Selective embolization of the internal iliac arteries for the treatment of severe hemorrhagic cystitis following hematopoietic SCT

Hemorrhagic cystitis (HC) is a frequent and sometimes life-threatening complication after hematopoietic SCT (HSCT). Many therapeutic approaches have been performed to control HC, but their effect is still limited. The present study investigated the role of selective embolization of the internal iliac arteries in patients with severe HC after HSCT. Among 324 patients treated in our hospital by HSCT, 10 patients with late-onset HC were enrolled in this study. All the patients underwent allogeneic transplantation and CY for preconditioning, no improvement in routine management. A retrograde arterial catheterization of the femoral artery by modified Seldinger's technique was used to perform digital angiography of the aortoiliac sector. Selective embolization of the internal iliac arteries was then performed with gelatin sponge to confirm the occlusion of the vesical hypervascularization. Eight patients achieved complete response (CR), their hematuria and symptoms ceased after embolization treatment, including six from first treatment of embolization and two from second treatment. Two other patients obtained no response to embolization treatment. Our study showed that selective embolization of the internal iliac arteries is an effective treatment option in patients with severe HC after HSCT.