Analysis of prognostic factors in patients diagnosed with bladder cancer complicated by hemorrhage treated by drug-eluting bead embolization

Background

Transcatheter bladder arterial chemoembolization (TACE) is an alternative treatment used to control bladder cancer (BC) with bleeding, especially in older adult patients with comorbidities. This retrospective observational study evaluated the effect and prognostic factors of transcatheter drug-eluting bead (DEB) embolization in patients with advanced BC.

Methods

We assessed 39 patients diagnosed with BC with hemorrhage who were either inoperable or unwilling to undergo surgery at our hospital between January 2018 and October 2022. All patients underwent TACE by DEB loaded with epirubicin and imaging scans after 2 months to evaluate the curative effect according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) standard to determine treatment. Re-examination and follow-up were performed every 3-6 months to observe hematuria recurrence and the curative effect.

Results

A total of 95 interventional treatments were performed in 39 patients, and all participants achieved complete hemostasis within 5 days after the first intervention. Computed tomography or magnetic resonance imaging showed that the total effective rate [complete response (CR) + partial response (PR)] was 64.1%, and the disease benefit rate (CR +PR + stable disease) was 79.5%. A total of 30 patients (76.9%) had no hematuria recurrence. Logistic regression analysis indicated that the type of blood supply in BC may relate to whether the patients benefited from the intervention. Hematuria recurrence was significantly associated with the total number of tumors and the type of blood supply (P<0.05).

Conclusions

Superselective embolization of bladder arteries with DEB can be used to treat BC with hemorrhage. However, hypovascular tumor blood supply may result in poor postoperative efficacy and hematuria recurrence. Additionally, multiple bladder tumors may be a risk factor for hematuria recurrence.

Post-Traumatic Intraparenchymal Renal Hemorrhages: Correlation between CT and DSA Vascular Findings for Superselective Embolization Procedures

BACKGROUND

This study aims to investigate the correlation between computed tomography (CT) and digital subtraction angiography (DSA) findings in patients affected by acute post-traumatic intraparenchymal renal hemorrhages and evaluate their conservative management with superselective embolization.

METHODS

This retrospective multicenter analysis focuses on patients affected by renal bleedings detected by contrast-enhanced CT and treated with superselective endovascular embolization. CT findings were compared to DSA. Embolization procedural data were analyzed and renal function was evaluated before and after the intervention.

RESULTS

Twenty-seven patients were retrospectively evaluated in one year. Compared to DSA, CT showed 96.3% diagnostic accuracy in terms of hemorrhage recognition; concerning the type of vascular lesion, there was discrepancy between CT and DSA in five cases. The technical success rate of embolization was 100%, while primary clinical success was 88.9%. The inferior parenchymal third was the most frequent site of renal injury. Microcoils were the most adopted embolics. Renal function did not change significantly before and after embolization.

CONCLUSIONS

CT has elevated diagnostic accuracy in detecting post-traumatic intraparenchymal renal hemorrhages; in a small percentage, the type of vascular lesion may differ from the findings observed at DSA. In this scenario, superselective embolization presents high clinical success with a low complication rate.

[The application of superselective embolization of renal vessels in case of bleeding after percutaneous nephro- lithotomy]

BACKGROUND

Bleeding, injures to surrounding organs and pleura are serious complications of percutaneous nephrolithotripsy. The inefficiency of hemostatic therapy is an indication for superselective embolization of the renal vessels. This technique demonstrates the high efficiency in case of postoperative bleeding.

AIM

To develop a treatment algorithm and to evaluate an efficiency of superselective embolization of the renal vessels, based on the results of treatment of postoperative complications, which are associated with bleeding.

MATERIALS AND METHODS

A retrospective analysis of 1375 patients treated from January 2011 to December 2018 for large (over 1.5 cm) and staghorn renal stones was performed. A number of patients had various complications in the early postoperative period, which were graded according to the Clavien-Dindo classification, including bleeding due to intraoperative damage to renal vessels, which required additional interventions. The treatment strategy was based on the assessment of volume and severity of blood loss as well as the hemodynamic stability.

RESULTS

Based on the severity of bleeding and hemodynamic stability, the treatment algorithm was developed. The analysis of the results of superselective embolization of renal arteries demonstrates the high effectiveness of this technique in case of postoperative bleeding.

CONCLUSION

Superselective embolization is an effective method of hemostasis in case of postoperative bleeding. The proposed algorithm allows for early coordination of therapeutic measures depending on the severity of bleeding and the patients condition in order to evaluate the risk of continued bleeding and the determine the optimal treatment strategy.

Endovascular Management of Radiation-Induced Hemorrhagic Cystitis

Radiation-induced hemorrhagic cystitis (HC) is an unpleasant and sometimes life-threatening complication confronted while treating pelvic malignancies. A wide array of treatment modalities such as bladder irrigation, fulguration, hyperbaric oxygen therapy, and surgical methods has been proposed to treat hematuria, but there is no consensus on the optimal therapeutic strategy for the same. Reported here is a successful superselective embolization of the bilateral vesical arteries in a patient with refractory radiation-induced HC. This technique proved to be effective in controlling intractable hemorrhage and can be considered an option for the treatment of HC not amenable to conventional techniques.