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incidence of resistant bacteria. Transperineal prostate biopsy (TPB) is a method that has been shown to drastically decrease infectious complications by avoiding the rectum altogether. However, it has been understood that due to pain, TPB must be done under general anesthesia, thus increasing cost and procedural time. The previous described freehand transperineal prostate biopsy (FHTPB) technique, only utilizes 2 puncture sites through which all prostate biopsies are taken. Thus the objective of the current study was to investigate patient pain during FHTPB under local anesthesia only.METHODS: Retrospective review of all prospectively performed FHTPBs under local anesthesia between January 1, 2012 and October 30, 2015 was performed. Primary outcome measurements were patient reported pain utilizing both numerical and visual analog scale at multiple time points throughout the procedure.RESULTS: 33 patients with an average age, BMI, positive family history, prostate volume and PSA of 74.64 AE9.43 years, 28.21 AE4.26 15%, 50.34 AE32.0mL and 9.79AE6.50ng/dL respectively, underwent FHTPB under local anesthesia. The procedure was well tolerated by all patients with probe insertion and local anesthetic injection as the highest pain rating median of 3 (3-4) and 4 (3-5) respectively, and a post-procedural pain rating of 2 (1-2). Additionally, patients described bladder discomfort when obtaining cores form the anterior horn. The mean procedural time was 9.19 AE3.54mins with a mean of 12.94 AE3.38cores taken per biopsy.CONCLUSIONS: Freehand transperineal prostate biopsy under local anesthesia only is feasible, safe and tolerated by patients.

Repeat excision and primary anastomosis urethroplasty has excellent results for short bulbar strictures, comparable to those achieved in the initial and secondary setting.

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