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


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 complications occurred.


CONCLUSIONS
This paper describes in detail the implantation procedure for an RBI. It is a feasible, safe and very well-tolerated procedure.
Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands.
Ben G L
BGL
Vanneste
Department of Urology, Maastricht University Medical Center+, Maastricht, Netherlands.
Kees
K
van De Beek
Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands.
Ludy
L
Lutgens
Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands.
Philippe
P
Lambin
D020341:Absorbable Implants; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D059351:Organ Sparing Treatments / Q000295:instrumentation*; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000517:prevention & control*; D011880:Radiotherapy Planning, Computer-Assisted; D012007:Rectum / Q000528:radiation effects*
Biodegradable Plastics; Prostatic Neoplasms; Radiotherapy