Superselective vesical artery embolization in the management of intractable hematuria secondary to hemorrhagic cystitis

  • Suyash Mohan
  • Sunil Kumar
  • Deepak Dubey
  • Rajendra V. Phadke
  • Sanjay S. Baijal
  • Manoj Kathuria
Original Article



To evaluate the efficacy and outcome of superselective vesical arterial embolization in the management of severe intractable hematuria secondary to hemorrhagic cystitis.

Materials and methods

We retrospectively reviewed the medical records of nine patients with severe intractable hematuria treated with superselective vesical artery embolization at our institution between March 2003 and February 2015. There were six males and three females with a mean age of 56.1 years. Seven patients had transitional cell carcinoma (TCC) of urinary bladder and had undergone transurethral resection of bladder tumor and pelvic radiotherapy. One patient had synchronous renal pelvis and bladder TCC. One patient had aortoarteritis and was receiving cyclophosphamide therapy and another patient had carcinoma cervix post-pelvic radiotherapy. Following the failure of conservative management, superselective vesical artery catheterization and embolization was performed with 300–500-μ PVA particles in all patients. Coil embolization of inferior gluteal artery followed by particle embolization of vesical arteries was done in one patient in whom superior, inferior vesical and inferior gluteal arteries were arising as a trifurcation.


The technical success rate was 100% with complete cessation of hematuria within 48 h in all patients. No significant complications were noted, except for post-embolization syndrome in one patient, which improved on symptomatic treatment. During a mean follow-up period of 14.45 months (ranging from 3–28 months), one patient had mild recurrent hematuria (at 2 months) which resolved spontaneously.


Superselective vesical artery embolization is a safe and effective procedure in controlling intractable life-threatening hematuria in a select group of patients who have failed conventional treatment protocols. This procedure may be considered as the treatment of choice since it usually obviates the need for emergency surgery in these severely ill patients.


Embolization Therapeutic Urinary bladder Hematuria Cystitis 



Transitional cell carcinoma


Transurethral resection of bladder tumor


Hemorrhagic cystitis


Takayasu’s arteritis




Internal iliac artery


Author's contribution

SM data collection, manuscript writing. SK protocol/project development, manuscript editing. DD data collection, manuscript editing. RVP protocol/project development, manuscript editing. SSB data collection, manuscript editing. MK protocol/project development, data collection, manuscript editing.

