Salvage superselective vesical artery embolization for intractable hematuria refractory to conservative and endoscopic management: angiographic patterns and short-term outcomes by etiology

Öz

Background/Objective: Intractable bladder hematuria may persist despite continuous bladder irrigation and endoscopic hemostasis, exposing frail patients to repeated transfusions and the morbidity associated with urinary diversion or palliative cystectomy. This study evaluated the outcomes and safety of salvage microcatheter-based superselective vesical artery embolization (SVAE) in patients refractory to conservative and endoscopic management and described the angiographic patterns across malignant, radiation-induced, and non-malignant etiologies. Materials and Methods: This retrospective single-center series included 16 consecutive patients (13 men, 3 women; mean age 67.7 years) who underwent SVAE between January 2015 and December 2025. All patients had hematuria refractory to a stepwise protocol of bladder irrigation, transfusion support, cystoscopy, and endoscopic hemostasis with electrocautery and/or transurethral resection. Demographics, digital subtraction angiography findings, embolization details, hemoglobin values, and 30-day adverse events graded by the modified Society of Interventional Radiology classification were analyzed using the Wilcoxon signed-rank test and exact binomial 95% confidence intervals (CIs). Results: Technical success was achieved in all procedures (16/16, 100%; 95% CI, 79.4–100); bilateral embolization was performed in 10 patients (62.5%). Hematuria control during the observed follow-up period was achieved in all patients (16/16, 100%; 95% CI, 79.4–100); none required repeat embolization, urinary diversion, or palliative cystectomy. The mean hemoglobin level increased from 8.38 ± 0.82 to 10.36 ± 0.92 g/dL (p<0.001), although this increase was partly attributable to peri-procedural transfusion. Two patients (12.5%) developed mild post-embolization syndrome; no moderate-or-worse 30-day adverse events occurred. Median clinical follow-up was 7.5 months (range, 1–24 months). Conclusion: Salvage microcatheter-based SVAE was associated with encouraging short-term bleeding control and a low 30-day adverse-event burden in this cohort. These hypothesis-generating findings require confirmation in larger prospective studies with longer follow-up, particularly in radiation-induced cases.

Anahtar Kelimeler

• Digital Subtraction Angiography
• Therapeutic Embolization
• Hematuria
• Salvage Therapy
• Urinary Bladder

Destekleyen Kurum

This study was supported by the Başkent University Research Fund (Project No: KA26/137).

Proje Numarası

KA26/137

Etik Beyan

Başkent University Institutional Review Board, Project No: KA26/137; decision letter no: E-94603339-604.01-564021; 11 March 2026.

Teşekkür

The authors thank the staff of the Department of Interventional Radiology and the Department of Urology, Başkent University Dr. Turgut Noyan Application and Research Center, for their support during patient care and data collection.

Konservatif ve endoskopik tedaviye dirençli inatçı hematüride kurtarma amaçlı süperselektif vezikal arter embolizasyonu: etiyolojiye göre anjiyografik paternler ve kısa dönem sonuçlar

Öz

Amaç: İnatçı mesane hematürisi, sürekli mesane irrigasyonu ve endoskopik hemostaza rağmen devam edebilir ve kırılgan hastaları tekrarlayan transfüzyonlara ve üriner diversiyon veya palyatif sistektominin morbiditesine maruz bırakır. Bu çalışmada, konservatif ve endoskopik tedaviye dirençli hastalarda mikrokateter temelli süperselektif vezikal arter embolizasyonunun (SVAE) bir kurtarma (salvage) tedavisi olarak sonuçları ve güvenliği değerlendirilmiş; malign, radyasyona bağlı ve malign olmayan etiyolojilerdeki anjiyografik paternler tanımlanmıştır. Gereç ve Yöntem: Bu retrospektif tek merkezli seri, Ocak 2015–Aralık 2025 arasında SVAE uygulanan 16 ardışık hastayı (13 erkek, 3 kadın; ortalama yaş 67,7 yıl) içermektedir. Tüm hastalarda hematüri; mesane irrigasyonu, transfüzyon desteği, sistoskopi ve elektrokoter ve/veya transüretral rezeksiyon ile endoskopik hemostazdan oluşan kademeli protokole dirençliydi. Demografik veriler, dijital subtraksiyon anjiyografi (DSA) bulguları, embolizasyon ayrıntıları, hemoglobin değerleri ve modifiye Society of Interventional Radiology (SIR) sınıflamasına göre derecelendirilen 30 günlük advers olaylar; Wilcoxon işaretli sıra testi ve kesin (exact) binomial %95 güven aralıkları kullanılarak analiz edildi. Bulgular: Teknik başarı tüm işlemlerde sağlandı (16/16, %100; %95 GA, 79,4–100) ve 10 hastada (%62,5) bilateral embolizasyon uygulandı. Gözlenen izlem süresi boyunca hematüri kontrolü tüm hastalarda sağlandı (16/16, %100; %95 GA, 79,4–100); hiçbir hastada tekrar embolizasyon, üriner diversiyon veya palyatif sistektomi gerekmedi. Ortalama hemoglobin düzeyi 8,38 ± 0,82 g/dL’den 10,36 ± 0,92 g/dL’ye yükseldi (p<0,001), ancak bu artış kısmen periprosedürel transfüzyona bağlıydı. İki hastada (%12,5) hafif post-embolizasyon sendromu gelişti; 30 gün içinde orta veya daha yüksek şiddette advers olay gözlenmedi. Medyan klinik izlem 7,5 ay (aralık, 1–24 ay) idi. Sonuç: Mikrokateter temelli kurtarma SVAE, bu kohortta umut verici kısa dönem kanama kontrolü sağladı ve 30 günlük advers olay yükü düşüktü. Bu hipotez oluşturucu bulguların, özellikle radyasyona bağlı olgularda, daha uzun izlemli ve daha geniş prospektif çalışmalarla doğrulanması gerekmektedir.

Anahtar Kelimeler

• Dijital Subtraksiyon Anjiyografisi
• Terapötik Embolizasyon
• Hematüri
• Kurtarma Tedavisi
• Üriner Mesane

Destekleyen Kurum

Başkent Üniversitesi Araştırma Fonunca desteklenmiştir.

Proje Numarası

KA26/137

Etik Beyan

Bu çalışma Başkent Üniversitesi Tıp ve Sağlık Bilimleri Araştırma Kurulu tarafından onaylanmış ve Başkent Üniversitesi Araştırma Fonunca desteklenmiştir.

Teşekkür

Yazarlar, hasta bakımı ve veri toplama süreçlerindeki destekleri nedeniyle Başkent Üniversitesi Dr. Turgut Noyan Uygulama ve Araştırma Merkezi Girişimsel Radyoloji ve Üroloji Bölümü personeline teşekkür ederler.

Kaynakça

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