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Freehand transperineal prostate biopsy under local anesthesia using a novel needle guide system with angle-adjustment feature

Eriz Özden^1,*, Erdem Öztürk²

1 Department of Urology, Faculty of Medicine, Ankara University, Ankara, 6810, Turkiye
2 Department of Urology, University of Health Sciences, Ankara Dr. Abdurrahman Yurtaslan Training and Research Hospital, Ankara, 6810, Turkiye

* Corresponding Author: Eriz Özden. Email:

(This article belongs to the Special Issue: Advancing Early Detection of Prostate Cancer: Innovations, Challenges, and Future Directions)

Canadian Journal of Urology 2025, 32(5), 477-482. https://doi.org/10.32604/cju.2025.067507

Received 05 May 2025; Accepted 06 August 2025; Issue published 30 October 2025

Abstract

Overview: Freehand transperineal prostate biopsy (TPPB) needle guides are designed to maintain a parallel alignment between the co-axial introducer needle and the ultrasound (US) transducer. However, this parallel alignment necessitates transducer angulations within the patient’s rectum for sampling anterior or posterior regions of the prostate, which introduces several problems both for the patient and the operator. This article introduces a technique using a TPPB needle guide system with a novel angle-adjustment feature, which minimizes intrarectal transducer movements. Objectives: Freehand TPPB typically requires anterior or posterior angulation of the ultrasound (US) transducer, which leads to prostate compression, increased patient discomfort, reduced sonographic image quality, and challenges in MRI-ultrasound fusion biopsy registration. To address these issues, a novel TPPB needle guide system (PERINO-FLEX) featuring a co-axial needle angle adjustment mechanism has been introduced. The system includes a rotating component through which the coaxial needle passes, enabling up to 45 degrees of anterior or posterior angulation within the perineum, without the need to angulate the intrarectal US transducer. In this article, we aim to describe the TPPB technique utilizing this unique angle-adjustment feature and to highlight its advantages.

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Keywords

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Supplementary Material

Supplementary Material File

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