Morbidity After Transperineal Prostate Biopsy in 3000 Patients Undergoing 12 vs 18 vs More Than 24 Needle Cores

Complications After Systematic, Random, and Image-guided Prostate Biopsy

“…In a retrospective study by Berger et al, hematospermia was the most frequently reported complication after TRUS-guided PB (36.3%), and was significantly higher with more cores taken (31.8%, 37.4% and 38.4% after 6-core, 10-core and 15-core biopsies, respectively; p<0.001). Similarly, Pepe et al found that hematospermia significantly correlated with the number of cores following transperineal PB (30.4% and 10.7% following >/=24 cores vs. 12 cores, respectively; p=0.001) 10 . Conversely, in a recent MRI in-bore PB series with a median of 4 cores, the rate of hematospermia was similar to TRUS-guided prostate biopsies with 10 median cores (36% vs. 33%, p>0.05) 14 .…”

“…Namekawa et al, recently reported on 2.086 men undergoing an initial PB under lumbar spinal anesthesia: PSA , IPSS score, prostate volume, abnormal DRE and history of α-blocker use were independent predictors of LUTS and urinary retention 13 . When compared to TRUS-guided PB, the occurrence of acute urinary retention after transperineal approach is slightly higher, ranging from 1.7% to 11.1% [8][9][10]25,26 . Pepe et al reported 11.1%, which was significantly correlated with the number of cores taken 10,27 .…”

“…When compared to TRUS-guided PB, the occurrence of acute urinary retention after transperineal approach is slightly higher, ranging from 1.7% to 11.1% [8][9][10]25,26 . Pepe et al reported 11.1%, which was significantly correlated with the number of cores taken 10,27 . Tsivian et al showed a severe worsening of urinary symptoms with urinary retention in 6%, with a return to baseline within 6 weeks 9 .…”

“…However, in a biopsy-based multivariable analysis, the repeat biopsy procedure itself was not associated with a greater risk of serious complications requiring hospital admission compared to the initial biopsy session 59 . In patients undergoing transperineal PB, the reported incidence of infections and sepsis is close to zero (0-0.2%), given the avoidance of bacterial contamination (which is common during transrectal access), as well as the limited number of cores taken when performing transperineal MRI-guided in bore biopsy [8][9][10]13,[25][26][27]29,[63][64][65][66][67] . Although data are currently limited, it is uncertain whether the lower incidence of infectious complications after MRI-targeted PB could be related to the sampling route (i.e.…”

“…A recent statewide study from the Michigan Urological Surgery Improvement Collaborative (MUSIC) group, reported a reduction in hospitalization rates for infectious complications from 1.19% to 0.56%, when adopting a specific protocol for antibiotic prophylaxis (by shifting from a monotherapy to a multi-drug prophylaxis or performing culture-directed prophylaxis) 51 . Although transperineal approach for PB is infrequently used in many parts of the world largely due to logistical reasons, the incidence of re-admissions for urinary infection or sepsis is lower, ranging from 0% to 0.7% in published reports 9,10,25,26 (Table 2).Despite the currently limited available body of literature, the lower incidence of infections and hospitalizations among patients undergoing MRI-targeted PB appears mostly related to the transperineal access, rather than the number of cores taken 29,64 . In summary, the occurrence of serious major complications after transrectal PB requiring hospital admission, ranges from 0.5% to 6.9%, and has increased over time.…”