Introductions and Objectives
An estimated 800,000 prostate biopsies are performed annually in the United States1. The majority of the biopsies are performed via a transrectal approach thru the rectal wall, which introduces bacteria into the prostate paerenchyma2. Coliform bacteria resistance to flouroquinolone antibiotics is estimated at 22%2,3,4. Accordingly, infectious complications are as high as 7% and the risk of hospitalization as high as 4%5. This study demonstrates a significant reduction in rate of infection and hospitalization utilizing an approach in which the biopsy needle is passed into the prostate thru the perineum using a free hand technique under constant ultrasound monitoring.

A retrospective study was performed on 213 patients from Jan. 2012 to Oct. 2013. The patients did not receive bowel prep or antibiotics preoperatively. Patients were offered the option of sedation or local anesthesia. An IV was placed to administer a dose of cefazolin. The patient was placed dorsal lithotomy and propofol was administered IV. A transrectal ultrasound of the prostate was performed for measurement and identification of potentially pathological regions. A 14-gauge needle was placed into the perineum at the mid prostate. A total of 10ml of 2% lidocaine was infiltrated into the skin, subcutaneous tissue and pelvic floor. Under ultrasound supervision, the biopsy gun was placed and reintroduced thru the 14-gauge needle into the prostate meeting up with the location of the ultrasound image. Three separate regions of the prostate were sampled; far lateral, mid prostate and apical. Based on the size of the prostate, 2-4 samples were obtained from each region. The patients were instructed to avoid lifting for 24 hours.

A total of 213 patients underwent biopsy from January 2012 to October 2013. All patients opted for sedation. All surgical procedure times were no more than 10 minutes, and the total procedure room time, no more than 15 minutes. No patient suffered a urinary tract infection nor were hospitalized within 30 days post-procedure. No patients experienced urinary retention requiring a foley, or treatment for hematuria. Out of the 213 patients, 136 biopsies were positive for cancer (63.8%).

We have demonstrated that a free hand transperineal technique can be performed safely and requires no more procedure or OR time than that of a transrectal technique. Most importantly, infection and hospitalization rates were zero. We have demonstrated that the free hand transperineal ultrasound guided prostate biopsy represents a safe and accurate alternative to the transrectal approach.

Funding: None