Selective Embolization of the Vesical Arteries for the Treatment of Severe Hemorrhagic Cystitis after Hematopoietic Stem Cell Transplantation.

Background Hemorrhagic cystitis (HC) is a frequent and sometimes life-threatening complication after hematopoietic stem cell transplantation (HSCT). Many therapeutic approaches have been performed to control HC, but effective treatment for severe HC is still limited. This study investigated the role of selective embolization of the vesical arteries in patients with severe HC following hematopoietic stem cell transplantation (HSCT).

Methods Eight patients with late onset HC receiving HSCT were enrolled in the study, All patients underwent allogeneic transplantation and cyclophosphamide for preconditioning, including grade 3 or 4 HC, no improvement to routine management. A retrograde arterial catheterization of the femoral artery by seldinger’s technique was achieved in order to perform digital angiography of the aorto-iliac sector. Selective catheterization of the hypogastric arteries with a standard angiographic catheter was performed to localize the vesical vessels and confirm their bleeding site. Embolization of these arteries was carried out with gelatin sponge.

Results Eight patients with severe HC were treated with selective embolization of the vesical arteries. Five patients achieved complete response, with hematuria and symptoms ceased after 1–3 days of treatment. Two patients achieved partial response, with diminution of hematuria or presence of microscopic hematuria with no symptoms. One patient obtained no response to treatment.

Conclusion We investigated eight patients, among more than 280 patients treated in our hospital by allogeneic hematopoietic stem cell transplantation, in which HC was severe enough to require embolization. Our study showed that selective embolization of the vesical arteries is an effective treatment option in patients with severe HC following HSCT.