{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T04:03:24Z","timestamp":1784347404295,"version":"3.55.0"},"reference-count":29,"publisher":"Japanese Society of Internal Medicine","issue":"14","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Intern. Med."],"published-print":{"date-parts":[[2026,7,15]]},"DOI":"10.2169\/internalmedicine.6449-25","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T22:06:52Z","timestamp":1764799612000},"page":"1909-1916","source":"Crossref","is-referenced-by-count":0,"title":["Fournier's Gangrene Following Hydrogel Spacer-related Rectal Ulcer and Fistula in a Patient Undergoing Radiation Therapy for Prostate Cancer"],"prefix":"10.2169","volume":"65","author":[{"given":"Kazuya","family":"Kimura","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenta","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mizuki","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Urology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Okubo","sequence":"additional","affiliation":[{"name":"Department of Urology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromi","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Urology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shintaro","family":"Narita","sequence":"additional","affiliation":[{"name":"Department of Urology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Wada","sequence":"additional","affiliation":[{"name":"Department of Radiology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Kumagai","sequence":"additional","affiliation":[{"name":"Department of Radiology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimihiko","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sho","family":"Fukuda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuki","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So","family":"Kodama","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Saruta","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Shimodaira","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamotsu","family":"Matsuhashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichi","family":"Arita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoko","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Radiology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Nanjo","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology, Akita University Hospital, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomonori","family":"Habuchi","sequence":"additional","affiliation":[{"name":"Department of Urology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsunori","family":"Iijima","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Akita University Graduate School of Medicine, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"962","reference":[{"key":"1","doi-asserted-by":"crossref","unstructured":"1. Phan J, Swanson DA, Levy LB, Kudchadker RJ, Bruno TL, Frank SJ. Late rectal complications after prostate brachytherapy for localized prostate cancer: incidence and management. Cancer 115: 1827-1839, 2009.","DOI":"10.1002\/cncr.24223"},{"key":"2","doi-asserted-by":"crossref","unstructured":"2. Harvey M, Ong WL, Chao M, et al. Comprehensive review of the use of hydrogel spacers prior to radiation therapy for prostate cancer. BJU Int 131: 280-287, 2023.","DOI":"10.1111\/bju.15821"},{"key":"3","doi-asserted-by":"crossref","unstructured":"3. Hamstra DA, Mariados N, Sylvester J, et al. Continued benefit to rectal separation for prostate radiation therapy: final results of a phase III trial. Int J Radiat Oncol Biol Phys 97: 976-985, 2017.","DOI":"10.1016\/j.ijrobp.2016.12.024"},{"key":"4","doi-asserted-by":"crossref","unstructured":"4. Karsh LI, Gross ET, Pieczonka CM, et al. Absorbable hydrogel spacer use in prostate radiotherapy: a comprehensive review of phase 3 clinical trial published data. Urology 115: 39-44, 