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No, definitely didn't mean to promote transrectal - but to be fair, they are both transrectal, one just puts the needle into the rectum as well as the probe, the other only puts the probe in the rectum. That being said, it seems like the prevailing thought is that transperineal does not require anesthesia. I even read that on the Mayo page. So, although I slightly wish I had looked for someone who did transperineal (and actually the doctor who did mine has done them before, but the facility doesn't have the equipment for it and it is a very large medical group with campuses all over a very very large city). However, even with transperineal I would still request the procedure without anesthesia since most of what I read says it isnot required. Anesthesia is not without risk (although lower risk than sepsis) but I don't always react well to it. I have had huge blood pressure drops after multiple procedures that used anesthesia. Twice it involved me blacking out, falling and getting injured. (Talking bp's around 70/38)
But yeah, if my doctor has said "you would only be in the hospital for a few days" - I would probably have gone home and started calling other offices to find a different doctor and caneclled the procedure with him. I agree that is callous and also adding unnecessary stress,
Although it was very painful during the procedure, I would like to follow up and say within a few hours it became a very dull ache type pain, not bad at all. Also, after that initial blood clot-ish ejection the first time I urinated briefly after the procedure, I have not seen anything else like that (in maybe 5 more trips to the bathroom). One time did see the slightest hint of pink at the beginning. So I'm glad about that. Also, havent seen much blood coming out the other side.
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@spaceguy
Correct. But the difference is that nothing goes through the rectum when doing transperinal. The probe just sits in there (I had MRI/Fusion) procedure. The biggest difference is the needle under transrectal goes through the rectum where transperinal does not.
I preferred anesthesia. Many like me have a high anxiety stress issue and the procedure can and does cause a lot of stress and anxiety. With transperenial done with anesthesia (mine done this way at Mayo Jacksonville) there is no stress or anxiety and for me no pain or discomfort at all. I did not want the additiona risk of infection. I have read on MCC so many that did have it done transrectal the severe stress it caused when they did get infection and what they went through in hospital. It is important the risk is low (1-2%) but it is there and those that get infected will tell you would never have it done transrectal again.
For those reading this post I have copied the difference below from medical forum of the differences between the two so they know our posts are saying same thing.
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- Rectal (Transrectal) Biopsy: Yes, this method does go through the rectum. A needle is inserted through the rectal wall, typically guided by an ultrasound probe placed inside the rectum. It's commonly used for prostate biopsies but carries a slightly higher risk of infection due to the rectal bacteria.
- 🧪 Transperineal Biopsy: No, this method does not go through the rectum. Instead, the needle is inserted through the perineum — the skin between the scrotum and anus — while the ultrasound probe remains in the rectum for guidance. This approach reduces infection risk and allows better access to certain areas of the prostate.
So in short: rectal biopsies go through the rectum, while transperineal biopsies bypass it but still use rectal ultrasound for imaging.