Technique of hyaluronic acid injection

The injection technique of HA in the perirectal fat occurs before all needles are in treatment position according to the following procedure.

• Step 1. The transrectal ultrasound (TRUS) probe with the transperineal template is placed and fixed in the standard fashion.

• Step 2. Using TRUS guidance, the needle tip is placed in the perirectal fat (Fig. 5), between the posterior prostate capsule and the anterior rectal wall, at the level of the maximum transverse diameter of the prostate (reference level). Then under direct TRUS guidance, the needle tip is advanced to the level of the seminal vesicles.

• Step 3. The needle is connected to the syringe containing of HA. After aspirating to be certain that we are not in a vessel, we proceed to inject between 6 and 8 cc within the space between the seminal vesicles and the apex of the prostate. This is performed under TRUS guidance to see and verify the new space created by the injection of HA (Fig. 6). The total injected amount allows us to create the new space >2 cm.

• Step 4. The needle is removed and all needles treatment is placed under TRUS Guidance. It can be performed as an outpatient. After the discharge from the theater clinic, the patient continues normal-life activities

Figure 5. The needle tip is placed in the perirectal fat

Figure 6. Magnetic resonance image demonstrating the additional perirectal space created by the hyaluronic acid injection
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