2018.","DOI":"10.1016\/j.urology.2017.11.016"},{"key":"5","doi-asserted-by":"crossref","unstructured":"5. Mariados N, Sylvester J, Shah D, et al. Hydrogel spacer prospective multicenter randomized controlled pivotal trial: dosimetric and clinical effects of perirectal spacer application in men undergoing prostate image guided intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 92: 971-977, 2015.","DOI":"10.1016\/j.ijrobp.2015.04.030"},{"key":"6","doi-asserted-by":"crossref","unstructured":"6. Aminsharifi A, Kotamarti S, Silver D, Schulman A. Major complications and adverse events related to the injection of the SpaceOAR hydrogel system before radiotherapy for prostate cancer: review of the Manufacturer and User Facility Device Experience database. J Endourol 33: 868-871, 2019.","DOI":"10.1089\/end.2019.0431"},{"key":"7","doi-asserted-by":"crossref","unstructured":"7. Hall WA, Tree AC, Dearnaley D, et al. Considering benefit and risk before routinely recommending SpaceOAR. Lancet Oncol 22: 11-13, 2021.","DOI":"10.1016\/S1470-2045(20)30639-2"},{"key":"8","doi-asserted-by":"crossref","unstructured":"8. Grewal H, Keder R, Dhillon G, Sidhu G, Kashyap R, Sailagundala K. SpaceOAR hydrogel complications in prostate cancer. Br J Radiol 96: 20230717, 2023.","DOI":"10.1259\/bjr.20230717"},{"key":"9","unstructured":"9. Schaeffer EM, Srinivas S, Adra N, et al. Prostate Cancer, Version 4.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 21: 1067-1096, 2023."},{"key":"10","doi-asserted-by":"crossref","first-page":"e70036","DOI":"10.1002\/deo2.70036","volume":"5","author":"S Yagi","year":"2024","unstructured":"10. Yagi S, Kawano M, Kawasaki K, Murakami T, Miyake J, Furukawa S. A rectal ulcer caused by hydrogel spacer insertion: a case report and review of the literature. DEN Open 5: e70036, 2024.","journal-title":"DEN Open","ISSN":"https:\/\/id.crossref.org\/issn\/2692-4609","issn-type":"print"},{"key":"11","doi-asserted-by":"crossref","unstructured":"11. Teh AY, Ko HT, Barr G, Woo HH. Rectal ulcer associated with SpaceOAR hydrogel insertion during prostate brachytherapy. BMJ Case Rep 2014: bcr2014206931, 2014.","DOI":"10.1136\/bcr-2014-206931"},{"key":"12","doi-asserted-by":"crossref","unstructured":"12. Iinuma K, Mizutani K, Kato T, et al. Spontaneous healing of rectal penetration by SpaceOAR<sup>\u00ae<\/sup> hydrogel insertion during permanent iodine-125 implant brachytherapy: a case report. Mol Clin Oncol 11: 580-582, 2019.","DOI":"10.3892\/mco.2019.1937"},{"key":"13","doi-asserted-by":"crossref","unstructured":"13. Imai K, Sakamoto H, Akahane M, Nakashima M, Fujimoto T, Aoyama T. Spontaneous remission of rectal ulcer associated with SpaseOAR<sup>\u00ae<\/sup> hydrogel insertion in radiotherapy for prostate cancer. IJU Case Rep 3: 257-260, 2020.","DOI":"10.1002\/iju5.12209"},{"key":"14","doi-asserted-by":"crossref","unstructured":"14. Bharwad AV, Rowe K, Kallail KJ. Deep rectal ulceration associated with hydrogel spacer for prostate radiation therapy. Ann Intern Med Clin Cases 1: e210224, 2022.","DOI":"10.7326\/aimcc.2022.0224"},{"key":"15","unstructured":"15. Lee E, Gong AJ, Giangeruso E, Song D, Heller T. Hydrogel-associated ulcer masquerading as malignancy: a rare complication in a prostate cancer patient. Pract Gastroenterol 46: 44-48, 2022."},{"key":"16","unstructured":"16. Fournier JA. Gangrene foundroyante de la verge. Sem Med 3: 344-346, 1883."