Preoperative pelvimetric and prostatic measurements as predictors of intraoperative blood loss in open transvesical...

Open transvesical prostatectomy (OTP) is still used for the treatment of benign prostatic obstruction (BPO) in patients with large prostate volumes, particularly where endoscopic techniques are not available. Intraoperative bleeding remains an important concern, but reliable preoperative predictors have not been established. This study aimed to investigate whether preoperative pelvic imaging features are associated with intraoperative blood loss in OTP.

We retrospectively analyzed 60 patients who underwent OTP between 2018 and 2025. Preoperative magnetic resonance imaging or computed tomography was reviewed to obtain pelvic and prostatic measurements. Estimated intraoperative blood loss was extracted from operative notes. Correlation and multivariate regression analyses were performed to explore potential predictors.

The mean estimated blood loss was 183.3 ± 111.7 ml, with a median of 160 ml (IQR: 100-220). Significant correlations were observed with prostate volume (r = 0.44, p < 0.001), apical depth (r = 0.38, p = 0.003), and operative duration (r = 0.36, p = 0.005). In multivariate regression, prostate volume (β = 0.88, p < 0.001) and apical depth (β = 0.54, p = 0.020) remained significant independent predictors, whereas other pelvic measurements showed weaker or non-significant associations. The final model explained 32% of the variance in estimated blood loss (R² = 0.32).

Prostate volume and apical depth may provide preliminary indicators of bleeding risk in OTP, while the role of other pelvic dimensions appears limited. These findings should be interpreted with caution due to the retrospective design, modest sample size, and reliance on estimated blood loss. Prospective studies with standardized measurement methods are warranted.