Preoperative selective arterial embolization followed by transurethral resection of bladder tumor for large bladder tumors: Early clinical experiences

Abstract

Purpose: Transurethral resection of bladder tumor for large tumors (>= 5 cm) is challenging, even for experienced surgeons, due to increased risks of transfusion, bladder perforation, and incomplete resection. We developed a sequential strategy involving preoperative selective arterial embolization (SAE) followed by transurethral resection to address these challenges. Materials and Methods: This retrospective study evaluated patients who underwent preoperative SAE followed by transurethral resection for non-muscle-invasive bladder cancer at two tertiary hospitals between 2021 and 2024. Potential candidates were patients newly diagnosed with large bladder tumors (longest diameter of the main mass >= 5 cm) and suspected non-muscle-invasive bladder cancer on preoperative studies. Results: Eleven patients (mean age, 73.2 years) were included in this study. The mean tumor size was 5.78 cm (range, 5.0-8.0 cm). SAE was performed on the day of surgery in seven cases (63.6%) and 1-4 days before surgery in four cases (36.4%), and complete tumor resection was successfully achieved in all cases. The mean operative time was 78.8 minutes (range, 33-149 minutes). No complications related to transurethral resection or SAE, including the need for transfusion or reoperation, were observed. Pathology results revealed Ta in six cases and T1 in five cases. Disease recurrence occurred in six patients (54.5%); however, none demonstrated disease progression during a median follow-up of 24 months (range, 6-44 months). Conclusions: Our early experiences demonstrated that preoperative SAE followed by transurethral resection for large non-muscle-invasive bladder cancers may be a feasible approach for achieving complete resection without complications.