Transperineal prostate biopsy without routine antibiotics demonstrates decreased infection risk

Infections are the most feared complication of transrectal prostate biopsies, along with growing concerns of antibiotic resistance. Our institution transitioned to a transperineal approach without use of perioperative antibiotics or bowel preparations. We aimed to compare the safety outcomes associated with transperineal and transrectal prostate biopsy techniques.

A retrospective analysis of patients who underwent transrectal and transperineal prostate biopsies at our institution from 2019-2022 was performed.

We identified 319 patients-174 transrectal and 145 transperineal. 8 patients who had transperineal biopsy (5.5%) received peri-operative antibiotics, compared to 100% with transrectal biopsy. 35.86% of transperineal patients received a bowel preparation, compared to 100% in the transrectal group. 44.14% and 49.43% of patients received a prior prostate biopsy in the transperineal and transrectal groups, respectively. Patients in the transperineal biopsy group had zero infectious complications, 1 ER visit, and zero 30-day readmissions. This is compared to 9 infectious complications (5.17%, p = 0.005), 8 ER visits (4.60%, p = 0.036), and 7 30-day readmissions (4.02%, p = 0.015) in the transrectal group.

In a single institution series, patients undergoing transperineal biopsy had fewer infectious complications compared to those undergoing transrectal biopsy. Despite only a small percentage of patients receiving perioperative antibiotics and a majority of patients not receiving a bowel preparation in the transperineal group, there were zero infectious complications or 30-day readmissions. With greater infectious complications with transrectal biopsy and growing antibiotic resistance, we underline the safety of transperineal prostate biopsy which can largely be done without perioperative antibiotics or a bowel preparation.