Interesting:
Boston scientific corporation became aware of the following event through the article "seed lost to perineum from hydrogel spacer after brachytherapy for prostate cancer" written by makoto nakiri, md et al. According to the literature, the patient received hydrogel spacer injection, that was performed by transrectal ultrasound guidance, seven months after combined androgen blockade (cab) therapy initiated. Seventy seeds were placed during brachytherapy (bt) without complication or loss. The patient's external beam radiation therapy, prescribed dose 45 gy, was performed one month after bt. A pelvic magnetic resonance imaging (mri) was taken during normal post-planning, one month after hydrogel implantation, revealing no problems with the insertion. Six months later after bt and the hydrogel injection, the patient went to the hospital after the brachytherapy and complained of redness, pain, bleeding. Erythema was observed in addition to swelling and induration on the side of the perineal anus. A formation of the pinhole fistula in the center of the lesion was noted with serous effusion with loss of a seed from the fistula. Laboratory tests were performed, that revealed elevated c-reactive protein levels to 5. 91 mg/dl and elevated blood glucose levels to 230 mg/dl. In addition, the patient's hemoglobin a1c was 5. 8% before bt and had increased to 7. 6%. Abdominal computed tomography (ct) showed a high-density area suggestive of the seed on the right side of the perineum and inflammatory findings around the tissue. Pelvic magnetic resonance imaging showed a tunnel like discharge of hydrogel from the dorsal prostate to the perineum. The fistula was incised, the seed was removed, and drainage was performed. The perineal drainage and urine cultures performed were negative. The patient received antibiotic therapy and underwent wound cleaning. Thereafter, the inflammation improved based on receding erythema and reduced c-reactive protein levels. Indigo carmine was injected through the perineal fistula to evaluate for urethral and rectal fistulas, neither of which were observed. After the inflammation subsided, the fistula site was sutured. Spontaneous remission was observed following conservative treatment with antibiotics and drainage. Two years after treatment, no recurrence of prostate cancer or relapse of inflammation was noted. Retrospective imaging studies showed a seed placed near the coating on the right side of the dorsal prostatic margin had fallen out of the perineum. It was noted there were three factors thought to have contributed to this event, the first one was the injection of hydrogel could cause physical compression, resulting in ischemia changes around the perineum and rectum. The second factor discussed was the diabetes type 2 that the patient had. The last one was that the physician placed the seed along the outer capsule of the prostate. No further information has been obtained despite good faith efforts.