TY  - EJOU
AU  - Lichtbroun, Benjamin J. 
AU  - Patel, Mann 
AU  - Consalvo, Alexis 
AU  - Khizir, Labeeqa 
AU  - Said, Munisa 
AU  - Chien, Austin 
AU  - Chua, Kevin 
AU  - Pfail, John 
AU  - Passarelli, Rachel 
AU  - Packiam, Vignesh T. 
AU  - Golombos, David 
AU  - Elsamra, Sammy 
AU  - Jang, Thomas L. 
AU  - Srivastava, Arnav 
AU  - Ghodoussipour, Saum 

TI  - Transperineal prostate biopsy without routine antibiotics demonstrates decreased infection risk
T2  - Canadian Journal of Urology

PY  - 2025
VL  - 32
IS  - 1
SN  - 1488-5581

AB  -  <b>Introduction:</b> Infections are the most feared complication of transrectal prostate biopsies, along with growing concerns of antibiotic resistance. Our institution transitioned to a transperineal approach without use of perioperative antibiotics or bowel preparations. We aimed to compare the safety outcomes associated with transperineal and transrectal prostate biopsy techniques. <b>Materials and Methods:</b> A retrospective analysis of patients who underwent transrectal and transperineal prostate biopsies at our institution from 2019–2022 was performed. <b>Results:</b> We identified 319 patients—174 transrectal and 145 transperineal. 8 patients who had transperineal biopsy (5.5%) received peri-operative antibiotics, compared to 100% with transrectal biopsy. 35.86% of transperineal patients received a bowel preparation, compared to 100% in the transrectal group. 44.14% and 49.43% of patients received a prior prostate biopsy in the transperineal and transrectal groups, respectively. Patients in the transperineal biopsy group had zero infectious complications, 1 ER visit, and zero 30-day readmissions. This is compared to 9 infectious complications (5.17%, <i>p</i> = 0.005), 8 ER visits (4.60%, <i>p</i> = 0.036), and 7 30-day readmissions (4.02%, <i>p</i> = 0.015) in the transrectal group. <b>Conclusions:</b> In a single institution series, patients undergoing transperineal biopsy had fewer infectious complications compared to those undergoing transrectal biopsy. Despite only a small percentage of patients receiving perioperative antibiotics and a majority of patients not receiving a bowel preparation in the transperineal group, there were zero infectious complications or 30-day readmissions. With greater infectious complications with transrectal biopsy and growing antibiotic resistance, we underline the safety of transperineal prostate biopsy which can largely be done without perioperative antibiotics or a bowel preparation.
KW  - transperineal; transrectal; prostate biopsy; antibiotic stewardship; sepsis; bowel preparation

DO  - 10.32604/cju.2025.064701