Poking Around: A Comparative Study of Complications in Trans-rectal Versus Trans-perineal Prostate Biopsies

Background Trans-rectal prostate biopsy (TRPB) has historically been the commonest method for diagnosing prostate cancer but carries an increased risk of infection related to rectal flora. Trans-perineal prostate biopsy (TPPB), which avoids the rectal mucosa, is proposed to reduce infectious complications. This study compares post-biopsy infection rates and length of hospital stay (LOS) between TRPB and TPPB at Mater Dei Hospital, Malta. Methods A retrospective cohort study was conducted on all TRPBs performed in 2022 and all TPPBs performed in 2024 by urologists at Mater Dei Hospital. Outcomes analyzed were prostatitis, sepsis, and LOS. Sepsis was defined using Sepsis-3 criteria. Categorical values were analyzed using Chi-square and Fisher's exact tests, and LOS was analyzed using Welch's t-test and the Mann-Whitney U test. Statistical analysis was performed using Microsoft Excel (Redmond, WA, USA). Results Of 177 TRPB cases, 10 (5.6%) developed prostatitis compared with two of 231 TPPB cases (0.9%). This difference was statistically significant (χ²(1)=8.03, p=0.0046; Fisher's p=0.0061). Median LOS for admitted patients was longer after TRPB (six days) than TPPB (five days), but this difference was not statistically significant (Welch t=0.898, p=0.507; Mann-Whitney U=15.5, p=0.415). No TPPB patient developed sepsis. Conclusion TPPB demonstrated significantly fewer infectious complications and eliminated sepsis compared with TRPB. These findings support the trans-perineal route as a safer standard of care.