MRI Fusion Trans-perineal Prostate Biopsies under Local Anaesthesia
This leaflet contains evidence-based information about your proposed urological procedure. Although we have consulted specialist surgeons and practitioners during its preparation, most of the content is adapted from the British Association of Urological Surgeons (BAUS); so that it represents best practice in UK urology. You should use this leaflet in addition to any advice already given to you.
This leaflet contains evidence-based information about your proposed urological procedure. Although we have consulted specialist surgeons and practitioners during its preparation, most of the content is adapted from the British Association of Urological Surgeons (BAUS); so that it represents best practice in UK urology. You should use this leaflet in addition to any advice already given to you.
Key points
Most common side-effects are bleeding and reduced urinary flow, but infection is rare Many of the prostate cancers that we diagnose are not life-threatening; they may require no active treatment only careful monitoring. |
Do I need any preparation?
While your procedure will be carried out under local anaesthetic, you DO NOT need to fast. You can eat and drink as usual. It is highly recommended that you come well-nourished and hydrated. You need to take your prescription medication as usual. If you are on any anti-coagulant medication (blood thinning medication), please inform your urologist and seek further advice.
What does this procedure involve?
The procedure will be performed using local anaesthetic, in one of our outpatient’s clinics. Sometimes, we do it under a spinal or general anaesthetic in theatre. The procedure involves putting an ultrasound probe into your rectum (back passage) to scan your prostate. Guided by ultrasound and prostate MRI images, biopsies are taken from your prostate through your perineum (the skin between your scrotum and rectum).
What are the alternatives?
- Observation with repeat blood tests & Prostate MRI – Repeating your blood tests and only investigating further if you PSA (prostate specific antigen) levels rise.
- MRI Fusion Trans-perineal Prostate Biopsy of Prostate under general anaesthesia – Although general anaesthesia involves added risks, this approach can be applied if you are not able to tolerate the procedure under local anaesthesia.
What happens on the day of the procedure?
A member of the urology team will give you a container for a urine sample to test for infections. They will also measure and record your vital signs: blood pressure, heart rate, oxygen saturation, and temperature.
Your urologist (or a member of their team) will briefly review your medical history and medications, and will discuss the procedure again with you to confirm your consent.
Details of the procedure
- We position you in special support which allow the surgeon to access the skin behind your scrotum
- We will use an antiseptic solution to clean your perineum
- We will inject local anaesthetic into the perineum skin, this will sting for a few seconds before the area becomes numb
- We than insert an ultrasound probe into your back passage to scan your prostate. This probe uses ultrasound waves to produce an image of the prostate and may show abnormalities within the gland. We overlay a previously taken high-definition image (MRI) onto the live ultrasound image and use an advanced software package (MRI fusion) ensure that the samples are taken with great accuracy
- Guided by ultrasound and MRI, biopsies are taken with the help of a needle, through the perineum (the skin behind the testicles).
- The biopsy needles are guided into position using the ultrasound scanner (pictured) and the MRI Fusion software.
- The number of biopsies taken depends on your PSA level, the MRI report and other risk factors
- We apply a dressing to your perineum.
- The procedure takes 25 to 30 minutes to complete.
- You should expect to go home after couple of hours of the procedure.
Are there any after-effects?
The possible after-effects and your risk of getting them are shown below. Some are self-limiting or reversible, but others are not. The impact of these after-effects can vary a lot from patient to patient; you should ask your surgeon’s advice about the risks and their impact on you as an individual:
| After-effect | Risk |
| Blood in your urine for up to 10 days | Almost all patients |
| Blood in your semen which can last up to six weeks (this poses no risk to you or your sexual partner) | Almost all patients |
| Bruising in your perineal area (space between your testicles and back passage). | Between 1 in 2 & 1 in 10 patients |
| Discomfort in your prostate caused by bruising from the biopsies | Between 1 in 2 & 1 in 10 patients |
| Temporary problems with erections caused by bruising from the biopsies | 1 in 20 patients (5%) |
| Inability to pass urine (acute retention of urine) | 1 in 20 patients (2%) |
| Bleeding in your urine preventing you from passing urine (clot retention) | 1 in 50 patients (2%) |
| Failure to detect a significant cancer in your prostate | Between 1 in 10 & 1 in 50 patients |
| Need for a repeat procedure if biopsies are inconclusive or your PSA level rises further | Between 1 in 10 & 1 in 50 patients |
| Bleeding in your urine requiring emergency admission for treatment | 1 in 100 patients (1%) |
| Infection in your urine requiring antibiotics | 1 in 100 patients (1%) |
| Septicaemia (blood infection) requiring emergency admission for treatment | Less than 1 in 100 patients (<1%) |
What is my risk of a hospital-acquired infection?
Your risk of getting an infection in hospital is between 4 & 6%; this includes getting MRSA or a Clostridium difficile bowel infection. This figure is lower for a day-case admission but higher in a group of patients who have had:
- long-term drainage tubes (e.g. catheters);
- long hospital stays; or
- multiple hospital admissions.
What can I expect when I get home?
- We advise you to drink plenty of fluid (up to 2 litres of water) per day for 3-4 days.
- you will be given advice about your recovery at home
- you will be given 2 doses of antibiotics to take home
- if the bleeding in your urine does not stop, you should contact your GP or specialist nurse or report to nearest accident and emergency.
- if you are unable to pass urine at all, you should contact your GP immediately or go to your local Emergency Department
- we will review the results of your biopsies in a multidisciplinary team (MDT) meeting within three weeks. The MDT comprises of urologist, oncologists, radiologists and histopathologists.
General information about surgical procedures
Before your procedure
Please tell a member of the medical team if you have:
- an implanted foreign body (stent, joint replacement, pacemaker, heart valve, blood vessel graft);
- a regular prescription for a blood thinning agent (e.g. warfarin, aspirin, clopidogrel, rivaroxaban, dabigatran);
- a present or previous MRSA infection; or
- a high risk of variant-CJD (e.g. if you have had a corneal transplant, a neurosurgical dural transplant or human growth hormone treatment).
Smoking and surgery
Ideally, we would prefer you to stop smoking before any procedure. Smoking can worsen some urological conditions and makes complications more likely after surgery. For advice on stopping, you can:
- contact your GP;
- access your local NHS Smoking Help Online; or
- ring the free NHS Smoking Helpline on 0300 123 1044
Driving after surgery
It is your responsibility to make sure you are fit to drive after any surgical procedure. You only need to contact the DVLA if your ability to drive is likely to be affected for more than three months. If it is, you should check with your insurance company before driving again.