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

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. Materials 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: persistent hematuria, bladder cancer, superselective vesical artery embolization