Ureteral embolization for palliation of bladder tumour bleeding

Ureteral embolization is a minimally invasive procedure used to treat various conditions affecting the ureter, including ureteral bleeding, ureteral injuries, ureteral fistulas, and ureteral obstruction. The procedure involves blocking or occluding the ureter, thereby addressing the underlying condition. 

Indications

Ureteral embolization is indicated for patients with:

1. Ureteral Bleeding: Hematuria (blood in urine) due to trauma, kidney stones, tumours, or other causes.
2. Ureteral Injuries: Damage to the ureter caused by surgical procedures, accidents, or other trauma.
3. Ureteral Fistulas: Abnormal connections between the ureter and nearby structures, such as the bladder or bowel.
4. Ureteral Obstruction: Blockage of the ureter, which may be due to kidney stones, tumours, strictures, or other conditions (Click here to read more on Ureteric Obstruction)

Procedure

1. 

   Pre-procedure Assessment:
   • Imaging Studies: CT scans, MRI, or contrast-enhanced imaging to evaluate the anatomy, location, and extent of the ureteral condition.
   • Medical History and Physical Examination: Assessment of symptoms, underlying conditions, and overall health.
2. Preparation:
   • Informed Consent: Explanation of the procedure, its risks, benefits, and alternatives, followed by obtaining informed consent from the patient.
   • Patient Preparation: Fasting before the procedure, as advised by the healthcare provider.
3. Anaesthesia:
   • Local anaesthesia is typically used to numb the skin and tissues around the insertion site.
4. Access and Catheterization:
   • A catheter is inserted through the skin (percutaneously) and guided under imaging (fluoroscopy or ultrasound) to the affected area of the ureter.
   • Alternatively, a retrograde approach may be used, where the catheter is inserted through the urethra and guided up into the ureter.
5. Embolization:
   • Embolic agents, such as coils, particles, or liquid embolic materials, are injected through the catheter into the ureter.
   • These embolic agents block the ureter which reduces the bleeding or sealing off fistulas.
6. Confirmation and Post-procedure Care:
   • The position of the embolic agents is confirmed using imaging (X-ray or fluoroscopy) to ensure proper placement and occlusion of the ureter.
   • The catheter is removed, and pressure is applied to the insertion site to prevent bleeding.
   • Post-procedure monitoring for any immediate complications and instructions for follow-up care.

Benefits

• Control of Bleeding: Effectively stops ureteral bleeding, reducing the risk of hematuria and associated complications.
• Closure of Fistulas: Seals off abnormal connections (fistulas) between the ureter and adjacent structures, such as the bladder or bowel.
• Minimally Invasive: Compared to surgical interventions, ureteral embolization is minimally invasive with shorter recovery times.

Risks and Considerations

• Recurrent Bleeding or Fistulas: In some cases, there may be a risk of recurrent bleeding or fistula formation, necessitating further treatments or interventions.
• Infection: Risk of infection at the insertion site or within the urinary tract, requiring monitoring and appropriate antibiotic therapy.
• Tissue Damage or Perforation: Minimal risk of damage to surrounding tissues or inadvertent perforation during the procedure.
• Complications of Anesthesia: Risks associated with local anaesthesia administration, such as allergic reactions or nerve injury.

Conclusion

Ureteral embolization is an effective and minimally invasive procedure for treating various ureteral conditions, including bleeding, injuries, fistulas, and obstructions. Ureteral embolization addresses the underlying condition and restores normal urinary function. Close monitoring and follow-up care are essential to assess treatment outcomes and manage any potential complications.