Superselective embolization of bladder arteries in the treatment of intractable bladder haemorrhage

Bladder hemorrhage following radiation therapy is a serious complication in patients undergoing this treatment. Several methods have been proposed to control this particular situation; however, results have been far from satisfactory, with the exception of drastic measures such as hypogastric artery ligation and radical cystectomy. We recently used a method of superselective embolization of the bladder arteries which enabled us to control severe intractable bleeding in a patient submitted to bladder irradiation for a transitional cell infiltrating carcinoma. Compared to selective embolization and other methods, the advantages of superselective embolization are a lower recurrence rate concerning bleeding, fewer side-effects and the possibility of using adaptable embospheres (150-1000 micron) which, on account of their marked plasticity, offer better occlusion of the vessels. For these reasons, superselective embolization of the bladder arteries should be considered as the treatment of choice in intractable bladder hemorrhage.