Transcatheter bilateral superselective arterial embolization, a minimally invasive method for persistent hematuria in elderly and comorbid patients with bladder and prostate cancer

Abstract

Objective: In this article, we aimed to share our experience with superselective vesical and prostatic artery embolization applied by transarterial microcatheter method as a treatment option for recurrent resistant hematuria due to bladder and prostate cancer in elderly and comorbid patients.

Material and Methods: Bilateral transarterial microcatheter method was used for superselective vesical or prostatic artery embolization in 10 patients whose follow-up treatment was continued in our clinic with macroscopic hematuria due to bladder and prostate cancer diagnoses and could not be treated with other palliative and radical surgical methods due to comorbidity and high surgical operative risk. Before and after embolization treatment; hemoglobin (Hb) and hematocrit (Hct) values of the patients, the amount of transfusion of blood and blood products, postoperative complications, urethral foley catheter removal times and patient satisfaction were evaluated. The patients were followed up with controls intermittently for an average of 15 months.

Results: The mean age of the patients included in the study was 77.5 (69-86) years. The average hemoglobin value before and after the embolization procedure was 8,16 mg/dL and 9,48 mg/dL, respectively. The average hematocrit value before and after the embolization procedure was 25,5 and 30,4 , respectively. The average amount of blood products (erythrocyte suspension) transfusion was 2.1 (1-3) units before the procedure, and there was no need for blood transfusion in the follow-up after the procedure. The urethral catheters of all patients were removed on the 5th day (3-7 days) after the urine color became completely clear. There were no major complications, recurrent urethral catheterization or mortality, morbidity related to the treatment after the embolization procedure.

Conclusion: Superselective vesical and prostatic artery embolization treatment applied by transarterial microcatheter method is an effective and reliable alternative in the case of resistant hematuria due to bladder or prostate cancer that cannot be controlled with other palliative methods due to the high risk of anesthesia in elderly patients with comorbidities.

Keywords

• Resistant hematuria
• bladder cancer
• superselective vesical artery embolization

Mesane ve prostat kanseri olan yaşlı ve komorbid hastalarda dirençli hematüride minimal invaziv bir yöntem, transkateter bilateral süperselektif arter embolizasyonu

Abstract

Amaç: Bu makalede yaşlı ve komorbid hastalarda mesane ve prostat kanserine bağlı tekrarlayan dirençli hematürilerde bir tedavi seçeneği olarak transarteriyel mikrokateter yöntemi ile uygulanan süperselektif vezikal ve prostatik arter embolizasyonu tecrübemizi paylaşmayı amaçladık.

Gereç ve Yöntemler: Mesane ve prostat kanseri tanılarına bağlı makroskopik hematüri sebebiyle kliniğimizde takip-tedavisi sürdürülen, komorbidite (geçirilmiş serebrovasküler hastalık ve koroner arter hastalığı) ve yüksek cerrahi operatif risk sebebiyle diğer palyatif ve radikal cerrahi yöntemlerle tedavi edilemeyen 10 hastaya transarteriyel mikrokateter yöntemi ile bilateral süperselektif vezikal veya prostatik arter embolizasyonu işlemi uygulandı. Embolizasyon tedavisi öncesi ve sonrasında; hastaların hemoglobin (Hb) ve hematokrit (Hct) değerleri, uygulanan kan-kan ürünleri transfüzyon miktarı, gelişen postoperatif komplikasyonlar, üretral foley kateter çekilme süreleri ile hasta memnuniyet derecesi değerlendirildi. Hastalar ortalama 15 ay süresince aralıklı olarak kontrollerle takip edildi.

Bulgular: Çalışmaya dahil edilen hastaların ortalama yaşı 77,5 (69-86) yıl idi. Embolizasyon işlemi öncesi hastalara ait ortalama Hb değeri 8,16 mg/dl ve işlem sonrası ortalama Hb değeri 9,48 mg/dl olarak hesaplandı. Ortalama Hct değerleri ise işlem öncesi 25,5 ve işlem sonrası 30,4 idi. Ortalama kan ürünleri (eritrosit süspansiyonu) transfüzyonu miktarları ise işlem öncesi 2.1 (1-3) ünite olup işlem sonrası takiplerde kan transfüzyonu ihtiyacı olmadı. Hastaların tümünün üretral kateterleri idrar rengi tamamen berrak hale geldikten sonra ortalama 5. günde (3-7 gün) çekildi. Postop hicbir hastada girişime bağlı majör komplikasyon, tekrar üretral kateterizasyon ya da mortalite, morbidite meydana gelmedi.

Sonuç: Yaşlı ve komorbiditesi olan hastalarda mesane veya prostat kanserine bağlı meydana gelen ve yüksek anestezi riski sebebiyle diğer palyatif yöntemlerle kontrol altına alınamayan dirençli hematüri durumunda transarteriyel mikrokateter yöntemi ile uygulanan süperselektif vezikal ve prostatik arter embolizasyonu tedavisi etkin ve güvenilir bir alternatiftir.

Keywords

• dirençli hematüri,
• mesane kanseri
• süperselektif vezikal arter embolizasyonu

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