Superselective vesical artery embolization in the management of intractable hematuria secondary to hemorrhagic cystitis

Suyash Mohan, Sunil Kumar, Deepak Dubey, Rajendra V. Phadke, Sanjay S. Baijal, Manoj Kathuria

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate the efficacy and outcome of superselective vesical arterial embolization in the management of severe intractable hematuria secondary to hemorrhagic cystitis. Materials and methods: We retrospectively reviewed the medical records of nine patients with severe intractable hematuria treated with superselective vesical artery embolization at our institution between March 2003 and February 2015. There were six males and three females with a mean age of 56.1 years. Seven patients had transitional cell carcinoma (TCC) of urinary bladder and had undergone transurethral resection of bladder tumor and pelvic radiotherapy. One patient had synchronous renal pelvis and bladder TCC. One patient had aortoarteritis and was receiving cyclophosphamide therapy and another patient had carcinoma cervix post-pelvic radiotherapy. Following the failure of conservative management, superselective vesical artery catheterization and embolization was performed with 300–500-μ PVA particles in all patients. Coil embolization of inferior gluteal artery followed by particle embolization of vesical arteries was done in one patient in whom superior, inferior vesical and inferior gluteal arteries were arising as a trifurcation. Results: The technical success rate was 100% with complete cessation of hematuria within 48 h in all patients. No significant complications were noted, except for post-embolization syndrome in one patient, which improved on symptomatic treatment. During a mean follow-up period of 14.45 months (ranging from 3–28 months), one patient had mild recurrent hematuria (at 2 months) which resolved spontaneously. Conclusions: Superselective vesical artery embolization is a safe and effective procedure in controlling intractable life-threatening hematuria in a select group of patients who have failed conventional treatment protocols. This procedure may be considered as the treatment of choice since it usually obviates the need for emergency surgery in these severely ill patients.

Original languageEnglish (US)
JournalWorld Journal of Urology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Cystitis
Hematuria
Urinary Bladder
Arteries
Transitional Cell Carcinoma
Radiotherapy
Kidney Pelvis
Clinical Protocols
Urinary Bladder Neoplasms
Cervix Uteri
Catheterization
Cyclophosphamide
Medical Records
Emergencies
Therapeutics
Carcinoma

Keywords

  • Cystitis
  • Embolization
  • Hematuria
  • Therapeutic
  • Urinary bladder

ASJC Scopus subject areas

  • Urology

Cite this

Superselective vesical artery embolization in the management of intractable hematuria secondary to hemorrhagic cystitis. / Mohan, Suyash; Kumar, Sunil; Dubey, Deepak; Phadke, Rajendra V.; Baijal, Sanjay S.; Kathuria, Manoj.

In: World Journal of Urology, 01.01.2018.

Research output: Contribution to journalArticle

@article{c9a6372536d342f38cc1abb28405bde2,
title = "Superselective vesical artery embolization in the management of intractable hematuria secondary to hemorrhagic cystitis",
abstract = "Purpose: To evaluate the efficacy and outcome of superselective vesical arterial embolization in the management of severe intractable hematuria secondary to hemorrhagic cystitis. Materials and methods: We retrospectively reviewed the medical records of nine patients with severe intractable hematuria treated with superselective vesical artery embolization at our institution between March 2003 and February 2015. There were six males and three females with a mean age of 56.1 years. Seven patients had transitional cell carcinoma (TCC) of urinary bladder and had undergone transurethral resection of bladder tumor and pelvic radiotherapy. One patient had synchronous renal pelvis and bladder TCC. One patient had aortoarteritis and was receiving cyclophosphamide therapy and another patient had carcinoma cervix post-pelvic radiotherapy. Following the failure of conservative management, superselective vesical artery catheterization and embolization was performed with 300–500-μ PVA particles in all patients. Coil embolization of inferior gluteal artery followed by particle embolization of vesical arteries was done in one patient in whom superior, inferior vesical and inferior gluteal arteries were arising as a trifurcation. Results: The technical success rate was 100{\%} with complete cessation of hematuria within 48 h in all patients. No significant complications were noted, except for post-embolization syndrome in one patient, which improved on symptomatic treatment. During a mean follow-up period of 14.45 months (ranging from 3–28 months), one patient had mild recurrent hematuria (at 2 months) which resolved spontaneously. Conclusions: Superselective vesical artery embolization is a safe and effective procedure in controlling intractable life-threatening hematuria in a select group of patients who have failed conventional treatment protocols. This procedure may be considered as the treatment of choice since it usually obviates the need for emergency surgery in these severely ill patients.",
keywords = "Cystitis, Embolization, Hematuria, Therapeutic, Urinary bladder",
author = "Suyash Mohan and Sunil Kumar and Deepak Dubey and Phadke, {Rajendra V.} and Baijal, {Sanjay S.} and Manoj Kathuria",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s00345-018-2604-0",
language = "English (US)",
journal = "World Journal of Urology",
issn = "0724-4983",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Superselective vesical artery embolization in the management of intractable hematuria secondary to hemorrhagic cystitis

