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Re: Superselective Vesical Artery Embolization in the Management of Intractable Hematuria Secondary to Hemorrhagic Cystitis.

Editorial Comment: As mentioned, hemorrhagic cystitis is a morbid condition. We often see it in urology patients after radiation for prostate cancer or other pelvic malignancies. The authors report their experience using an alternative approach to manage refractory hemorrhagic cystitis. In this case series they describe superselective vesical artery embolization to treat intractable hematuria, with good success. The approach is likely not appropriate for every patient with hemorrhagic cystitis as evidenced by the fact that this busy center of excellence is reporting only 9 cases spanning 12 years. However, this technique does appear to come at a cost. Of the 9 patients in this case series 5 had major complications related to over embolization with gluteal and thigh pain. Nevertheless, the embolization procedures were successful, with cessation of hematuria in all but 1 case over a relatively long period of time. Thus, we have intravesical instillation approaches that have been used for decades and the emergence of 2 newer options for patients, including laser vaporization to control specific bleeding sites and/or superselective embolization.