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Outcome of transcatheter arterial embolization for bladder and prostate hemorrhage
Anne Delgal1, Jean-Pierre Cercueil, Nicolas Koutlidis
1Division of Urology and Andrology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon Cedex, France.
Insights
Transcatheter arterial embolization effectively controls intractable bladder and prostate bleeding when conservative treatments fail. This minimally invasive procedure offers a safe alternative to surgery for severely ill patients.
Area of Science:
- Interventional Radiology
- Urology
- Vascular Surgery
Background:
- Refractory bladder or prostate bleeding poses significant clinical challenges.
- Conservative management often proves insufficient for life-threatening hemorrhage.
Purpose of the Study:
- To evaluate the efficacy and outcomes of transcatheter arterial embolization (TAE).
- To assess TAE as a treatment for intractable bladder or prostate bleeding post-failed conservative therapy.
Main Methods:
- Retrospective analysis of 20 patients (2 women, 18 men) aged 73 ± 17.2 years.
- Selective pelvic angiography followed by embolization techniques including superselective distal embolization and proximal coil/particle occlusion.
- Assessment based on clinical bleeding control and post-embolization angiography.
Main Results:
- Technical success rate of 90% (18/20 patients).
- Initial bleeding control achieved in 83.3% (15/18) after the first procedure, with success after repeat procedures in the remaining 3.
- Periprocedural mortality was 20% (4/20), attributed to underlying conditions; no major catheterization complications.
Conclusions:
- Selective angiographic embolization is a safe and effective treatment for refractory bladder or prostate bleeding.
- TAE should be considered the primary treatment, often avoiding the need for emergency surgery in high-risk patients.
Purpose:
We evaluated the efficacy and outcomes of transcatheter arterial embolization for intractable bladder or prostate bleeding after failed conservative treatment.
Materials And Methods:
We retrospectively studied the records of 2 women and 18 men with a mean +/- SD age of 73 +/- 17.2 years referred between 1999 and 2008 for selective pelvic angiography after failed conventional therapy. Embolization was feasible in 18 patients, including bilateral and unilateral embolization in 13 and 5, respectively. It consisted of superselective distal particulate or glue embolization of the vesical or prostatic arteries in 11 patients, selective proximal coil or gelatin sponge particle occlusion of the anterior division of the internal iliac artery in 2, the 2 techniques in 3 and coil blockade in 2. Clinical bleeding control and post-embolization angiography findings were used to assess outcomes.
Results:
The technical success rate was 90% (18 of 20 cases). Bleeding was controlled after the first procedure in 15 of 18 patients (83.3%) and after a repeat procedure in the remaining 3. The periprocedural mortality rate was 20% (4 of 20 patients) and all deaths were related to underlying conditions. No major complications related to catheterization occurred. Late bleeding recurrence was reported in 4 of the 14 survivors (28.6%). Mean post-embolization followup was 16 months (range 15 days to 56 months). During followup 6 more patients died, including 2 of repeat bleeding.
Conclusions:
Selective angiographic embolization is safe and effective to control refractory, life threatening bladder or prostate bleeding. This procedure should be considered the treatment of choice since it usually obviates the need for emergency surgery in these severely ill patients.
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