Transperineal ultrasound-guided prostate (TP) biopsy is performed under general anaesthesia with the patient’s legs supported in stirrups. An ultrasound probe is inserted into the rectum and used to guide each needle biopsy. Transperineal biopsy differs from transrectal biopsy in that the needles pass through the area of skin between the anus and scrotum, called the perineum. These samples are then sent to pathologist to examine under a microscope, with results available after a few days.
Transperineal prostate biopsy offers the advantage of more complete prostate sampling with an almost zero risk of severe infection. Transperineal biopsy, however, takes longer than transrectal biopsy (about twenty minutes) and requires a general anaesthetic.
Before Your Biopsy
Certain medications increase the risk of bleeding and need to be stopped prior to surgery. You should tell your surgeon about all prescription medicines, over the counter medicines, vitamins, and herbal supplements that you are taking. Some patients, such as those with artificial heart valves or high blood clotting risk, will need to take blood-thinning injections whilst coming off their tablet medications.
After the biopsy you may require Flomaxtra tablets to minimize the risk of urinary retention. This medication should start on the evening of the day of surgery, and continue for a total of ten days.
After Your Biopsy
Because of the general anaesthetic you must have a friend or family member drive you home after the procedure. You must not drive a car, operate machinery, drink alcohol, or sign legal documents for twenty-four hours following anaesthesia.
You may experience some discomfort or bruising in the area between the scrotum and anus for first few days, which can often be managed with paracetamol.
It is normal to pass urine frequently for a few days after the procedure. You may notice a slow urinary stream for a few days due to temporary swelling of the prostate.
It is normal to see some blood in the urine or semen for up to 2 weeks after the procedure.
Specific Risks and Side Effects of TP Biopsy
- Inability to pass urine, requiring temporary catheterization, is uncommon.
- Urine infection is uncommon since antibiotics are given prior to the procedure.
- Erectile dysfunction may occur after transperineal biopsy. It is often relatively minimal and transient.
- Excessive bleeding is rare.
- Septicemia, a severe infection of the blood, is extremely rare after transperineal prostate biopsy.
- Anaesthetic complications, such as heart attack or stroke.
- Infection, for example of the urinary tract, chest, or other sites.
- Bleeding which may occasionally require a blood transfusion.
- Clots forming in the legs (DVT), which may then pass to the lungs.
- Allergic reactions to drugs, antiseptics, or wound dressings.
- Death is extremely rare after any surgical procedure. The risk of death relates to the patient’s general health and the complexity of the surgery, and may arise due to either anaesthetic or surgical complications.
When to contact your surgeon
- If you experience fevers, sweats, shakes, nausea or vomiting after you go home, or if you feel generally unwell.
- If you are unable to pass urine after the procedure.
- If urinary symptoms fail to settle after a few days, or if you develop burning pain whilst passing urine.
- If bleeding is severe or clots are present in the urine.