Compliance with ethical standards

Conflicts of interest

All the authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    deVries CR, Freiha FS (1990) Hemorrhagic cystitis. J Urol 143:1–9PubMedCrossRefGoogle Scholar
  2. 2.
    Han Y, Wu D, Sun A, Xie Y, Xu J, Zhou J, Zhu X, Wang Z, Ruan C (2008) Selective embolization of the internal iliac arteries for the treatment of severe hemorrhagic cystitis following hematopoietic SCT. Bone Marrow Transpl 41(10):881–886CrossRefGoogle Scholar
  3. 3.
    Choong S, Walkden M, Kirby R (2000) The management of intractable haematuria. BJU Int 86:951PubMedCrossRefGoogle Scholar
  4. 4.
    Capelli Schellpfeffer M, Gerber G (1999) The use of hyperbaric oxygen in urology. J Urol 162:647PubMedCrossRefGoogle Scholar
  5. 5.
    Delgal A, Cercueil JP, Koutlidis N, Michel F, Kermarrec I, Mourey E, Cormier L, Krausé D, Loffroy R (2010) Outcome of transcatheter arterial embolization for bladder and prostate hemorrhage. J Urol 183(5):1947–1953PubMedCrossRefGoogle Scholar
  6. 6.
    De Berardinis E, Vicini P, Salvatori F, Sciarra A, Gentile V, Di Silverio F (2005) Superselective embolization of bladder arteries in the treatment of intractable bladder haemorrhage. Int J Urol 12(5):503–505PubMedCrossRefGoogle Scholar
  7. 7.
    Giné E, Rovira M, Real I, Burrel M, Montaña J, Carreras E, Montserrat E (2003) Successful treatment of severe hemorrhagic cystitis after hemopoietic cell transplantation by selective embolization of the vesical arteries. Bone Marrow Transpl 31(10):923–925CrossRefGoogle Scholar
  8. 8.
    Palandri F, Bonifazi F, Rossi C, Falcioni S, Arpinati M, Giannini MB, Ansaloni F, Bandini G, Baccarani M (2005) Successful treatment of severe hemorrhagic cystitis with selective vesical artery embolization. Bone Marrow Transpl 35(5):529–530CrossRefGoogle Scholar
  9. 9.
    Lang EK, Deutsch JS, Goodman JR et al (1979) Transcatheter embolization of hypogastric branch arteries in the management of intractable bladder hemorrhage. J Urol 121:30PubMedCrossRefGoogle Scholar
  10. 10.
    Vela-Ojeda J, Tripp-Villanueva F, Sanchez-Cortes E, Ayala-Sanchez M, Garcia-Ruiz Esparza MA, Rosas-Cabral A et al (1999) Intravesical rhGM-CSF for the treatment of late onset hemorrhagic cystitis after bone marrow transplant. Bone Marrow Transpl 24:1307–1310CrossRefGoogle Scholar
  11. 11.
    Strickland P (1980) Complications of radiotherapy. Br J Hosp Med 23:552–565PubMedGoogle Scholar
  12. 12.
    Antonakopoulos GN, Hicks RM, Berry RJ (1984) The subcellular basis of damage to the human urinary bladder induced by irradiation. J Pathol 143:103–116PubMedCrossRefGoogle Scholar
  13. 13.
    Dean ALJ (1927) Ulceration of the urinary bladder as a late effect of radium application to the uterus. JAMA 89:1121CrossRefGoogle Scholar
  14. 14.
    Pyeritz RE, Droller MJ, Bender WL, Saral R (1978) An approach to the control of massive hemorrhage in cyclophosphamide induced cystitis by intravenous vasopressin: a case report. J Urol 120:253PubMedCrossRefGoogle Scholar
  15. 15.
    Philips FS, Sternberg SS, Cronin AP, Vidal PM (1961) Cyclophosphamide and urinary bladder toxicity. Cancer Res 21:1577PubMedGoogle Scholar
  16. 16.
    Krane DM, Levine LA (1992) Hemorrhagic cystitis. AUA Update Ser 11:242Google Scholar
  17. 17.
    Pomer S, Karcher G, Simon W (1983) Cutaneous ureterostomy as last resort treatment of intractable hemorrhagic cystitis following radiation. Br J Urol 55:392–394PubMedCrossRefGoogle Scholar
  18. 18.
    Koc S, Hagglund K, Ireton R, Perez-Simon JA, Collins SJ, Appelbaum FR (2000) Successful treatment of severe hemorrhagic cystitis with cystectomy following matched donor allogeneic hematopoietic cell transplantation. Bone Marrow Transpl 26:899–901CrossRefGoogle Scholar
  19. 19.
    Tomic R, Gransfors T, Modig H (1996) Morbidity after preoperative radiotherapy and cystectomy in patients with bladder cancer. Scand J Urol Nephrol 31:149–154CrossRefGoogle Scholar
  20. 20.
    Lang EK (1981) Transcatheter embolization of pelvic vessels for control of intractable hemorrhage. Radiology 140:331–339PubMedCrossRefGoogle Scholar
  21. 21.
    Appleton DS, Sibley GN, Doyle PT (1988) Internal iliac artery embolization for the control of severe bladder and prostate haemorrhage. Br J Urol 61:45PubMedCrossRefGoogle Scholar
  22. 22.
    Nabi G, Sheikh N, Greene D et al (2003) Therapeutic transcatheter arterial embolization in the management of intractable haemorrhage from pelvic urological malignancies: preliminary experience and long-term follow-up. BJU Int 92:245PubMedCrossRefGoogle Scholar
  23. 23.
    Hald T, Mygind T (1974) Control of life threatening vesical hemorrhage by unilateral hypogastric artery muscle embolization. J Urol 112:60–63PubMedCrossRefGoogle Scholar
  24. 24.
    McIvor J, Williams G, Southcott RD (1982) Control of severe vesical hemorrhage by therapeutic embolization. Clin Radiol 33(5):561–567PubMedCrossRefGoogle Scholar
  25. 25.
    Gujral S, Bell R, Kabala J, Persad R (1999) Internal iliac artery embolization for intractable bladder hemorrhage in the perioperative phase. Post Grad Med J 75:167–168CrossRefGoogle Scholar
  26. 26.
    Kobayashi T, Kusano S, Matsubayashi T, Uchida T (1980) Selective embolization of the vesical artery in the management of massive bladder hemorrhage. Radiology 136(2):345–348PubMedCrossRefGoogle Scholar
  27. 27.
    Ozono S, Okajima E, Hirao Y, Babaya K, Komada S, Matsuki H, Takahashi S, Ohishi H, Yoshioka T (1988) Transcatheter arterial embolization of vesical artery in the treatment of invasive bladder cancer. Eur Urol 15(3–4):176–179PubMedCrossRefGoogle Scholar
  28. 28.
    Nino-Murcia M, Friedland GW (1988) Bladder infarct. Urol Radiol 9(4):234–236PubMedCrossRefGoogle Scholar
  29. 29.
    Prasad V, Sacks BA, Kraus S, Clouse ME (2009) Embolotherapy for Lower Urinary Tract Hemorrhage. J Vasc Interv Radiol 20:965–970PubMedCrossRefGoogle Scholar
  30. 30.
    Ramzy S (1976) The arterial supply of the urinary bladder. Acta Anatomica 96:128–134CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Suyash Mohan
    • 1
  • Sunil Kumar
    • 4
  • Deepak Dubey
    • 3
  • Rajendra V. Phadke
    • 4
  • Sanjay S. Baijal
    • 4
  • Manoj Kathuria
    • 2
  1. 1.Department of RadiologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of RadiologyUniversity of Texas Medical BranchGalvestonUSA
  3. 3.Department of UrologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
  4. 4.Department of RadiodiagnosisSanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia

Personalised recommendations