Transperineal prostate biopsy without routine antibiotics demonstrates decreased infection risk

Introduction: 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. Materials and Methods: A retrospective analysis of patients who underwent transrectal and transperineal prostate biopsies at our institution from 2019-2022 was performed. Results: 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%, p = 0.005), 8 ER visits (4.60%, p = 0.036), and 7 30-day readmissions (4.02%, p = 0.015) in the transrectal group. Conclusions: 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.