Transperineal prostate biopsy: safe and accurate method for early diagnosis

A transperineal prostate biopsy is a medical procedure that allows samples of prostate tissue to be obtained through the skin between the anus and the scrotum, called the perineum. This method is recognized for reducing the risk of infections compared to transrectal biopsy and offering better accuracy in cancer screening of prostate.

This technique is used when prostate cancer is suspected and is a safe and effective alternative to confirm the diagnosis. In addition, transperineal biopsy is usually performed with the help of ultrasound to guide the needle and can be performed under anesthesia for greater patient comfort.

Understanding how the patient is prepared, what to expect during and after the procedure, and what its benefits and potential complications are is key to making informed decisions about prostate health care.

Key Points

• Transperineal biopsy helps detect prostate cancer with a lower risk of infection.
• It is performed with ultrasound guidance and you can use anesthesia for greater comfort.
• Knowing the process and its advantages allows for better preparation and recovery.

What is a transperineal prostate biopsy?

Transperineal prostate biopsy is a technique used to obtain samples of prostate tissue by inserting a needle through the skin between the scrotum and the anus. It is a method that improves accuracy in the detection of prostate cancer and reduces the risk of serious infections.

This technique differs from other forms of biopsy and has specific diagnostic applications based on clinical history and the results of previous studies.

Definition and basic procedure

A transperineal prostate biopsy involves taking small samples of the prostate using fine needles inserted through the skin of the perineum, the area between the scrotum and the anus. This access avoids contact with the rectum, reducing the likelihood of infections.

During the procedure, the doctor uses ultrasound guidance to precisely direct the needle to the desired location within the prostate. Several punctures are made to obtain sufficient tissue for analysis.

The procedure is performed under local anesthesia or light sedation, and the patient usually needs only a few days to recover and return to normal activities.

Differences from other types of prostate biopsy

The main difference with a transrectal biopsy is the point of entry. In the transperineal one, the needle enters through the skin of the perineum, while in the transrectal one it enters through the rectum.

The transperineal method has a lower risk of sepsis and infectious complications, since it avoids fecal contamination. In addition, it does not cause rectal bleeding, which is common in transrectal bleeding.

Although the recovery time may be similar in both methods, the transperineal method offers better precision in locating tumors, especially in areas difficult to reach with transrectal access.

Main clinical indications

Transperineal prostate biopsy is recommended in patients with prostate exam or magnetic resonance imaging results that suggest the presence of cancer.

It is also preferred when seeking to avoid infections in patients with a history of prostatitis or recurrent urinary tract infections.

In addition, this technique is useful for reevaluating cases with previous negative biopsies, but with high clinical suspicion, due to its precision in sampling deep areas of the prostate.

Transperineal biopsy preparation and process

The transperineal biopsy requires careful preparation and an organized procedure. The preparation includes specific medical instructions, while the process follows clear steps to obtain prostate samples. Afterwards, immediate care must be taken to avoid complications.

Preparations prior to the procedure

Before the biopsy, the patient must inform the doctor about medications he is taking, especially anticoagulants or aspirin, to prevent bleeding.

Fasting for at least 6 hours is recommended if local anaesthesia or sedation will be administered.

The doctor may order preventive antibiotic therapy to reduce the risk of infections. The area between the anus and the scrotum must be cleaned before the procedure.

It is important to arrange transportation to go home because of the effects of sedation or discomfort after the biopsy.

Stages of the step-by-step procedure

• First, the patient is placed in a comfortable position, usually lying on his back.
• Then, the perineum area is cleaned and disinfected.
• An ultrasound is used to guide the needle through the skin of the perineum and into the prostate.
• Several small tissue samples are obtained with a special needle.
• During the procedure, local anesthesia may be used to reduce pain.
• The procedure takes about 20 to 30 minutes.

Immediate post-biopsy care

Afterwards, it is common to feel mild pain and discomfort in the perineum that usually last a few days.

• Heavy physical exertion and heavy lifting should be avoided for 48 hours.
• If bleeding occurs in the urine, semen, or rectum, small amounts are normal.
• A doctor should be consulted if fever, severe pain, or heavy bleeding occur.
• Drinking plenty of water helps prevent infections.
• Medical follow-up is key to reviewing results and controlling possible effects.

Advantages, Disadvantages, and Security Considerations

Transperineal biopsy offers a different approach to obtaining prostate samples, impacting accuracy and the risk of infections. This method has significant benefits, but it also involves certain risks and clear differences compared to transrectal biopsy.

Clinical benefits of the transperineal technique

The transperineal technique allows direct access to the prostate through the perineum, making it easier to take samples from hard-to-reach areas, such as the anterior region. This improves the detection of areas suspected of cancer that could be missed with other methods.

In addition, by not crossing the rectal wall, it significantly reduces the risk of serious infections and sepsis. The transperineal biopsy can be performed guided by magnetic resonance imaging and ultrasound to increase accuracy in identifying lesions.

These benefits make the method safer and more effective for patients at high risk of infection or previous prostatectomies.

Possible risks and complications

Although safer for infections, transperineal biopsy can cause discomfort in the perineal area, such as pain or bruising. Some patients may experience swelling or minor bleeding at the puncture site.

There is a low risk of urinary retention that requires medical attention. The technique may be more complex and extend the time of the procedure due to the change in approach and the need for local or general anesthesia in some cases.

It is important to inform the patient about these minor risks to prepare realistic expectations and ensure adequate post-biopsy follow-up.

Safety comparison with transrectal biopsy

The main safety difference is the lower infection rate with transperineal biopsy. By not crossing the rectum, possible bacterial contamination that can cause urinary tract infections, prostatitis or sepsis, which are more common in the transrectal route, is avoided.

Systemic complications are rare in the transperineal technique. However, transrectal biopsy is usually faster and more consistent in most centers, although with greater infectious risks.

For these reasons, many specialists recommend the transperineal technique to improve the safety of prostate sampling, especially in patients with an infectious history or with risky conditions.

Frequently Asked Questions

A transperineal prostate biopsy may cause some side effects, and recovery time varies from patient to patient. The technique uses a needle that goes through the skin of the perineum to obtain tissue samples. There are different costs and anesthesia is commonly needed. There are also some disadvantages associated with the procedure.

What are the side effects of a transperineal prostate biopsy?

The most common side effects include mild pain or discomfort in the perineum area. There may be minor bleeding during urination or in semen. Rarely, infections or difficulty urinating occur.

What is the recovery time after a transperineal prostate biopsy?

The recovery usually lasts between one and three days. During this time, the patient should avoid strenuous physical activities and maintain good hygiene to prevent infections.

What technique is used for transperineal prostate biopsy?

An ultrasound guided needle through the skin of the perineum is used to take samples of the prostate. This method allows for more direct access and reduces infections compared to transrectal biopsy.

What are the costs associated with a transperineal prostate biopsy?

Costs may vary depending on the clinic, country and whether the patient has health insurance. They are generally higher than those of a transrectal biopsy due to the use of advanced technology and anesthesia.

Is anesthesia required for transperineal prostate biopsy?

Yes, local anesthesia or sedation is used to minimize pain during the procedure. This helps keep the patient comfortable and reduces anxiety.

What are the disadvantages of a transperineal biopsy?

Although it reduces the risk of infection, transperineal biopsy can be more expensive and requires more time in preparation and procedure. It can also cause more pain in the perineum area.

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