How do you manage acute tenesmus related to SpaceOAR?

Fortunately, this does not happen very often. First, make sure there is no mucosal injury by inquiring about significant hematochezia. If there is, then delay sim, consult colorectal surgeon or GI just to be safe, but usually, this will resolve with conservative management.

If there is no hematochezia, then again treat conservatively with anti inflammatories - I use celecoxib and topical agents prn.

In my experience, this improves over time and resolves completely as the spacer agent is absorbed.

Generally, we did not do anything specific for the tenesmus. It was/is most prominent within the first few days of placement and reassurance is all that is needed. Most patients felt the pressure was less after few weeks and once the spacer was absorbed in a few months, there were no symptoms.