervention to keep in mind

“…Comploj et al 1 described SAE as a safe option in terminal ill patients or in bad medical conditions, they included 25 patients and have similar characteristics to our cohort. 1 Compared to our cohort, they had a mean hospitalization time of 2 days before embolization, which is much lower compared to our study (23.6 days), however, the success rate was <40% which can be explained to the bad patient condition included in the study. 1 The lack of patients included, and the retrospective fashion are the main limitations of our study.…”

“…Refractory hematuria (RH) is a challenge in the urological practice, if not treated promptly it can be life-threatening. 1 Different etiologies can explain RH, including, bladder tumors, radiation cystitis, prostate cancer, kidney cancer, among others. 2 Patients with RH usually have and advanced age and are in palliative care due to their oncological condition.…”

“…2 Patients with RH usually have and advanced age and are in palliative care due to their oncological condition. 1,2 Initial treatment of this condition includes bladder irrigation, irrigation with alum, formaldehyde, bladder hydrodistension and endoscopic fulguration. 2 The failure of these treatments can end in life-threatening RH, with limited treatments options, in many cases due to the advanced disease, surgical procedure is not feasible and should be the last option of treatment.…”

Management of Medium and Long Term Complications Following Prostate Cancer Treatment Resulting in Urinary Diversion – A Narrative Review

“…Internal iliacal artery embolization can be taken into consideration if hematuria is intractable and contraindication exist regarding a definite surgical solution with cystectomy. However, success rate vary widely and a non-neglectable amount of patients is prone to further interventions ( 40 ).…”

“…Internal iliacal artery embolization can be taken into consideration if hematuria is intractable and contraindication exist regarding a definite surgical solution with cystectomy. However, success rate vary widely and a non-neglectable amount of patients is prone to further interventions (40). Cystectomy with urinary diversion can be seen as the last resort of end-stage bladder following radiation therapy and reduced quality of life due to persisting patients' suffering.…”