REsUlts

We identified 19 eligible trials: ten randomised trials, seven prospective trials and two retrospective trials. Four of the randomised trials originated from Europe, two from Asia, one from North America, two from South America and one from Canada. Two retrospective studies from DK were identified. A total of 295 papers were excluded; 18 were not available in English, 275 were irrelevant (eg case reports) and two papers were not available in full text. The study characteristics are listed in table 1.

Post-biopsy complications were described in all of the included trials. Non-infectious complications, regardless of study type, included haematuria (14.3-62.3%), haemospermia (17.8-59.1%) and rectal bleeding (4.8-21%)[6-13]. The post-biopsy infectious complications ranged from post-bioptic positive urine cultures (0.9-18.1%), urinary tract infection (UTI)(0.8-9.3%), prostatitis (0.67-0.7%), epididymitis (0.4%) and dysuria (0.4-13.3%), to more severe complications such as fever (0.3-8.6%), need for hospitalisation (0.4-3.1%), sepsis (0.17-5.7%), septic shock (0.2-0.45%) and death (0.2%)[6, 7, 9-22].