Transrectal prostatic ultrasound and transperineal biopsy

What is this?

This procedure involves using an ultrasound probe, inserted via the back passage, to scan the prostate. Biopsies are taken through the skin behind the testicles (the perineum) using a special grid shown below. The sampling is targeted and the number of samples taken depends on the size of the prostate, usually ranging from 30 to 50 samples. The reason this approach is adopted is because you have already undergone a number of biopsies previously (via the rectum) which have not identified the cause of your elevated PSA. Transrectal biopsies, as you have had done before, carry a greater risk if performed in this number.

What alternatives are there?

Observation with repeat blood tests but without biopsies

What to expect before procedure

You will usually be admitted on the day of your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. If you are taking Warfarin, you must inform the clinic staff at your pre-assessment visit so that you are advised when to stop your Warfarin prior to the procedure. Usually you are asked to withold Warfarin for 3 days. A blood test, INR, will be performed prior to your biopsy. If you are taking Aspirin, you do not need to stop these. If you are taking Clopidogrel, you must inform the medical staff because the biopsy may need to be postponed or alternative arrangements made. After checking for alllergies, you will normally be given an intravenous injection of antibiotic at the time of your anaesthetic.

What happens during the procedure?

After the general or spinal anaesthetic has been given, a catheter will be placed in the water pipe (urethra). Your legs will be placed in special supports so that the surgeon can gain access to the skin behind the testicles and insert the ultrasound probe into the rectum. The doctor will examine the prostate through the back passage (anus) before inserting the ultrasound probe. This probe is as wide as a man’s thumb and approximately 4 inches long. In order to take samples (biopsies) of the prostate, a special grid is used so that all areas of the prostate can be covered. The biopsy needs are inserted into the prostate through the skin of the perineum, guided by the ultrasound probe. After the sampling has been completed, a dressing will be applied to the perineum and held in place with a pair of disposable pants.

After the procedure

The catheter will be removed the day after surgery unless you have a fever or a lot of blood in the urine. You will normally be able to go home later the same day after check have been made to ensure that you are passing urine normally. Following this type of biopsy, blood in the urine is common for 2-3 days, with the occasional blood clot, but this should clear quickly if you increase your fluid intake. You may expect to see blood in the semen for up to 6 weeks. You will be given antibiotics to take home for a 3-day period . The average hospital stay is 1 day.

Potential side effects




At Home

When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge. It is important that you:

Any discomfort can usually be relieved by simple painkillers.

What to look out for

If you experience a fever, shivering or develop symptoms of cystitis (frequency and burning on passing urine), you should contact your GP. If there is a lot of bleeding in the urine, especially with clots of blood, you should contact the Urology Department. If you develop a fever outside surgery opening hours, you must telephone the emergency number at your GP surgery so that a doctor can assess your condition.

Other Information

You will receive an appointment for discussion of the biopsy results at the time of your examination. It will be at approximately 14 days before the pathology results on the tissue removed are available. It is normal practice for the results of all biopsies to be discussed in detail at a multi-disciplinary meeting before any further treatment decisions are made. You and your GP will be informed of the results after this discussion. We sometimes need to order additional tests as a result of the discussion at this meeting and, as a result, you may receive appointments for a bone scintigram, CT scan or MRI scan before you are seen again in outpatients.


There is no specific research in this area at the moment but all operative procedures performed in the department are subject to rigorous audit at a monthly Audit & Clinical Governance meeting.

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