Introduction:

The rate of post-biopsy urinary tract infections and sepsis is reduced with transperineal biopsy (TP-biopsy). However, there is currently no consensus regarding the use of antibiotic prophylaxis for TP biopsy. In this study, the complications of TP biopsy with regards to antibiotic use were examined at a single institution.

Methods:

A retrospective review of patients who underwent TP biopsy between November 2017 to September 2020 was performed. Pre-procedural antibiotics were administered at discretion of the surgeon. TP 12 core biopsies were performed per institutional protocol. Chi square tests were performed to compare comorbidities, complication rates and pre-procedural antibiotic administration. Mann-Whitney U tests were run to compare prostate volume and procedure duration among patients.

Results:

A total of 372 TP biopsies were examined, 298 in the office under local anesthesia and 67 in the OR under general anesthesia. Overall, 40 patients (10.8%) developed complications: 29/298 (9.7%) in office and 11/67 (16.4%) operating room biopsies. Six patients (1.6%) experienced urinary retention and 24 patients (6.5%) experienced mild hematuria. Three patients developed infectious complications, 2 (0.5%) of which had sepsis/bacteremia requiring IV antibiotics, none of whom had received prophylactic antibiotics. Patients with prostate volumes greater than 50gm had significantly higher rates of complications [18.7% vs 8.2%, p=0.017] as did patients with longer procedures [mean duration of 25 minutes vs. 18 minutes, p= 0.002]. Overall, 36/40 patients (90%) who developed post-biopsy complications did not receive prophylactic antibiotics. The relative risk for post-biopsy complications in patients not receiving prophylactic antibiotics was 1.681 (95% CI: 0.626-4.519).

Conclusion:

Patients who experienced post-TP biopsy complications had larger prostate volumes, longer procedure times and were less likely to have received prophylactic antibiotics. Men with larger prostates or with procedure times longer than 25 minutes should be considered to receive antibiotic prophylaxis prior to TP biopsy.

Funding: none