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Periprostatic Abscess Extending to the Perineum Following Hydrogel Spacer Placement: A Case Report.

Daichi Hirata1, Jun Kamei1, Hotaka Matsui1

  • 1Department of Urology, Graduate School of Medicine The University of Tokyo Tokyo Japan.

IJU Case Reports
|December 31, 2025
PubMed
Summary

Hydrogel spacers, used to reduce rectal toxicity in prostate cancer radiotherapy, can rarely lead to serious infections like periprostatic abscesses. This case highlights the importance of careful patient selection and management to ensure safety.

Keywords:
abscesshydrogel spacerpercutaneous drainageprostate cancerradiotherapy

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Area of Science:

  • Urology
  • Radiation Oncology
  • Medical Device Complications

Background:

  • Hydrogel spacers are frequently used to create space between the prostate and rectum, minimizing rectal dose during radiotherapy for prostate cancer.
  • Minimizing rectal toxicity is crucial for improving patient quality of life after prostate cancer treatment.

Purpose of the Study:

  • To report a rare case of a severe infectious complication following hydrogel spacer placement for prostate cancer radiotherapy.
  • To emphasize the potential risks associated with hydrogel spacer insertion.

Main Methods:

  • A 59-year-old male patient with prostate cancer underwent transperineal hydrogel spacer placement prior to stereotactic radiotherapy.
  • The patient subsequently developed a periprostatic abscess extending to the perineum and scrotum, requiring broad-spectrum antibiotics, emergency surgical drainage, and percutaneous cystostomy.

Main Results:

  • The patient developed a large periprostatic abscess with extension to the perineum and scrotum 22 days post-procedure.
  • Infection was successfully treated with antibiotics and multiple drainage procedures, with complete resolution after seven months.

Conclusions:

  • Severe infectious complications, though rare, can occur after hydrogel spacer placement.
  • Judicious patient selection and meticulous perioperative care are essential to mitigate risks and ensure patient safety during these procedures.