Erectile dysfunction (ED) is a concern for men undergoing prostate biopsy. With the increasing adoption of transperineal (TP) biopsy over transrectal (TR) biopsy, it remains unclear which approach carries a lower risk of erectile dysfunction. This study aims to be the first meta-analysis to evaluate erectile dysfunction following TR versus TP prostate biopsy at 1, 3 and 6 months intervals, thereby providing clinicians with evidence-based guidance for patient counseling and shared decision-making.
This review was prospectively registered on PROSPERO (CRD42024541557) and followed PRISMA guidelines, with searches conducted in PubMed, Scopus, and the Cochrane Library databases up to July 2024. A total of 22 studies reporting erectile function outcomes (IIEF scores) at baseline and 1, 3 and 6 months post-biopsy were identified. After applying inclusion and exclusion criteria, 12 studies were included in the final meta-analysis. TR and TP biopsy methods were compared using a random-effects model to assess standardized mean differences (SMD) in erectile function at each follow-up point. The risk of bias for each study was evaluated to ensure result reliability.
At 1 month follow-up, a significant decline in erectile function was observed overall (SMD: - 0.3785, p = 0.038). The TP approach showed a slightly more significant decline than the TR approach; however, this difference was not statistically significant (p = 0.074). At 3 months follow-up, no significant differences were observed between methods overall (SMD: - 0.1663, p = 0.132), although TP biopsy alone showed a modest yet considerable decline (SMD: - 0.1868, p = 0.03). At 6 months, erectile function had generally returned to baseline, with no significant differences observed between biopsy techniques (p = 0.41).
Both TR and TP prostate biopsies are associated with a transient decline in erectile function. These effects typically resolve by 6 months in most patients, with no significant long-term impact observed. While the initial functional impact may be slightly greater with the TP technique, this difference attenuates over time. These findings are crucial for managing patient expectations post-biopsy.
International urology and nephrology. 2025 Oct 06 [Epub ahead of print]
O Ermis, M G Sonmez, A Tozsin, M S Iyisoy, M Yilmaz, G Sonmez, O O Cakir, A Aydin, L Tunc, E Barret, T Herrmann, K Ahmed, S Guven
Istanbul Avcilar Government Hospital, Urology, Istanbul, Türkiye., Necmettin Erbakan University, Urology, Konya, Türkiye., Trakya University School of Medicine, Urology, Edirne, Türkiye., Department of Medical Education and Informatics, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Türkiye., Mediclin Kraichgau Klinik, Urology, Bad Rappenau, Germany., Erciyes University School of Medicine, Urology, Kayseri, Türkiye., King's College Hospital NHS Foundation Trust, Urology, London, UK., Acıbadem Hospital, Urology, Ankara, Türkiye., Department of Urology, Institut Mutualiste Montsouris, Paris, France., Cantonal Hospital Thurgau AG, Urology, Fraunfeld, Switzerland., Necmettin Erbakan University, Urology, Konya, Türkiye. .