Implantation of a biodegradable rectum balloon implant: tips, Tricks and Pitfalls

Vol. 43 (6): 1033-1042, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0494


ORIGINAL ARTICLE

Ben G.L. Vanneste 1, Kees van De Beek 2, Ludy Lutgens 1, Philippe Lambin 1
1 Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands; 2 Department of Urology, Maastricht University Medical Center+, Maastricht, Netherlands

 

ABSTRACT

Introduction: A rectum balloon implant (RBI) is a new device to spare rectal structures during prostate cancer radiotherapy. The theoretical advantages of a RBI are to reduce the high radiation dose to the anterior rectum wall, the possibility of a post-implant correction, and their predetermined shape with consequent predictable position.

Objective: To describe, step-by-step, our mini-invasive technique for hands-free transperineal implantation of a RBI before start of radiotherapy treatment.

Materials and Methods: We provide step-by-step instructions for optimization of the transperineal implantation procedure performed by urologists and/or radiation oncologists experienced with prostate brachytherapy and the use of the real-time bi-plane transrectal ultrasonography (TRUS) probe. A RBI was performed in 15 patients with localised prostate cancer. Perioperative side-effects were reported.

Results: We provide ‘tips and tricks’ for optimizing the procedure and proper positioning of the RBI. Please watch the animation, see video in https://vimeo.com/205852376/789df4fae4.

The side-effects included mild discomfort to slight pain at the perineal region in 8 out of 15 patients. Seven patients (47%) had no complaints at all. Two patients developed redness of the skin, where prompt antibiotic regimen was started with no further sequelae. One patient revealed a temporary urine retention, which resolved in a few hours following conservative treatment. Further no perioperative complicationsoccurred.

Conclusion: This paper describes in detail the implantation procedure for an RBI. It is a feasible, safe and very well-tolerated procedure.

Keywords: Prostatic Neoplasms; Radiotherapy; Biodegradable Plastics

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