Resumo
Resumo Os autores relatam o caso de uma paciente de 46 anos de idade, que, após ter sido submetida a tratamento radioterápico por neoplasia de colo uterino, desenvolveu cistite actínica com episódios frequentes de hematúria franca. A paciente necessitou ser submetida a repetidos cateterismos vesicais por retenção urinária, hemotransfusões e internacões hospitalares. As medidas conservadoras e as tentativas de hemostasia por cistoscopia não foram bem-sucedidas no controle do sangramento. A paciente foi então submetida a tratamento endovascular com embolização superseletiva das artérias vesicais e outros pedículos vasculares, que se demonstraram associados ao sangramento. O procedimento foi bem-sucedido e a paciente vem sendo acompanhada há nove meses sem a necessidade de novas hemotransfusões nem de novas internações hospitalares. De acordo com a revisão da literatura, o uso dessa técnica ainda não havia sido descrito em trabalhos brasileiros.
Palavras-chave
embolização terapêutica, cistite, hematúria, procedimentos endovasculares, bexiga urinária
Abstract
Abstract This article describes the case of a 46-year-old female patient who had been treated with radiotherapy for cervical cancer. She developed actinic cystitis with frequent episodes of severe hematuria. She required repeated catheterization to manage urinary retention, blood transfusions and hospital admissions. Conservative measures and attempts to achieve hemostasis by cystoscopy were unsuccessful at controlling bleeding. The patient therefore underwent endovascular treatment with superselective embolization of the vesical arteries and other vascular pedicles found to be linked with the bleeding. The procedure was successful and the patient has been in follow-up for 9 months with no need for further blood transfusions or admission to hospital. According to a review of the literature, use of this technique has not previously been described in Brazil.
Keywords
therapeutic embolization, cystitis, hematuria, endovascular procedures, urinary bladder
References
Delgal A, Cercueil JP, Koutlidis N. Outcome of transcatheter arterial embolization for bladder and prostate hemorrhage. J Urol. 2010;183(5):1947-53.
Loffroy R, Pottecher P, Cherblanc V. Current role of transcatheter arterial embolization for bladder and prostate hemorrhage. Diagn Interv Imaging. 2014;95(11):1027-34.
Han Y, Wu D, Sun A. Selective embolization of the internal iliac arteries for the treatment of severe hemorrhagic cystitis following hematopoietic SCT. Bone Marrow Transplant. 2008;41(10):881-6.
Palandri F, Bonifazi F, Rossi C. Successful treatment of severe hemorrhagic cystitis with selective vesical artery embolization. Bone Marrow Transplant. 2005;35(5):529-30.
Zheng X, Lin Y, Chen B. Severe hematuria after transurethral electrocoagulation in a patient with an arteriovesical fistula. BMC Urol. 2013;13(1):68-72.
Cho CL, Lai MHY, So HS, Kwok KKM, Chan JCS, Velayudhan V. Superselective embolisation of bilateral superior vesical arteries for management of haemorrhagic cystitis. Hong Kong Med J. 2008;14(6):485-8.
Kobayashi T, Kusano S, Matsubayashi T, Uchida T. Selective embolization of the vesical artery in the management of massive bladder hemorrhage. Radiology. 1980;136(2):345-8.
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