Background: Infections are the most feared complication of transrectal prostate biopsy. Unfortunately, these complications are not infrequent. With antibiotic resistance becoming increasingly common, our institution has transitioned to a transperineal approach without use of perioperative antibiotics or bowel preparation. Given this significant change in practice pattern, we retrospectively analyzed these patients for rates of post-operative complications, 30-day hospital readmissions, and detection of prostate cancer. Methods: We retrospectively analyzed 146 patients who underwent a transperineal prostate biopsy at our institution in 2022. We recorded rates of complications including UTIs, sepsis, hematuria, and 30-day hospital readmissions. We also analyzed the percentage of patients found to have prostate cancer. Results: Of the 146 patients analyzed, 8 patients received peri-operative antibiotics (5.47%) - this was at the discretion of the surgeon performing the procedure. The reason 8 patients received peri-operative antibiotics was due to a prior infectious complication following a previous transrectal prostate biopsy. No patient received bowel preparation. Pre-procedure MRI was performed in 134 patients who had a MRI-ultrasound fusion biopsy. Hematuria was reported in 12 patients (8.21%) and there were zero infectious complications (UTI or sepsis). There were no 30-day readmissions amongst this cohort. Median procedure time was 24 minutes (Table). 86 patients were found to have adenocarcinoma (58.90) while 48 patients had benign pathology (32.87%). Conclusions: Despite a small percentage of patients receiving perioperative antibiotics, we had zero patients develop sepsis or an UTI. Our 30-day readmission rate was also 0%. With the high reported rates of infectious complications after transrectal prostate biopsy and antibiotic resistance becoming increasingly common, our data supports the notion that transperineal prostate biopsies are safe and can largely be done without the use of perioperative antibiotics.

Continuous variables presented as median +IQR. Categorical variables presented as count (percent of total group).