Hyaluronic Acid Rectal Spacer for Rectal Protection in Salvage Cystoprostatectomy

Background: In salvage cystoprostatectomies (SCPs), rectal injuries can occur at a rate of 1% to 10%. Factors including T3 disease and prior pelvic radiation can lead to complications such as bleeding, recurrent wound infections and the need for colonic diversion. Methods: We present a male patient in his late 70s with a new diagnosis of pT2 muscle-invasive bladder cancer (MIBC). This is on a background of Stage IIB prostate cancer 10 years ago, managed with external beam radiotherapy. He patient had hyaluronic acid (HA) rectal spacer infiltration into the Denonvilliers’ space two weeks prior, for rectal protection. HA rectal spacers are easily identifiable due to their anechoic appearance on ultrasound imaging, making them easily distinguishable when injected into the Denonvilliers’ space intraoperatively. Results: The patient did not experience any symptoms related to rectal injury and had full bowel continence postoperatively. Conclusion: Although approved for use in radiation treatment for prostate cancer, their role in aiding dissection during SCP remains unexplored. We exhibit the use of HA rectal spacers for rectal protection during SCP.