Perineal Abscess Following SpaceOAR Insertion

Abstract

This case report discusses a 64-year-old male who presented with a perineal abscess following the insertion of the SpaceOAR hydrogel, highlighting a rare but potentially serious complication of the hydrogel. Hydrogel spacers have become integral in prostate cancer radiotherapy by reducing rectal toxicity. Ensuring proper technique, prophylactic antibiotics, and vigilant post-insertion monitoring are crucial for averting complications. This case underscores the significance of early diagnosis and management in preventing severe consequences and emphasizes the need for a high index of clinical suspicion when patients present with post-insertion symptoms.

Keywords: abscess; drainage; prostate cancer; radiation; spaceoar hydrogel.

Figure 1. CT of the pelvis with contrast (axial view)

Rim-enhancing collection (shown within the yellow circle) measuring 5.7 x 3.5 x 5.4 cm with internal areas of high attenuation between the prostate and rectum correlating with the location of SpaceOAR hydrogel placement with increased extension inferiorly into the perineum.

Figure 2. CT of the pelvis with contrast (sagittal view)

Moderate soft tissue inflammation at the perineum with a 3.2 x 5.3 x 5.0 cm heterogeneous complex fluid collection (shown within the yellow circle) located between the prostate and the rectum. There are areas of hyper-density within the collection as well as a small hyper-dense focus within the perineal soft tissues. The location of the collection is consistent with hydrogel placement.