Transperineal vs. transrectal biopsy to reduce postinterventional sepsis

Abstract

Purpose of reviewProstate biopsy is commonly performed in men suspected to have prostate cancer. It has traditionally been performed using a transrectal approach, but transperineal prostate biopsy has been increasingly adopted in part because of its lower associated infectious risk. We review recent studies evaluating the rate of potentially life-threatening post-biopsy sepsis and potential preventive strategies.Recent findingsAfter performing a comprehensive literature search, 926 records were screened and 17 studies published in 2021 or 2022 were found to be relevant. Studies varied in periprocedural perineal and transrectal preparation, antibiotic prophylaxis, and definition of sepsis. The sepsis rates after transperineal ultrasound-guided versus transrectal ultrasound-guided biopsy ranged between 0 and 1 versus 0.4 and 9.8%. Mixed efficacy was found for the topical application of antiseptics before transrectal biopsy to decrease postprocedural sepsis. Promising strategies include the use of topical rectal antiseptics before transrectal prostate biopsy and using a rectal swab to guide the antibiotic selection and the route of the biopsy.SummaryThe transperineal approach to biopsy is increasingly used because of lower associated sepsis rates. Our review of the recent literature supports this practice pattern change. Hence, transperineal biopsy should be offered as an option to all men.

Comparing the Effect of Pre-Biopsy Rectal Cleaning Together with Biopsy Needle Disinfection to Each Technique Alone on Hospitalization Rates because of Post-Biopsy Infections

“…However, its most important advantage is that it has lower post-biopsy ICs compared to TRUS-PB. A recent meta-analysis found that TP-PB had a lower risk of sepsis (0–1%) than TRUS-PB (0.4–9.8%) [21]. Another meta-analysis demonstrated a similar result that TP-PB was associated with significantly reduced ICs, 3.2% versus 5.6% (OR = 0.55; 95% CI, 0.33–0.92) compared to TRUS-PB [22].…”