Association Between Prostate Morphology and Intraoperative Blood Loss During Transurethral Resection of the Prostate:...

To evaluate the association between prostate morphology and intraoperative blood loss during TURP.

This prospective observational study included 1120 patients undergoing TURP. Intraoperative blood loss was quantitatively assessed using an endoscopic surgical monitoring system. The transverse and longitudinal diameters of the prostate were measured preoperatively by ultrasonography, and the W/L ratio was defined as the transverse-to-longitudinal diameter ratio. Univariable and multivariable linear regression analyses, nested regression models, and ROC analysis were used to evaluate the association between the W/L ratio and intraoperative blood loss.

The median intraoperative blood loss was 104 mL (IQR 36-214), and the median W/L ratio was 1.06 (IQR 1.02-1.18). Univariable analysis showed that the W/L ratio was negatively associated with intraoperative blood loss. In the multivariable analysis, after adjustment for age, BMI, prostate volume, operative time, Q _max, 5-ARI use, and surgeon experience category, the W/L ratio remained independently associated with intraoperative blood loss (B = - 45.957, 95% CI: -89.229 to -2.684, p = 0.037). Nested regression models showed that the addition of the W/L ratio increased the model R ² from 0.444 to 0.446, indicating statistically significant but limited incremental information. Exploratory ROC analyses yielded AUCs of 0.816 and 0.791 for intraoperative blood loss thresholds of ≥ 300 mL and ≥ 400 mL.

A lower prostate W/L ratio was independently associated with greater intraoperative blood loss during TURP. Although its effect size was smaller than those of operative time and prostate volume, the W/L ratio may serve as an adjunctive morphometric marker that is readily available from preoperative imaging. Trial Registration: Chinese Registry of Clinical Trial: ChiCTR2400088743.