Selective embolisation for intractable bladder haemorrhages: A systematic review of the literature

OBJECTIVE: To establish the current evidence and assess the effectiveness and safety of selective transarterial embolisation (STE) to control intractable bladder haemorrhage (IBH). MATERIALS AND METHODS: With a rise in the use of STE for the treatment of IBH, a systematic review was performed according to the Cochrane reviews guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. RESULTS: The literature search yielded 38 studies, of which 11 were excluded because of irrelevance of data. All included studies were observational cohort studies, with no randomisation or control groups apart from in relation to the materials used for embolisation. The studies were published between 1978 and 2016. There were 295 patients with an age range between 51 and 95 years. The success rate ranged from 43% up to 100%. The most reported complication was post-embolisation syndrome, although other complications were described such as mild transient gluteal claudication, nausea, and vomiting. CONCLUSION: STE of the internal iliac artery is a safe and effective alternative technique to control severe IBH, and has been successfully applied over many years to treat bladder haemorrhage associated with terminal pelvic malignancy.