Rectal Spacers

I think if you google SpaceOar complications and stick to the legitimate NIH or published studies you will see a high post infection rate and other potential issues, but you must balance that regarding the rectal issues that you are protecting yourself from later from the radiation. All surgeries carry a percentage of infection risks or complications, whether it is the prostate biopsy, tonsillectomy, appendectomy, gall bladder removal, or what ever. You just don’t want to be in that percentage that gets affected, but clearly people will be in that percentage.

I and my brother both had this done. Honestly don’t know which brand name they were, but all about the same. My understanding is that infections and complications are rare. Biggest problems happen if they “miss” the intended placement location. They will verify placement success in the Planning imaging. They said it may feel like I am sitting on a tennis ball, but I never experienced that. All in all, very successful for myself and brother with zero bowel impacts during and after five session sbrt

My RO put in the SpaceOAR. I've had no problems at all.

I like what I've heard about the inflatable balloon rectal spacer BioProtect.

Dr. John Sylvester did a presentation "Risks and Complications of Rectal Spacers" at a symposium on 2024. One interesting point he made was that a lot of lawsuits involving complications with spacers are settled out of court with payoffs and non disclosure requirements.
https://grandroundsinurology.com/risks-and-complications-of-rectal-spacers/

I had Barigel placement done 3 weeks ago by Dr Igel at Mayo Jacksonville. No problems at all . The biopsy was much worse.

It’s important to understand that with any new medical technique, there are improvements over time.

SpaceOAR Hydrogel - the first rectal spacer gel - was FDA-approved in 2015.

An improved version, SpaceOAR Vue was FDA-approved in 2019. SpaceOAR Vue is a modification of the standard SpaceOAR Hydrogel, containing approximately 1% iodine bound to the hydrogel to be more visible under CT scan.

Barrigel - said to be an improvement over SpaceOAR because it’s sculptable - was FDA-approved in 2022.

And even more recently, another spacer product called BioProtect was FDA-approved in 2023.

Each of these products was developed as an improvement to resolve weaknesses experienced in previous ones.

(I had the SpaceOAR Vue product injected in 2021; had no complications.)

All have been clinically demonstrated to reduce radiation-induced rectal injury (and in some cases, also provide improved GU, GI, and sexual benefits).

I would think that Mayo Clinic would offer all of them.

The only documented issues I’ve read about rectal spacers involve (1) human errors by the physician injecting the products and (2) patients whose anatomy (i.e., lack of perirectal space) not allowing enough space for the product to be injected.

(I’ve attached a 2T MRI image of the injected SpaceOAR product.)

Mayo PHX told me last month that they use Barrigel. It didn't matter because the surgeon could not inject it as I had no "perirectal fat" (which I had never heard of). They told me that injection or insertion of the SpaceOar and Bio Protect also required perirectal fat, so I was SOL in any case. 20 photon beam treatments done without any spacer -- no side effects yet after last treatment on June 15 (other than increased gas -- which makes no sense to me).

I have had no problems- yet. Interestingly, my RO referred me to another Urology practice for placement of a balloon and fiducial markers. The referral specified placement of SpaceOAR. However, while I was undergoing the procedures, a nurse (or medical tech) gave my daughter, who had driven me to the appointment, a card with information on Barrigel. I had already finished my nine weeks of radiation therapy when my daughter came across the card and gave it to me. I have inquired of the MO to determine which spacer was used in my case. The office of the MO has not responded to this time. Also my RO added a step in my procedure. After placing the absorbable gel barrier, be it SpaceOar or Barrigel he directly inserted an inflatable balloon prior to each treatment.Unlike the BioProtect approach with a gel filled absorbable balloon left in place for the duration of the radiation treatments, this one was inserted prior to each radiation, treatment. The deflated balloon was inserted, then positioned and inflated with a saline solution. After the radiation, the balloon was removed. This was done for each radiation session.

I had spaceoar inserted early January 2023 with no issues. At that time the 2 RO’s that I spoke to at Cornell Weill and out Orlando Health, about that particular subject, both were using spaceor vs barigel . Bio protect was just being introduced to the market. When I had my spaceoar inserted, there was a local representative in Orlando from Spaceoar that came into the operating room to make sure that everything was done properly. No issues

I had no issues with it at all beyond a couple days of mild discomfort/pressure as I got used to it. Mine was installed at the same time I had fiducial markers implanted so it wasn't an extra surgery. I'm two years post SBRT now and have had zero rectal issues at all, even during treatment. Whether that's due to the SpaceOAR or me just being lucky I can't say.