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Risk of infectious complications after transperineal prostate biopsy compared to transrectal biopsy : nationwide population-based cohort study in Sweden

Bonnedahl, Jesper ; Lundström, Karl Johan ; Lampa, Erik ; Robinson, David ; Stranne, Johan ; Carlsson, Stefan ; Wagenius, Magnus LU orcid ; Linder, Adam LU ; Örtegren, Joakim LU and Andreasson, Anders , et al. (2026) In Scandinavian Journal of Urology 61. p.44-50
Abstract

OBJECTIVE: Prostate biopsy is associated with a risk of significant infectious complications including sepsis. We investigated the risk of infections after transrectal (TR) biopsy compared to transperineal (TP) biopsy. MATERIALS AND METHODS: Men who had undergone prostate biopsy and diagnosed with prostate cancer were identified in the National Prostate Cancer Register (NPCR) of Sweden. Linkage with Swedish health care registers provided information on hospitalization, antibiotic prescriptions and comorbidities. Rate ratios for hospitalization, for infections, after TR and TP biopsies over day 1-7, 1-14, and 1-30 were estimated with Poisson regression. Filled prescriptions for urinary tract related antibiotics were also assessed.... (More)

OBJECTIVE: Prostate biopsy is associated with a risk of significant infectious complications including sepsis. We investigated the risk of infections after transrectal (TR) biopsy compared to transperineal (TP) biopsy. MATERIALS AND METHODS: Men who had undergone prostate biopsy and diagnosed with prostate cancer were identified in the National Prostate Cancer Register (NPCR) of Sweden. Linkage with Swedish health care registers provided information on hospitalization, antibiotic prescriptions and comorbidities. Rate ratios for hospitalization, for infections, after TR and TP biopsies over day 1-7, 1-14, and 1-30 were estimated with Poisson regression. Filled prescriptions for urinary tract related antibiotics were also assessed. RESULTS: Thirty-one thousand two hundred twenty-two men underwent biopsy between 1 January 2020 and 31 December 2023. 87% underwent TR and 13% TP biopsy. Hospitalization occurred in 0.6% of men (n = 24) after TP biopsy and 2.0% (n = 548) after TR biopsy. Rate ratios for hospitalization in the TR group compared to TP were 8.0 (95% confidence interval [CI]: 4.0-16.2) for day 1-7, 6.2 (3.2-11.9) for day 1-14, and 4.1 (2.4-6.8) for day 1-30. Filled antibiotic prescriptions were found for 4.5% of men (n = 187) after TP biopsy and 6.9% (n = 1,883) after TR biopsy. For antibiotic prescriptions, the rate ratios were 2.3 (1.8-2.9) for day 1-7 as well as day 1-14, and 1.6 (1.3-1.9) for day 1-30. CONCLUSIONS: A transrectal prostate biopsy was associated with a significantly higher risk of post-biopsy infectious complications compared to transperineal biopsy. These findings support the use of transperineal biopsy.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian Journal of Urology
volume
61
pages
7 pages
publisher
Taylor & Francis
external identifiers
  • scopus:105034121104
  • pmid:41841614
ISSN
2168-1813
DOI
10.2340/sju.v61.45537
language
English
LU publication?
yes
id
c8f8f192-e38b-47f1-9163-e37c71498f36
date added to LUP
2026-05-20 16:49:17
date last changed
2026-05-20 16:50:18
@article{c8f8f192-e38b-47f1-9163-e37c71498f36,
  abstract     = {{<p>OBJECTIVE: Prostate biopsy is associated with a risk of significant infectious complications including sepsis. We investigated the risk of infections after transrectal (TR) biopsy compared to transperineal (TP) biopsy. MATERIALS AND METHODS: Men who had undergone prostate biopsy and diagnosed with prostate cancer were identified in the National Prostate Cancer Register (NPCR) of Sweden. Linkage with Swedish health care registers provided information on hospitalization, antibiotic prescriptions and comorbidities. Rate ratios for hospitalization, for infections, after TR and TP biopsies over day 1-7, 1-14, and 1-30 were estimated with Poisson regression. Filled prescriptions for urinary tract related antibiotics were also assessed. RESULTS: Thirty-one thousand two hundred twenty-two men underwent biopsy between 1 January 2020 and 31 December 2023. 87% underwent TR and 13% TP biopsy. Hospitalization occurred in 0.6% of men (n = 24) after TP biopsy and 2.0% (n = 548) after TR biopsy. Rate ratios for hospitalization in the TR group compared to TP were 8.0 (95% confidence interval [CI]: 4.0-16.2) for day 1-7, 6.2 (3.2-11.9) for day 1-14, and 4.1 (2.4-6.8) for day 1-30. Filled antibiotic prescriptions were found for 4.5% of men (n = 187) after TP biopsy and 6.9% (n = 1,883) after TR biopsy. For antibiotic prescriptions, the rate ratios were 2.3 (1.8-2.9) for day 1-7 as well as day 1-14, and 1.6 (1.3-1.9) for day 1-30. CONCLUSIONS: A transrectal prostate biopsy was associated with a significantly higher risk of post-biopsy infectious complications compared to transperineal biopsy. These findings support the use of transperineal biopsy.</p>}},
  author       = {{Bonnedahl, Jesper and Lundström, Karl Johan and Lampa, Erik and Robinson, David and Stranne, Johan and Carlsson, Stefan and Wagenius, Magnus and Linder, Adam and Örtegren, Joakim and Andreasson, Anders and Holmbom, Martin and Stattin, Pär and Styrke, Johan}},
  issn         = {{2168-1813}},
  language     = {{eng}},
  month        = {{03}},
  pages        = {{44--50}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Journal of Urology}},
  title        = {{Risk of infectious complications after transperineal prostate biopsy compared to transrectal biopsy : nationwide population-based cohort study in Sweden}},
  url          = {{http://dx.doi.org/10.2340/sju.v61.45537}},
  doi          = {{10.2340/sju.v61.45537}},
  volume       = {{61}},
  year         = {{2026}},
}