Ces Urol 2026, 30(3):132-136 | DOI: 10.48095/cccu2026015

Complications of transperineal prostate biopsy

Kristína Maguthová, Petr Nencka, Jindřich Šonský, Petr Klézl, Robert Grill

Urologická klinika 3. LF UK a FN Královské Vinohrady, Praha

Major statement: Transperineal biopsy is currently the preferred method for the diagnosis of prostate cancer. Its lower incidence of infectious complications compared with the transrectal approach allows the procedure to be performed without routine antibiotic prophylaxis.

Summary
Aim: The aim of this study was to retrospectively evaluate the incidence and spectrum of complications following transperineal prostate biopsies performed at our institution.

Methods: Between April 2022 and April 2025, a total of 386 transperineal prostate biopsies were performed at our institution using magnetic resonance imaging - ultrasound fusion guidance. We evaluated the incidence and spectrum of complications following the procedure in this patient cohort. Complications were recorded during the follow-up visit after prostate biopsy, which was routinely performed at our institution approximately 14 days after the procedure.

Results: In 321 cases, this was the first prostate biopsy, while 65 patients underwent repeated biopsy. A total of 366 biopsies were performed under local anesthesia and 20 under general anesthesia. Antibiotic prophylaxis was administered in ten cases. The mean age of patients in the cohort was 66 years. The mean number of biopsy cores obtained was nine, and the mean prostatic specific antigen level was 9 ng/mL. Overall complications following transperineal prostate biopsy were recorded in 23 cases. Infectious complications requiring antibiotic treatment occurred in four cases. The most common complication was hematospermia (8×), followed by hematuria (5×), urinary tract infection (4×), and urinary retention (3×). Dysuria, hip pain, urethrorrhagia, and combined urinary retention with urinary tract infection were each observed in one case.

Conclusion: Transperineal prostate biopsy is associated with a minimal risk of infectious complications based on the evaluation of this cohort. According to our findings as well as the available literature, it is considered a safe method for the histological diagnosis of prostate cancer without the routine use of antibiotic prophylaxis.

Keywords: prostate cancer – complications of prostate biopsy – complications of transperineal prostate biopsy – transperineal prostate biopsy

Received: March 31, 2026; Revised: May 28, 2026; Accepted: June 4, 2026; Published: September 21, 2026