Background: In patients suspicious of prostate cancer, a prostate biopsy should be done. Biopsies are viable either via the transrectal or transperineal routes. As compared with the Transrectal Prostate Biopsy (TRPBx), Transperineal Prostate Biopsy (TPPBx) gives a non-inferior most cancers detection price. Aim: This work aims to determine the safety of the Transperineal (TP) vs. Transrectal (TR) Approach for the prevention of infectious complications after prostate biopsy. Materials and Methods: A systematic search was performed over different medical databases to identify Urology studies, which studied the outcome of the TP group versus the TR group of prostate biopsy patients. Using the meta-analysis process, either with fixed or random-effects models, we conducted a meta-analysis on the rate of infectious complications as a primary outcome (including fever, urinary tract infections, and sepsis), and urine retention and hematuria as secondary outcomes. Results: Seven studies were identified involving 1242 patients, 642 in the TP group and 654 in the TR group. The meta-analysis process revealed a highly significant decrease in the rate of infectious complications in the TP group compared to the TR group (p<0.01). Also, there was a non-significant difference in the rate of urine retention and hematuria in the TP group compared to the TR group (p>0.05 respectively). Conclusion: To conclude, our study indicated that transperineal prostate biopsy has the same diagnostic accuracy as a transrectal prostate biopsy; however, a transperineal prostate biopsy is safer and more valuable because it poses a significantly lower risk of infection and rectal bleeding. Despite the increased risk of pain after TP biopsy, we recommend that doctors should perform a transperineal prostate biopsy if possible.
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