Predicting blood loss during radical prostatectomy using internal pelvimetry

We retrospectively evaluated the possibility of predicting estimated blood loss (EBL) in 39 consecutive patients undergoing retropubic radical prostatectomy (RRP) using pelvimetry under a single surgeon at our institution from April 2004 to March 2006. For pelvimetry, the area of pelvic entrance (APE) and view of prostatic apex (VPA) were evaluated using preoperative images. Other perioperative data were also recorded, including the patient's age, prostate specific antigen (PSA), body mass index (BMI), use of neoadjuvant hormonal therapy, operative time and pathological data (such as pathological T factor and specimen weight). The relationship between these factors and EBL was analyzed. Average EBL was 761 ml (ranging from 232 to 2,149) and autologous blood transfusion was not performed. There was no statistically significant correlation or difference between EBL and perioperative parameters excluding APE, VPA and BMI. Multivariate analysis showed that the most influential factor for EBL was VPA (p = 0.001). A significantly lower EBL was seen in patients with a wide APE (125 or more), good VPA, and acceptable BMI (less than 25 kg/m2) versus other patients (429 +/- 137 ml vs 934 +/- 358 ml, p < 0.0001). Our findings demonstrate the potential of pelvimetric analysis such as the measurement of APE and the evaluation of VPA, as a useful tool for predicting blood loss during RRP. Moreover, these data also indicate that blood preparation may be spared in patients with acceptable BMI, wide APE, and good VPA.