In this episode of BackTable Urology, Dr. Jose Silva, radiation oncologist Dr. Neil Mariados, and urologic oncologist Dr. Dan Welchons discuss techniques and benefits of rectal spacing for radiation therapy in prostate cancer patients.

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Barrigel

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SHOW NOTES

First, Dr. Mariados explains the need for rectal spacing in order to minimize the toxicities of prostate radiation. He then discusses the national rectal spacing trials (SpaceOAR and Barrigel) that he and Dr. Welchons participated in. The doctors also mention that most patients are interested in rectal spacing in order to minimize toxicities, but having a tumor with extracapsular extension is a contraindication of the procedure.

Then, the doctors compare two rectal spacing products, SpaceOAR and Barrigel, in the context of setup and product materials. They explain the Barrigel technique, which is performed through the transperineal approach. Preoperatively, their patients receive Valium and oxycodone. After the surgery, the spacer can be visualized through a CT scan. Dr. Welchon also reflects on his process of learning the Barrigel procedure and the satisfaction that comes with helping patients avoid toxicities.

The stability of Barrigel is 1 year. Most patients feel little to no discomfort after the procedure, and the doctors do not prescribe any postoperative antibiotics. The most serious complication of rectal wall spacing is rectal wall invasion, which occurs after incorrect product placement. However, the doctors discuss ways to avoid this complication, like using tactile feedback. They also emphasize the similarities between rectal spacing technique and transperineal prostate biopsies. Finally, they emphasize the importance of publications and education to avoid misunderstanding and myths about rectal spacing.

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RESOURCES

Barrigel Rectal Spacer

https://barrigel.com/

Ep. 108 Minimizing Radiation Therapy Side Effects with Dr. Neil Mariados and Dr. Dan Welchons