Salvage superselective vesical artery embolization for intractable hematuria refractory to conservative and endoscopic management: angiographic patterns and short-term outcomes by etiology

Background/Objective: Intractable bladder hematuria may persist despite continuous bladder irrigation and endoscopic hemostasis, exposing frail patients to repeated transfusions and the morbidity associated with urinary diversion or palliative cystectomy. This study evaluated the outcomes and safety of salvage microcatheter-based superselective vesical artery embolization (SVAE) in patients refractory to conservative and endoscopic management and described the angiographic patterns across malignant, radiation-induced, and non-malignant etiologies.Materials and Methods: This retrospective single-center series included 16 consecutive patients (13 men, 3 women; mean age 67.7 years) who underwent SVAE between January 2015 and December 2025. All patients had hematuria refractory to a stepwise protocol of bladder irrigation, transfusion support, cystoscopy, and endoscopic hemostasis with electrocautery and/or transurethral resection. Demographics, digital subtraction angiography findings, embolization details, hemoglobin values, and 30-day adverse events graded by the modified Society of Interventional Radiology classification were analyzed using the Wilcoxon signed-rank test and exact binomial 95% confidence intervals (CIs).Results: Technical success was achieved in all procedures (16/16, 100%; 95% CI, 79.4–100); bilateral embolization was performed in 10 patients (62.5%). Hematuria control during the observed follow-up period was achieved in all patients (16/16, 100%; 95% CI, 79.4–100); none required repeat embolization, urinary diversion, or palliative cystectomy. The mean hemoglobin level increased from 8.38 ± 0.82 to 10.36 ± 0.92 g/dL (p