Control of severe vesical haemorrhage by therapeutic embolisation

Therapeutic embolisation is now recognised as having a role in the management of bladder haemorrhage and is particularly valuable in severe cases where the patient's life is at risk. This paper describes the procedures which were used to manage two patients with massive haematuria, from a tumour in one case and from an arterial malformation in the other. Previous reports indicate that haemorrhage from a bladder tumour can usually be controlled by embolisation which is limited to the tumour itself but haemorrhage due to post-radiation telangiectasis requires more extensive arterial occlusion and this was taken into account in planning the embolisation procedure in the first case. Neither patient developed gluteal pain after embolisation which was probably due to the fact that the superior gluteal arteries were not completely occluded. The left axillary approach was used as a catheter passing down the aorta can usually be manipulated into the internal iliac arteries and their smaller branches on both sides without difficulty.