Thyer Urology

The prostate is a walnut sized organ located just below the bladder that forms the junction between the male reproductive and urinary tracts and secretes fluid that makes up part of the semen.

When cancer is detected in the prostate, a radiation oncologist may recommend treatment with radiotherapy. Your radiation oncologist may request Mr Thyer place SpaceOAR or Barrigel and / or fiducial markers to the prostate.

SpaceOAR is a hydrogel that solidifies once placed in the body and creates a larger space between the prostate and rectum. The SpaceOAR minimises radiation inadvertently delivered to the rectum and nerves around the prostate. The SpaceOAR will dissolve and be resorbed by the body after 3 months.

Barrigel is a hyaluronic acid prostate spacer which can be sculpted in place to create an anatomical fit and minimise potential side effects of prostate radiotherapy to the bowel. Barrigel is fully absorbed by the body.

Fiducial markers are small grains of gold that are placed in the prostate to assist the radiation oncologist to deliver radiation to the prostate more accurately.

Pre operation

Ten days prior to the procedure you should notify Mr Thyer’s rooms if you are taking any blood thinning medication. Please ensure that if you are having fiducial markers inserted that these have been collected from the radiation oncologist. These can be brought with you to the hospital on the day of the procedure or you may arrange with your radiation oncologist to deliver them to Mr Thyer’s rooms.

The procedure

On arrival at hospital you will be given antibiotics to help prevent infection. You will require an enema if your bowels have not moved prior to coming to hospital. You will require a short general anaesthetic. Mr Thyer will introduce an ultrasound probe into the rectum to image the prostate. Local anaesthetic will be introduced around the prostate. If you are having fiducial seeds inserted these will be placed into the prostate under ultrasound guidance. For men having SpaceOAR / Barrigel , this will be inserted via the sterilised perineal skin just below the scrotum. The SpaceOAR / Barrigel will be carefully inserted into the plane between the rectum and prostate and ultrasound performed at the time of insertion will ensure good separation of prostate and rectum. After the procedure the nurse will check you have passed urine then you will be sent home.

Note:

1. Some men will have fiducial markers inserted using the trans-rectal route where the fiducial markers will enter the prostate via the rectum. There is a higher risk of infection but the procedure is faster and can be performed under sedation only.
2. The SpaceOAR / Barrigel can only be performed using a tran-perineal technique (via the skin between the anus and scrotum).

Risks

• Bleeding. Most people get some blood in the urine which usually lasts for 1 week. Blood in the semen may last for 2 months.
• Infection. This occurs in less than 1% of procedures. Call Mr Thyer if your temperature is over 38 Degrees after the procedure.
• Urinary retention. Rarely you may not be able to pass urine after the procedure and a catheter in the bladder overnight would be required.
• Fiducial marker migration. Occasionally a marker may migrate into the urethra and be passed out with the urine. We usually place one more seed in the prostate than is required by the radiation oncologist to minimise the chance of needing further seeds placed.
• Rectal symptoms. The SpaceOAR / Barrigel can occasionally cause pelvic pain, constipation and a sensation of fullness in the rectum leading to frequent sensation of a need to defecate (Tenesmus).
• Rectal injury. If the rectum is injured at the time of SpaceOAR / Barrigel insertion this may delay radiotherapy and necessitate the involvement of a colorectal surgeon. This complication is very rare.
• There are risks with any general anaesthetic which are very rare including blood clots, heart or lung problems and adverse drug reactions. The anaesthetist will discuss these with you at the time of the procedure.

Follow up

Mr Thyer will notify your radiation oncologist the same day the procedure is performed. After the procedure you should rest, minimise heavy lifting and take laxatives for 2 weeks. You will have a telephone follow up appointment at approximately 3 weeks made with Mr Thyer to check on your progress after the procedure.

When to contact Mr Thyer

Following the procedure, you should contact Mr Thyer if you:

• Have a fever over 38 Degrees
• Are unable to pass urine
• Have large clots in the urine
• Have not received a follow up appointment
• You can contact Mr Thyer via his rooms during working hours or after hours via the after hours nurse at Hollywood Hospital on (08) 9346 6000
• You can attend the emergency department at the hospital at which you had your procedure. (Hollywood Private Emergency Department charge a fee for attendance).