PMC9086491_01
Magnetic resonance images demonstrating intramural non-animal stabilized hyaluronic acid (NASHA) in (A) sagittal and (B) axial views denoted by*. Two days post hyaluronidase injection, the intramural NASHA is no longer visible in the same views (C, D).
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Upon routine review of the post-implant MRI images 2 weeks after HA insertion, a portion of the HA implant at the level of the prostate apex was determined to have infiltrated the rectal wall into the muscularis propria layer ( Figure 1 ).  Figure 1B  shows the low-density anterior border of the misinjected HA, with the low-density area corresponding to the muscularis propria layer of the rectal wall. MRI scans on day 2, day 7, and day 14 post HAS injection demonstrated complete reabsorption of the intramural HA at day 2 ( Figure 1 ).
Equipment required for preparing hyaluronidase (left to right):10 cc syringe, blunt drawing needle, normal saline, hyaluronidase, and spinal needle.
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The equipment used is shown in  Figure 2 .
Intraoperative transrectal ultrasound images demonstrating (A) the misinjected HA in the rectal wall and (B) the hyaluronic acid immediately after injection into the intramural NASHA (now hyperechoic).
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TRUS confirming the location of the HA within the rectal wall ( Figure 3 ). The HA was clearly visible on TRUS. No immediate dissolution was noted ( Figure 3B ).