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

Authors

  • Jesper Bonnedahl Department of Diagnostics and Intervention, Urology and Andrology, Umeå University, Umeå, Sweden
  • Karl-Johan Lundström Department of Diagnostics and Intervention, Urology and Andrology, Umeå University, Umeå, Sweden
  • Erik Lampa Epistat AB, Uppsala, Sweden
  • David Robinson Department of Urology, Ryhov Hospital, Jönköping, Sweden
  • Johan Stranne Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
  • Stefan Carlsson Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden
  • Magnus Wagenius Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
  • Adam Linder Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
  • Joakim Örtegren Department of Surgery, Region Kronoberg; Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • Anders Andreasson Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
  • Martin Holmbom Department of Urology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
  • Pär Stattin Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
  • Johan Styrke Department of Diagnostics and Intervention, Urology and Andrology, Umeå University, Umeå, Sweden

DOI:

https://doi.org/10.2340/sju.v61.45537

Keywords:

Urological diagnostic techniques, needle biopsies, infections; risk factors, prostatic neoplasms

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.

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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Published

2026-03-17

How to Cite

Bonnedahl, J., Lundström, K.-J., Lampa, E., Robinson, D., Stranne, J., Carlsson, S., … Styrke, J. (2026). Risk of infectious complications after transperineal prostate biopsy compared to transrectal biopsy: nationwide population-based cohort study in Sweden. Scandinavian Journal of Urology, 61(1), 44–50. https://doi.org/10.2340/sju.v61.45537

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Vol. 61 (2026)

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Copyright (c) 2026 Jesper Bonnedahl, Karl-Johan Lundström, Erik Lampa, David Robinson, Johan Stranne, Stefan Carlsson, Magnus Wagenius, Adam Linder, Joakim Örtegren, Anders Andreasson, Martin Holmbom, Pär Stattin, Johan Styrke

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As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY license, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work. 

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