To evaluate the efficacy and outcomes of transcatheter arterial embolization as an alternative therapeutic option in the control of intractable hematuria of vesical or prostatic origin after failed conservative treatment.
Materials & Methods
Retrospective study of 23 consecutive embolization procedures in 20 patients (18 men, 2 women, mean age 73 ± 17.2 years) with refractory bladder or prostate hemorrhage referred from 1999 to 2008 for selective pelvic angiography after failed conventional therapy. Vascular embolization was performed uni- (n = 5) or bilaterally (n = 13) as follows: superselective distal particulate or glue embolization of the vesical or prostatic arteries in 11 patients, selective proximal coil or gelatine sponge particles occlusion of the anterior division of internal iliac artery in 2 patients, both in 3 patients, and coil blockade technique in 2 patients. Success was monitored with postembolization angiography and cessation of hematuria clinically.
Results
The technical success rate was 90% (18 of 20 patients). The primary clinical success rate was 83.3% (15 of 18 patients). Secondary clinical success occurred in one additional patient (88.9%). The periprocedural mortality rate was 20% (4 of 20), mostly related to underlying conditions. No major complications related to catheterization occurred. Late bleeding recurrence was reported in 4 (22.2%) of 18 patients. Median follow-up postembolization was 7 months (range, 7 days-56 months). Six additional patients died during follow-up, but none of the deaths were due to re-bleeding.
Conclusion
Selective angiographic embolization is safe and effective for controlling chronic life-threatening bladder or prostate hemorrhage regardless of the cause, and should be considered as the treatment of choice, usually obviating the need for emergency surgery in critically ill patients.
1University of Dijon School of Medicine, Bocage Teaching Hospital - Department of Vascular and Interventional Radiology, Dijon, France
2University of Dijon School of Medicine - Department of Urology, Bocage Teaching Hospital, Dijon, France
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