In-Office, Urologist-Administered Propofol Sedation for Prostate Biopsies: Outcomes From 205 Cases

Propofol sedation (PS) administered by nonanesthesiologists has been demonstrated as safe across various medical disciplines, yet its in-office use in urology remains limited. Prostate biopsies are typically performed either under local anesthesia or anesthesiologists-administered anesthesia, including sedation and general anesthesia. Both approaches are associated with well-recognized limitations such as patient discomfort and substantial resource requirements, contributing to the slow transition from the transrectal to the transperineal approach for prostate biopsy. PS administered directly by urologists could potentially overcome these barriers.

In this study, a standardized, urologically performed and supervised PS workflow for prostate biopsies was established and interdisciplinarily implemented. Consecutive patients undergoing MRI/ultrasound fusion-guided prostate biopsy were retrospectively analyzed. Procedures were initially performed transrectally and subsequently expanded to the transperineal approach. Outcomes include descriptive analysis of sedation- and biopsy-related complications and patient-reported outcome measures (PROMs), biopsy access route, and utilization of anesthesia and operating room resources.

A total of 205 consecutive biopsies were performed under PS. No propofol-associated complications occurred. Biopsy-related complications were rare and limited to urinary retention (< 1%) and febrile urinary tract infection (< 2%). PROMs demonstrated excellent tolerability and comfort with this sedation method, with strong preferences for PS in the event of repeat biopsies. Following PS implementation, the proportion of transperineal biopsies substantially increased from initially 34% to 74%, while the use of general anesthesia and operating room resources was reduced from up to 45% to 17%.

In-office administration of PS by urologists is safe and associated with excellent patient acceptance. Through simpler workflows and reduced need of anesthesiology and operating room resources, PS facilitates the implementation of the transperineal approach for prostate biopsy.