Impact of morphological features as measured by magnetic resonance imaging on surgical difficulty encountered during retropubic radical prostatectomy

A large prostate and a narrow pelvis were thought to produce difficulties during prostate surgery. We assessed the impact of the morphological features of the prostate and bony pelvis on the operative difficulty of open retropubic radical prostatectomy (RRP). We analyzed the data of 80 patients who underwent RRP for localized prostate cancer without prior therapy. Estimated blood loss (EBL) and operation time (OT) were taken from the anesthesiology record. Preoperative magnetic resonance imaging (MRI) allowed the morphological parameters of the bony pelvis and the prostate to be measured. The relationship among EBL, OT and each of the morphological parameters was assessed using Pearson bivariate correlation analysis. Longitudinal diameter and prostate volume had a significant association with EBL and OT. Although none of the pelvic bone parameters were statistically significant, a steep pubic bone-prostate (PP) angle was significantly associated with increased EBL and OT. The PP angle, a newly developed parameter, is representative of the surgical space between the pubic bone and the prostate. A narrow working space beneath the pubic bone is liable to cause trouble when RRP is being performed.