Complications of transrectal versus transperineal prostate biopsy

Background: There are two established techniques of prostate biopsy: the more widely used transrectal technique, and the transperineal technique. Although the transrectal technique is faster, it is reported to have an increased risk of septic complications, which may be life threatening. The present study compares complication rates of both techniques at Nambour General Hospital. Methods: The present retrospective study was performed by reviewing all available medical charts of men who underwent prostate biopsy during the years 1996-2001. The following data were recorded in a database: date of birth; digital rectal examination findings; serum prostate specific antigen (PSA); biopsy technique; number of cores taken; number of positive cores; Gleason grade and score; complications. Results were tabulated and simple statistical analysis performed to compare both groups. Results: A total of 197 biopsies was included in the study, with 81 transperineal biopsies in 75 men, and 116 transrectal biopsies in 103 men. There was no statistically significant difference in complication rates, including sepsis, between transrectal biopsy and transperineal biopsy. The rate of sepsis was 1.2% for the transperineal technique, and 0% for the transrectal technique (P = 0.411, Fisher exact test). Overall complication rates were 22.2% for transperineal technique and 19.8% for transrectal technique (P = 0.773, Fisher exact test). Conclusion: Although the present study was limited by retrospective design and size it suggests that both techniques are equally safe. A review of medical literature supports a tranperineal approach to patients who will tolerate sepsis poorly, or who have a suspected inflammatory cause of their raised PSA.