3.3.1. Arterial Embolization

Improvements in interventional radiological techniques have led to improvements in morbidity and mortality compared with surgery in patients with refractory hemorrhagic radiation cystitis. The technical success rate reported is 88–100%. The main adverse events were Brown–Sequard's syndrome, bladder necrosis, and gluteal paresis or skin necrosis. Thanks to improved techniques, the incidence of adverse events has decreased from 65% to 9–31% [36,37]. The follow-up of these studies is brief.

#### 3.3.2. Cystectomy and Urinary Diversion

In some patients, treatment by means of cystectomy with urinary diversion is unfortunately inevitable when clot evacuation, bladder fulguration and bladder irrigation have failed. This therapeutic option should be reserved for patients for whom local and conservative treatments have proven unsuccessful, given its high rate of morbidity and mortality. Linder et al. reported a postoperative complication rate of 42% and a 90-day mortality rate of 16% [38].
