# Robot‐Assisted Radical Prostatectomy in a Patient With a Rectal Fistula Following Hydrogel Spacer Placement

## TL;DR

A patient with a rectal fistula from a hydrogel spacer successfully underwent robot-assisted prostate surgery after careful planning.

## Contribution

Demonstrates the feasibility of robot-assisted radical prostatectomy after rare hydrogel spacer complications.

## Key findings

- Robot-assisted radical prostatectomy was safely performed after hydrogel spacer-induced rectal fistula.
- Careful follow-up and surgical planning enabled successful management of a rare complication.
- Hydrogel spacers are generally safe but can lead to severe rectal complications in rare cases.

## Abstract

The polyethylene glycol‐based hydrogel spacer (SpaceOAR; Boston Scientific, Marlborough, MA, USA) reduces the rectal dose during prostate radiotherapy and rarely leads to rectal ulceration or fistula formation. We report a case in which robot‐assisted radical prostatectomy (RARP) was successfully performed following this rare complication.

A 62‐year‐old man developed hematochezia after SpaceOAR placement. Magnetic resonance imaging (MRI) and colonoscopy revealed a rectal ulcer with a fistula. The patient initially received bowel rest and antibiotics, followed by an ileostomy. After endoscopic confirmation of reepithelialization and MRI evidence of hydrogel resorption, the stoma was closed. At his request, the patient subsequently underwent RARP, which was safely performed with transrectal ultrasound guidance.

RARP after a hydrogel‐related rectal fistula is technically feasible; however, it should ideally be performed at an experienced center.

We performed RARP in a patient with prostate cancer complicated by a rectal fistula after hydrogel spacer placement.Hydrogel spacers improve the safety of radiotherapy but may rarely lead to severe complications such as rectal fistula.Careful follow‐up, timely intervention, and meticulous surgical planning can transform serious complications into manageable events.

We performed RARP in a patient with prostate cancer complicated by a rectal fistula after hydrogel spacer placement.

Hydrogel spacers improve the safety of radiotherapy but may rarely lead to severe complications such as rectal fistula.

Careful follow‐up, timely intervention, and meticulous surgical planning can transform serious complications into manageable events.