Introduction: Transperineal prostate (TP) biopsy has emerged as a substantial alternative to the conventional transrectal (TR) approach for prostate sampling by its ability to sample specific areas of the prostate more effectively. The objective of this review is to conduct a comparative analysis of the current literature regarding diagnostic accuracy, complication rate and clinical outcome of transrectal vs. transperineal approaches in prostate biopsy-naïve patients and in repeated biopsy scenarios. Materials and Methods: An extensive search of the literature in PubMed, Scopus, and Web of Science was conducted between September 2010 and September 2024. We utilized a robust and comprehensive retrieval strategy including phrasing the two approaches as follows: (perineal or transperineal) and (rectal or transrectal). Conclusions: The transperineal and transrectal approaches show similar results in the detection of PCa in biopsy-naïve men, similar rates of infection, urinary retention and effectiveness managing biopsy-associated pain. However, in the rebiopsy scenario, the TP approach has demonstrated increased accuracy compared to the TR approach. This has significant implications in decision making and patient counselling.

Erectile dysfunction (ED) is a frequent and significant complication of radical prostatectomy that impacts patients’ quality of life. Intracavernous injection treatment has become an important approach to post-prostatectomy ED, providing an immediate and proven means of regaining erectile function in men who are unresponsive to oral phosphodiesterase type 5 inhibitors. The scope of this article is to discuss the mechanisms, efficacy, and safety of ICI treatments using vasoactive compounds as a second-line treatment for ED after radical prostatectomy. We consider clinical results, satisfaction, and compliance, as well as predictors of success, like nerve-sparing procedures. Through our interpretation of evidence and clinical experience, ICI therapy is a cornerstone of penile rehabilitation and ED management following radical prostatectomy. Also, the prospects for further treatment optimization and patient outcomes are discussed.