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Updated: Nov 6, 2025
Transperineal Prostate Biopsy Using a Cone-shaped Double-hole Method with Dual-plane Probe Guidance
Published on: June 6, 2025
[Prostate biopsy 2021: current management]
Florian Wagenlehner1, Gernot Bonkat2, Adrian Pilatz1
1Justus-Liebig-Universität Gießen, Klinik für Urologie, Kinderurologie und Andrologie, Giessen.
Abstract:
Infectious complications following prostate biopsy are on the rise due to an increase in antimicrobial resistance, mainly against fluoroquinolones. The use of fluoroquinolones for perioperative prophylaxis is no longer approved by the national authorities in Germany. The EAU guideline group on urological infections has recently published a meta-analysis in two parts based on randomised controlled trials (RCTs). Transperineal prostate biopsy is associated with a significantly reduced rate of infectious complications compared with transrectal biopsy and should therefore be preferred. If transrectal biopsy is performed, intrarectal cleaning with povidone-iodine and antibiotic prophylaxis without fluoroquinolones should be chosen. Antibiotic prophylactic strategies include targeted prophylaxis after susceptibility testing of the rectal flora, augmented prophylaxis with multiple antibiotics and empiric mono-prophylaxis with non-fluoroquinolones. Data from RCTs are available for aminoglycosides, third-generation cephalosporins and fosfomycin trometamol.
Insights
To reduce infectious complications from prostate biopsies, opt for transperineal biopsy. If transrectal biopsy is necessary, use non-fluoroquinolone antibiotics and intrarectal cleaning with povidone-iodine.
Area of Science:
- Urology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Rising infectious complications post-prostate biopsy linked to fluoroquinolone resistance.
- Fluoroquinolone use for prophylaxis is now restricted in Germany.
- EAU guideline group reviewed randomized controlled trials (RCTs) on prostate biopsy infection prevention.
Purpose of the Study:
- To evaluate strategies for reducing infectious complications following prostate biopsy.
- To provide evidence-based recommendations for antibiotic prophylaxis in prostate biopsies.
Main Methods:
- Meta-analysis of randomized controlled trials (RCTs).
- Comparison of infectious complication rates between transperineal and transrectal prostate biopsy techniques.
- Evaluation of different antibiotic prophylactic strategies.
Main Results:
- Transperineal prostate biopsy significantly reduces infectious complications compared to transrectal biopsy.
- For transrectal biopsy, intrarectal povidone-iodine cleaning and non-fluoroquinolone antibiotic prophylaxis are recommended.
- RCT data supports aminoglycosides, third-generation cephalosporins, and fosfomycin trometamol for prophylaxis.
Conclusions:
- Transperineal biopsy is the preferred method to minimize infectious risks.
- Alternative antibiotic prophylaxis strategies are essential due to fluoroquinolone resistance.
- Evidence supports specific non-fluoroquinolone antibiotics for infection prevention.
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