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Minimizing Blood Loss in Bladder Cancer: Efficacy of Preoperative Embolization before Transurethral Resection of
Purpose:
To verify the efficacy of preoperative embolization in patients with bladder cancer at ≥T2 stage or a vesical imaging-reporting and data system (VI-RADS) score of ≥3 who require transurethral resection of bladder tumor (TURBT).
Materials And Methods:
Initially, 1707 patients diagnosed with bladder cancer were selected using CT and MRI between January 2018 and October 2023. After applying the inclusion criteria of ≥T2 stage, VI-RADS score ≥3, and having undergone TURBT, 128 patients were included (28 with and 100 without preoperative embolization). Propensity score matching (PSM) minimized selection bias. Differences in the preoperative and postoperative hemoglobin (Hb) levels (Hb gap) between patients with and without preoperative embolization were analyzed.
Results:
During PSM, comparisons adjusted by propensity scores were conducted using data from 28 patients per group (without preoperative embolization: 24 men and 4 women; mean age: 81.0 years; pathological stage: T1 [60.7%], T2 [39.3%]; with preoperative embolization: 25 men and 3 women; mean age: 81.0 years; pathological stage: T1 [53.6%], T2 [42.9%], T3 [3.6%]). An independent samples t-test revealed that the mean Hb gap was -0.90 and -1.30 (g/dL) in the groups with and without preoperative embolization, respectively (p = 0.045).
Conclusion:
Preoperative embolization was beneficial for postoperative Hb level management in patients at ≥T2 stage and with a VI-RADS score ≥3 on CT and MR images. The ease, safety, and simplicity of preoperative embolization under local anesthesia make this procedure an option for patients at a high bleeding risk.
