Nakiri Makoto, Ueda Kosuke, Hoshino Ryuji, Ogasawara Naoyuki, Kurose Hirofumi, Nishihara Kiyoaki, Muraki Koichiro, Hattori Chikayuki, Ogo Etsuyo, Igawa Tsukasa
Department of Urology Kurume University School of Medicine Kurume Japan.
Department of Radiology Kurume University School of Medicine Kurume Japan.
IJU Case Rep. 2023 Mar 9;6(3):169-172. doi: 10.1002/iju5.12579. eCollection 2023 May.
We describe a rare case of brachytherapy for prostate cancer in which a seed was lost from the perineum after a hydrogel injection.
A 71-year-old Japanese man was diagnosed with localized high-risk prostate cancer. Trimodality therapy with I-125 brachytherapy was selected, and combined androgen blockade therapy was initiated. Brachytherapy and hydrogel injection were performed 7 months after combined androgen blockade initiation; 6 months later, the patient visited our hospital with complaints of redness and bleeding in the perineum. Serous effusion and loss of a seed on the right side of the perineal anus were observed. Pelvic magnetic resonance imaging showed a tunnel like discharge of hydrogel from the dorsal prostate to the perineum. The fistula was incised, the seed was removed, and drainage was performed.
Appropriate diagnosis and treatment with careful follow-up are required in patients at high risk of infection after brachytherapy with hydrogel injection.
我们描述了一例罕见的前列腺癌近距离放射治疗病例，该病例在注射水凝胶后一枚籽源从会阴处丢失。
一名71岁的日本男性被诊断为局限性高危前列腺癌。选择了I-125近距离放射治疗的三联疗法，并开始了联合雄激素阻断治疗。在开始联合雄激素阻断治疗7个月后进行了近距离放射治疗和水凝胶注射；6个月后，患者因会阴发红和出血前来我院就诊。观察到会阴肛门右侧有浆液性渗出和一枚籽源丢失。盆腔磁共振成像显示水凝胶从前列腺背侧向会阴呈隧道样排出。切开瘘管，取出籽源，并进行引流。
对于接受水凝胶注射近距离放射治疗后有高感染风险的患者，需要进行适当的诊断、治疗并仔细随访。
