Selective arterial embolization for control of haematuria secondary to advanced or recurrent transitional cell carcinoma of the bladder

Aim: Haematuria is a common symptom in patients with advanced transitional cell carcinoma of the bladder. We report our experience of selective pelvic embolization using gelfoam as an embolic agent to treat intractable haematuria in these patients. Methods: Three male patients aged 66-79 (mean 73.6 years) with inoperable or recurrent transitional cell carcinoma of the bladder underwent selective embolization to treat haematuria over a 9 month period. Initial pathological tumour stages were T2, T3, and T3a. Gelfoam was used as the embolic agent. Results: In all patients extensive vesical neovascularisation was identified without a single focus of active extravasation. Following embolization all patients experienced cessation of haematuria. Mean transfusion requirements were 8.6 units pre-embolization and 0.3 units post-embolization. At follow up of between 6-13 months (mean 10 months) no further episodes of bleeding had been reported. No patient experienced procedure-related complications. Conclusion: Radiologically guided embolization is a safe and effective method for palliating haematuria in patients with transitional cell carcinoma. On the basis of our experience we would recommend gelfoam as the embolic agent of choice