AU - Mohan, Suyash

AU - Kumar, Sunil

AU - Dubey, Deepak

AU - Phadke, Rajendra V.

AU - Baijal, Sanjay S.

AU - Kathuria, Manoj

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose: To evaluate the efficacy and outcome of superselective vesical arterial embolization in the management of severe intractable hematuria secondary to hemorrhagic cystitis. Materials and methods: We retrospectively reviewed the medical records of nine patients with severe intractable hematuria treated with superselective vesical artery embolization at our institution between March 2003 and February 2015. There were six males and three females with a mean age of 56.1 years. Seven patients had transitional cell carcinoma (TCC) of urinary bladder and had undergone transurethral resection of bladder tumor and pelvic radiotherapy. One patient had synchronous renal pelvis and bladder TCC. One patient had aortoarteritis and was receiving cyclophosphamide therapy and another patient had carcinoma cervix post-pelvic radiotherapy. Following the failure of conservative management, superselective vesical artery catheterization and embolization was performed with 300–500-μ PVA particles in all patients. Coil embolization of inferior gluteal artery followed by particle embolization of vesical arteries was done in one patient in whom superior, inferior vesical and inferior gluteal arteries were arising as a trifurcation. Results: The technical success rate was 100% with complete cessation of hematuria within 48 h in all patients. No significant complications were noted, except for post-embolization syndrome in one patient, which improved on symptomatic treatment. During a mean follow-up period of 14.45 months (ranging from 3–28 months), one patient had mild recurrent hematuria (at 2 months) which resolved spontaneously. Conclusions: Superselective vesical artery embolization is a safe and effective procedure in controlling intractable life-threatening hematuria in a select group of patients who have failed conventional treatment protocols. This procedure may be considered as the treatment of choice since it usually obviates the need for emergency surgery in these severely ill patients.

AB - Purpose: To evaluate the efficacy and outcome of superselective vesical arterial embolization in the management of severe intractable hematuria secondary to hemorrhagic cystitis. Materials and methods: We retrospectively reviewed the medical records of nine patients with severe intractable hematuria treated with superselective vesical artery embolization at our institution between March 2003 and February 2015. There were six males and three females with a mean age of 56.1 years. Seven patients had transitional cell carcinoma (TCC) of urinary bladder and had undergone transurethral resection of bladder tumor and pelvic radiotherapy. One patient had synchronous renal pelvis and bladder TCC. One patient had aortoarteritis and was receiving cyclophosphamide therapy and another patient had carcinoma cervix post-pelvic radiotherapy. Following the failure of conservative management, superselective vesical artery catheterization and embolization was performed with 300–500-μ PVA particles in all patients. Coil embolization of inferior gluteal artery followed by particle embolization of vesical arteries was done in one patient in whom superior, inferior vesical and inferior gluteal arteries were arising as a trifurcation. Results: The technical success rate was 100% with complete cessation of hematuria within 48 h in all patients. No significant complications were noted, except for post-embolization syndrome in one patient, which improved on symptomatic treatment. During a mean follow-up period of 14.45 months (ranging from 3–28 months), one patient had mild recurrent hematuria (at 2 months) which resolved spontaneously. Conclusions: Superselective vesical artery embolization is a safe and effective procedure in controlling intractable life-threatening hematuria in a select group of patients who have failed conventional treatment protocols. This procedure may be considered as the treatment of choice since it usually obviates the need for emergency surgery in these severely ill patients.

KW - Cystitis

KW - Embolization

KW - Hematuria

KW - Therapeutic

KW - Urinary bladder

UR - http://www.scopus.com/inward/record.url?scp=85058704316&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058704316&partnerID=8YFLogxK

U2 - 10.1007/s00345-018-2604-0

DO - 10.1007/s00345-018-2604-0

M3 - Article

JO - World Journal of Urology

JF - World Journal of Urology

SN - 0724-4983

ER -