Comparison of complications after transrectal and transperineal prostate biopsy: a national population-based study.

To assess the complications of transrectal (TR) compared to transperineal prostate (TP) biopsies.

Men diagnosed with prostate cancer between 1st April 2014 and 2017 in England were identified by the National Prostate Cancer Audit. Administrative hospital data were then used to categorise the type of prostate biopsy and subsequent complications requiring hospital admission. Administrative hospital data were used to identify patients staying overnight immediately after biopsy and those readmitted separately for hospital admissions because of sepsis, urinary retention or haematuria. Procedure related mortality and total length of hospital stay within 30 days was also recorded. Generalised linear models were used to calculate adjusted risk differences (aRD).

73,630 men undergoing prostate biopsy were identified. Those having TP biopsy (n=13,723) were more likely to have an overnight hospital stay (12.3% vs 2.4%; aRD 9.7%: 95% CI 7.1% to 12.3%), were less likely to be readmitted because of sepsis (1.0% vs 1.4%; aRD -0.4%: CI -0.6% to -0.2%), and were more likely to be readmitted with urinary retention (1.9% vs 1.0%; aRD 1.1%: CI 0.7% to 1.4%) than those undergoing a TR biopsy (n=59,907). There were no significant differences in the risk of haematuria or mortality.

TP biopsy has a lower risk of readmission for sepsis but a higher risk of readmission for urinary retention than TR biopsy. Use of the TP route would prevent one readmission for sepsis in 278 men at the cost of three additional men readmitted for urinary retention.

BJU international. 2020 Mar 02 [Epub ahead of print]

Brendan Berry, Matthew G Parry, Arunan Sujenthiran, Julie Nossiter, Thomas E Cowling, Ajay Aggarwal, Paul Cathcart, Heather Payne, Jan van der Meulen, W Clarke

Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK., Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK., Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, UK., Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK., Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK., Department of Urology, The Christie and Salford Royal Hospitals Manchester NHS Foundation Trust, Manchester, UK.