From the Guidelines
Transperineal prostate biopsy can cause several side effects and complications, though it's generally considered safer than the transrectal approach regarding infection risk. Common side effects include pain or discomfort at the biopsy site, which typically resolves within a few days and can be managed with over-the-counter pain medications like acetaminophen or ibuprofen 1. Blood in the urine (hematuria) occurs in about 50% of patients and usually clears within a week. Blood in semen (hematospermia) is very common, affecting up to 90% of patients, and may persist for several weeks or even months but is harmless. Temporary urinary difficulties such as frequency, urgency, or retention affect 10-20% of patients, with severe retention requiring catheterization in 1-2% of cases. Rectal bleeding is rare with the transperineal approach. Infection is the most serious potential complication but occurs in less than 1% of transperineal biopsies, significantly lower than with transrectal biopsies 1.
Side Effects and Complications
- Pain or discomfort at the biopsy site
- Hematuria (blood in the urine)
- Hematospermia (blood in the semen)
- Temporary urinary difficulties (frequency, urgency, or retention)
- Rectal bleeding (rare with the transperineal approach)
- Infection (less than 1% of transperineal biopsies) ### Management and Prevention Prophylactic antibiotics (typically a fluoroquinolone like ciprofloxacin 500mg or cephalosporin) are usually given before the procedure to further reduce infection risk 2. Patients should seek immediate medical attention if they develop fever, severe pain, inability to urinate, or heavy bleeding. The transperineal approach reduces infection risk because it avoids passing needles through rectal tissue, which harbors bacteria that could cause serious infections like sepsis. For patients on anticoagulation or antiplatelet therapy, the risk of bleeding should be considered, and the decision to discontinue or continue these medications should be made on a case-by-case basis 3.
From the Research
Side Effects and Complications of Transperineal Prostate Biopsy
The side effects and complications of transperineal prostate biopsy can be categorized into infectious and noninfectious complications.
- Infectious complications include: + Sepsis: The risk of sepsis is low, with a rate of 0.05% to 0.08% 4, 5, 6. + Urinary tract infections: The incidence of urinary tract infections is low, ranging from 0.7% to 1.35% 4, 5, 6.
- Noninfectious complications include: + Hematuria: The incidence of hematuria ranges from 31.5% to 42% 5, 7, 8. + Hematospermia: The incidence of hematospermia ranges from 13% to 31% 5, 7, 8. + Urinary retention: The incidence of urinary retention ranges from 1.2% to 11.7% 5, 7, 8. + Pain: The incidence of pain ranges from 18% to 31% 5, 7, 8. + Erectile dysfunction: Erectile dysfunction is a transient complication, with most patients recovering within 3 to 6 months 7.
Factors Influencing Complications
The number of needle cores used during the biopsy procedure can influence the risk of complications.
- Studies have shown that the risk of complications increases with the number of needle cores used, with 12 cores having the lowest risk and more than 24 cores having the highest risk 5.
- The use of antibiotic prophylaxis may also influence the risk of infectious complications, although the evidence is mixed 4, 6.
Comparison with Transrectal Prostate Biopsy
Transperineal prostate biopsy has been compared to transrectal prostate biopsy in terms of complications.