Superselective transarterial embolization of intractable hematuria using Gelfoam particles: A retrospective...

This study evaluates the effectiveness and clinical outcomes of superselective transarterial embolization (TAE) using Gelfoam particles for the management of intractable hematuria. Twenty patients (7 men and 13 women; mean age 70.65 years [range, 47-86 years]) with intractable hematuria who underwent superselective TAE between April 2014 and July 2021 were included in this retrospective study. Embolization of the vesical arteries was performed in all 20 patients using Gelfoam particles. Patients were divided into 2 groups based on the cause of hematuria: radiation cystitis and cancer bleeding. Retrospective evaluations of patient demographics, technical and clinical success rates, hematuria grade, serum hemoglobin (Hb) level (g/dL), complications, and mortality rate were performed. Hematuria was graded as follows: grade I (none); grade II (microscopic); grade III (macroscopic, without transfusion); grade IV (macroscopic, with intermittent transfusion); and grade V (macroscopic, with daily transfusion). The Wilcoxon signed-rank test was performed to compare the pre- and post-embolization hematuria grades and serum Hb levels within each group. The technical success rate was 100% (20/20 patients), and the overall clinical success rate was 85% (17/20 patients). The overall mean serum Hb level increased from 7.57 to 11.30 (P < .001), and the overall mean hematuria grade decreased from 4 to 2 (P < .001) after TAE. In the radiation cystitis group, the clinical success rate was 90% (10/11 patients), the mean serum Hb level increased from 7.8 to 12.2 (P = .004), and the mean hematuria grade decreased from 4 to 1.6 (P = .004). In the cancer bleeding group, the clinical success rate was 77% (7/9 patients), the mean serum Hb level increased from 7.3 to 10.2 (P = .021), and the mean hematuria grade decreased from 4 to 2.4 (P = .017). Minor complications were noted in 8/20 (40%) cases, notably post-embolization syndrome, managed conservatively. No major complications occurred in either group. Eleven deaths occurred during the mean follow-up period of 9.6 ± 31 months, and none of the deaths were procedure-related. Superselective TAE with Gelfoam particles is a feasible, effective, and safe treatment for intractable hematuria, both in patients with radiation cystitis and cancer bleeding.