Abstract
Background: We assess the clinical outcomes and utility of cone‑beam computed tomography (CBCT) during transcatheter arterial embolization (TAE) in patients with malignant intractable hematuria, related to lower urinary tract malignancy. Methods: A total of 22 consecutive patients (20 males and 2 females; age 71.8 ± 9.6 years) underwent CBCT during TAE for malignant intractable hematuria from May 2023 to August 2024. CBCT was performed on both internal iliac arteries for selective imaging. Contrast‑enhanced three‑dimensional (3D) images were acquired during breath‑hold for embolization planning, with automated feeder detection aiding vessel visualization. Follow‑up CT was performed 2-3 months after TAE, and regular visits monitored hematuria recurrence and treatment effects. Results: In all, 27 TAE procedures were performed in 22 patients, including those with bladder and prostate cancers. Technical success was achieved with all procedures. Clinical improvement in hematuria was observed in 86.4% of patients within 2 days. Five patients required re‑intervention, and all improved. Significant changes were noted in hemoglobin, heart rate, transfusion, and tumor size, with 85.7% showing tumor reduction on follow‑up imaging. CBCT provided valuable information in 52.1% cases, leading to treatment plan adjustments, particularly in identifying additional feeders and enabling superselective embolization. No major complications were reported. Conclusion: TAE is a safe and effective treatment for malignant intractable hematuria, leading to significant clinical improvement. CBCT further enhances TAE by providing crucial imaging that optimizes the embolization process.