Safety and intraoperative adhesion characteristics of laparoscopic radical prostatectomy within 48 hours after transperineal prostate biopsy: a retrospective cohort study

Abstract Objective To evaluate the safety and intraoperative adhesion characteristics of laparoscopic radical prostatectomy performed within 48 h after transperineal prostate biopsy. Methods We retrospectively reviewed 206 patients with prostate cancer who underwent laparoscopic radical prostatectomy after transperineal biopsy from June 2023 to September 2025. Patients were divided into an interval time (IT) < 48-hour group ( n = 97) and an IT > 1-week group ( n = 109). Baseline characteristics, perioperative outcomes, pathological findings, 30-day complications, and intraoperative periprostatic adhesion scores were compared. Adhesion scores were independently assessed from surgical videos by three senior urologists blinded to group allocation. Multivariable regression and propensity score matching were performed. Results Baseline characteristics were comparable between groups. Operative time, estimated blood loss, catheterization duration, positive surgical margin rate, and 30-day complications did not differ significantly. The IT < 48-hour group had a shorter total hospitalization duration (15.74 ± 0.94 vs. 17.84 ± 2.48 days; P < 0.001), lower rectoprostatic space adhesion scores [2 (1–2) vs. 2 (2–3); P < 0.001], and lower total intraoperative adhesion scores [5 (4–6) vs. 5 (4–6); P = 0.035]. Multivariable analyses and propensity score matching yielded consistent findings. Conclusion In this retrospective cohort of carefully selected patients, laparoscopic radical prostatectomy within 48 h after transperineal prostate biopsy was not associated with worse short-term perioperative outcomes and was associated with lower video-based rectoprostatic-space and total adhesion scores. These findings require validation in prospective multicenter studies.