Transperineal prostate biopsy (TPB) is increasingly favoured for its diagnostic precision and lower infectious risk compared to transrectal approaches. Despite its advantages, acute urinary retention (AUR) remains a notable complication following TPB. While alpha-blockers have shown benefit in reducing AUR following transrectal biopsies, their effectiveness in TPB has yet to be clearly established. This review explores the existing literature to determine whether peri-procedural alpha-blockade can lower AUR incidence in TPB patients.

A systematic search was conducted using Ovid MEDLINE and Embase databases. Search terms included “transperineal” and “urinary retention,” and studies were selected based on predefined eligibility criteria. Studies evaluating peri-procedural alpha-blocker use and post-biopsy urinary retention outcomes were included for qualitative synthesis.

From 361 screened articles, five met inclusion criteria. Notably, no randomized controlled trials were identified. One observational study reported a reduction in AUR incidence from 12.5% to 5.3% with a single peri-operative dose of tamsulosin. In contrast, two other studies suggested a potential increase in retention risk with tamsulosin, though both were limited by retrospective designs and heterogeneous protocols.

Preliminary data suggest that peri-operative alpha-blockers may reduce the risk of acute urinary retention following transperineal prostate biopsy. However, findings across available studies are mixed and limited by methodological variability. While there appears to be a potential therapeutic role, well-designed prospective trials are needed to confirm these benefits and inform evidence-based clinical guidelines.