},{"key":"17","doi-asserted-by":"crossref","unstructured":"17. Fernandez AM, Jones CP, Patel HV, et al. Real-world complications of the SpaceOAR hydrogel spacer: a review of the Manufacturer and User Facility Device Experience database. Urology 180: 52-57, 2024.","DOI":"10.1016\/j.urology.2023.09.016"},{"key":"18","doi-asserted-by":"crossref","unstructured":"18. Balen A, Sobel D, Elsamra S, Golijanin D. SpaceOAR hydrogel present 32 week after instillation prevents neobladder creation in patient undergoing robot-assisted laparoscopic radical cystoprostatectomy. J Endourol Case Rep 6: 442-444, 2020.","DOI":"10.1089\/cren.2020.0088"},{"key":"19","doi-asserted-by":"crossref","unstructured":"19. Fischer-Valuck BW, Chundury A, Gay H, Bosch W, Michalski J. Hydrogel spacer distribution within the perirectal space in patients undergoing radiotherapy for prostate cancer: impact of spacer symmetry on rectal dose reduction and the clinical consequences of hydrogel infiltration into the rectal wall. Pract Radiat Oncol 7: 195-202, 2017.","DOI":"10.1016\/j.prro.2016.10.004"},{"key":"20","doi-asserted-by":"crossref","unstructured":"20. Kam J, Kissane L, Makary J, et al. PD15-09: Real world assessment of MRI predictors of rectal complications following transperineal SpaceOAR hydrogel insertion. 2023 Apr 29; American Urological Association Annual Meeting; Chicago, USA. J Urol 209 (Suppl 4): e422, 2023.","DOI":"10.1097\/JU.0000000000003262.09"},{"key":"21","doi-asserted-by":"crossref","unstructured":"21. Narukawa T, Aibe N, Tsujimoto M, et al. Increasing rectum-prostate distance using a hydrogel spacer to reduce radiation exposure during proton beam therapy for prostate cancer. Sci Rep 13: 18319, 2023.","DOI":"10.1038\/s41598-023-45557-7"},{"key":"22","doi-asserted-by":"crossref","unstructured":"22. Grossman CE, Akin O, Damato AL, Nunez DA, Zelefsky MJ. Depth of hydrogel spacer rectal wall infiltration was not associated with rectal toxicity: results from a randomized prospective trial. Adv Radiat Oncol 9: 101624, 2024.","DOI":"10.1016\/j.adro.2024.101624"},{"key":"23","doi-asserted-by":"crossref","unstructured":"23. Hughes T, Bowen D, Saeed K, Julieb\u00f8-Jones P, Somani B. Management of Fournier&apos;s gangrene: a practical guide for clinicians. Br J Hosp Med (Lond) 84: 1-9, 2023.","DOI":"10.12968\/hmed.2023.0119"},{"key":"24","doi-asserted-by":"crossref","unstructured":"24. Zhang KF, Shi CX, Chen SY, Wei W. Progress in multidisciplinary treatment of Fournier&apos;s gangrene. Infect Drug Resist 15: 6869-6880, 2022.","DOI":"10.2147\/IDR.S390008"},{"key":"25","doi-asserted-by":"crossref","unstructured":"25. Kopechek KJ, Patel HV, Koch GE. Modern management of Fournier&apos;s gangrene. Curr Urol Rep 26: 47, 2025.","DOI":"10.1007\/s11934-025-01275-3"},{"key":"26","doi-asserted-by":"crossref","unstructured":"26. Yanar H, Taviloglu K, Ertekin C, et al. Fournier&apos;s gangrene: risk factors and strategies for management. World J Surg 30: 1750-1754, 2006.","DOI":"10.1007\/s00268-005-0777-3"},{"key":"27","doi-asserted-by":"crossref","unstructured":"27. Eke N. Fournier&apos;s gangrene: a review of 1726 cases. Br J Surg 87: 718-728, 2000.","DOI":"10.1046\/j.1365-2168.2000.01497.x"},{"key":"28","doi-asserted-by":"crossref","unstructured":"28. Rudolph R, Soloway M, Depalma RG, Persky L. Fournier&apos;s syndrome: synergistic gangrene of the scrotum. Am J Surg 129: 591-596, 1975.","DOI":"10.1016\/0002-9610(75)90324-4"},{"key":"29","doi-asserted-by":"crossref","unstructured":"29. Dearnaley D, Syndikus I, Mossop H, et al.; the CHHiP Investigators. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol 17: 1047-1060, 2016.","DOI":"10.1016\/S1470-2045(16)30102-4"}],"container-title":["Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.jstage.jst.go.jp\/article\/internalmedicine\/65\/14\/65_6449-25\/_pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T03:26:07Z","timestamp":1784345167000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jstage.jst.go.jp\/article\/internalmedicine\/65\/14\/65_6449-25\/_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":29,"journal-issue":{"issue":"14","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2169\/internalmedicine.6449-25","relation":{},"ISSN":["0918-2918","1349-7235"],"issn-type":[{"value":"0918-2918","type":"print"},{"value":"1349-7235","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]},"article-number":"6449-25"}}