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Introduction and objectives <p>Erectile dysfunction (ED) is a concern for men undergoing prostate biopsy. With the increasing adoption of transperineal (TP) biopsy over transrectal (TR) biopsy, it remains unclear which approach carries a lower risk of erectile dysfunction. This study aims to be the first meta-analysis to evaluate erectile dysfunction following TR versus TP prostate biopsy at 1, 3 and 6&#xa0;months intervals, thereby providing clinicians with evidence-based guidance for patient counseling and shared decision-making.</p> Materials and methods <p>This review was prospectively registered on PROSPERO (CRD42024541557) and followed PRISMA guidelines, with searches conducted in PubMed, Scopus, and the Cochrane Library databases up to July 2024. A total of 22 studies reporting erectile function outcomes (IIEF scores) at baseline and 1, 3 and 6&#xa0;months post-biopsy were identified. After applying inclusion and exclusion criteria, 12 studies were included in the final meta-analysis. TR and TP biopsy methods were compared using a random-effects model to assess standardized mean differences (SMD) in erectile function at each follow-up point. The risk of bias for each study was evaluated to ensure result reliability.</p> Results <p>At 1&#xa0;month follow-up, a significant decline in erectile function was observed overall (SMD: − 0.3785, <i>p</i> = 0.038). The TP approach showed a slightly more significant decline than the TR approach; however, this difference was not statistically significant (<i>p</i> = 0.074). At 3&#xa0;months follow-up, no significant differences were observed between methods overall (SMD: − 0.1663, <i>p</i> = 0.132), although TP biopsy alone showed a modest yet considerable decline (SMD: − 0.1868, <i>p</i> = 0.03). At 6&#xa0;months, erectile function had generally returned to baseline, with no significant differences observed between biopsy techniques (<i>p</i> = 0.41).</p> Conclusion <p>Both TR and TP prostate biopsies are associated with a transient decline in erectile function. These effects typically resolve by 6&#xa0;months in most patients, with no significant long-term impact observed. While the initial functional impact may be slightly greater with the TP technique, this difference attenuates over time. These findings are crucial for managing patient expectations post-biopsy.</p>

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Erectile dysfunction following prostate biopsy: a comparative analysis of transrectal versus transperineal approaches

  • 期刊论文

  • 发表日期：

    2025年10月6日

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  • O. Ermis,
  • M. G. Sonmez,
  • A. Tozsin,
  • M. S. Iyisoy,
  • M. Yilmaz,
  • G. Sonmez,
  • O. O. Cakir,
  • A. Aydin,
  • L. Tunc,
  • E. Barret,
  • T. Herrmann,
  • K. Ahmed,
  • S. Guven

摘要

Introduction and objectives

Erectile dysfunction (ED) is a concern for men undergoing prostate biopsy. With the increasing adoption of transperineal (TP) biopsy over transrectal (TR) biopsy, it remains unclear which approach carries a lower risk of erectile dysfunction. This study aims to be the first meta-analysis to evaluate erectile dysfunction following TR versus TP prostate biopsy at 1, 3 and 6 months intervals, thereby providing clinicians with evidence-based guidance for patient counseling and shared decision-making.

Materials and methods

This review was prospectively registered on PROSPERO (CRD42024541557) and followed PRISMA guidelines, with searches conducted in PubMed, Scopus, and the Cochrane Library databases up to July 2024. A total of 22 studies reporting erectile function outcomes (IIEF scores) at baseline and 1, 3 and 6 months post-biopsy were identified. After applying inclusion and exclusion criteria, 12 studies were included in the final meta-analysis. TR and TP biopsy methods were compared using a random-effects model to assess standardized mean differences (SMD) in erectile function at each follow-up point. The risk of bias for each study was evaluated to ensure result reliability.

Results

At 1 month follow-up, a significant decline in erectile function was observed overall (SMD: − 0.3785, p = 0.038). The TP approach showed a slightly more significant decline than the TR approach; however, this difference was not statistically significant (p = 0.074). At 3 months follow-up, no significant differences were observed between methods overall (SMD: − 0.1663, p = 0.132), although TP biopsy alone showed a modest yet considerable decline (SMD: − 0.1868, p = 0.03). At 6 months, erectile function had generally returned to baseline, with no significant differences observed between biopsy techniques (p = 0.41).

Conclusion

Both TR and TP prostate biopsies are associated with a transient decline in erectile function. These effects typically resolve by 6 months in most patients, with no significant long-term impact observed. While the initial functional impact may be slightly greater with the TP technique, this difference attenuates over time. These findings are crucial for managing patient expectations post-biopsy.