Purpose: To describe a novel case series using rectal spacer gel to displace and protect the rectum during prostate cancer cryoablation. Materials and Methods: Fifty men with clinically localized grade group 1–5 prostate cancer underwent concurrent rectal spacer gel and primary (n=27) or salvage (n=23) prostate cryoablation. Polyethylene glycol hydrogel (PEG; SpaceOAR, Boston Scientific, USA) or hyaluronic acid hydrogel (HAG; Barrigel, Pallette Life Sciences, USA) were used in 31 and 19 cases, respectively. Twenty-two of 50 patients (44%) had biopsy proven magnetic resonance imaging (MRI) visible tumor. Fifty-four percent of patients had involvement of the prostatic apex; the dominant MRI lesion measured an average of 12.0 (range, 5–25) mm. The primary outcome was rectal displacement measurement after gel insertion. Secondary outcomes include assessment of oncologic outcomes. Results: The median rectal displacement was 9 (range, 4.0–14.6) mm by intraoperative ultrasound or postoperative MRI. No significant difference in displacement was noted between primary or salvage, PEG or HAG. HAG delivery, sculpting ability, and ultrasound image degradation were more favorable compared with PEG. Due to increased rectal distance, iceball margins could be extended beyond the prostate capsule. No rectal fistulas were observed over a median follow-up of 253 (range, 8–1,157) days. One case of perineal cellulitis, classified as a Clavien-Dindo grade II complication, was observed. The median prostate-specific antigen (PSA) dropped to 2.78 ng/dL from a preoperative value of 5.33 ng/dL (p<0.0001); 5 of 52 patients (9.6%) had a higher PSA than pretreatment at last follow-up. Posttreatment biopsy was performed for rising PSA, detecting in-field recurrence in 3 patients (5.8%). Conclusion Rectal spacer hydrogel at the time of prostate cryoablation achieved significant prerectal displacement potentially reducing the risk of collateral rectal injury and enabling more aggressive treatment margins.

Undernutrition is the result of complex interplay of factors such as household food security, childcare, feeding practices, nutrition and sanitation. Therefore, this study aimed to determine the prevalence of stunting, wasting, underweight based on WHO child growth standards 2006 and undernutrition based on Composite Index Anthropometric Failure (CIAF) and its association with the biological, behavioural, socio-economic and physical environment factors among children under-5 years. This was a cross sectional study involving children aged between 6 and 59 months recruited through stratified random sampling from the Tenom district. Sociodemographic background was obtained from mothers via a questionnaire. Height and weight measurements were measured using standardised instrument. The height-for-age, weight-for-age and BMI-for-age were classified according to the WHO Child Growth Standard 2006. Bivariate analysis and multivariate logistic regression analysis were conducted. The prevalence of undernutrition based on CIAF was 42.3%, underweight 34.7%, stunting 33.3% and wasting 10.0%. After adjusting for all confounders, childhood undernutrition was significantly associated with unimproved sanitation (adjusted OR 2.98, 95% CI: 1.082 to 8.225) and frequent illness (adjusted OR 2.07, 95% CI: 1.015 to 3.274). These findings support the association of biological and physical environmental factors with the nutritional status of children under-5 years old.