Assessment of complications after transperineal and transrectal prostate biopsy using a risk-stratified pathway identifying patients at risk for post-biopsy infections

Abstract

Introduction

Evidence of transperineal (TP) superiority over transrectal (TR) biopsy is growing due to lower infectious complication rates. However, TR biopsy is the most common procedure, and it seems that a cross-over to TP is delayed by logistical challenges such as costs, complexity, and lack of experience. We investigate whether well-selected patients without any risk factors may further undergo TR biopsy if all precautions to avoid infections are warranted.

Materials and methods

Data were collected in our academic institution between August 2021 and March 2022 and after clinical implementation of the currently updated European Association of Urology guideline recommendations on the performance of prostate biopsy. Patients underwent either TP or TR biopsy according to a riskstratification based on risk factors of infectious complications. Follow-up asked for post-biopsy complications. Inverse Probability of Treatment Weighting (IPTW) propensity score was used to balance baseline characteristics. Complications were subdivided into infectious and non-infectious complications.

Results

In total, 294 patients were included with 161 patients undergoing TR vs. 133 patients undergoing TP biopsy. Complication rates were 2.2% for TP vs. 5.5% for TR biopsy concerning all complications. Infectious complication rates only were 0.7% for TP vs. 1.8% for TR biopsy. After IPTW adjustment, differences were statistically significant different (p = 0.01).

Conclusion

Our study revealed that even in a well-selected patient cohort with presumably lower risk of infectious complications, TR biopsy leads to more post-biopsy complications than TP biopsy. This conclusion should motivate the urological community to switch to TP biopsy.

Keywords:

• MRI fusion biopsy
• transrectal biopsy
• transperineal biopsy
• post-biopsy complications
• EAU recommendations

Acknowledgment

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author contributions

Conception and design: Sebastian Berg, Karl Tully, Vincent Hoffmann, Florian Roghmann, Guido Müller, Joachim Noldus, Moritz Reike. Administrative support: Sebastian Berg, Henning Bahlburg, Moritz Reike. Collection and assembly of data: Sebastian Berg, Karl Tully, Vincent Hoffmann, Nicolas von Landenberg, Henning Bahlburg. Data analysis and interpretation: Sebastian Berg, Vincent Hoffmann, Florian Roghmann, Joachim Noldus, Guido Müller, Moritz Reike. Manuscript writing: Sebastian Berg, Henning Bahlburg, Guido Müller. Revision of the draft and supervision: Sebastian Berg, Joachim Noldus, Moritz Reike. Final approval of manuscript: All authors.

Disclosure statement

No potential conflict of interest was reported by the author(s).