Impact of pelvic biometric measurements and visceral obesity on complications after open radical prostatectomy

Objective: To investigate the impact of pelvic biometric measurements, visceral and subcutaneous adipose tissue areas on trifecta outcomes (cancer control, continence, and potency) and surgical magrin status after open radical retropubic prostatectomy. Method: A retrospective study was performed on 270 patients who were diagnosed as clinically localized prostate cancer between 2005-2011 and had computed tomography imaging before radical retropubic prostatectomy operations. Pelvic bony and soft tissue measurements, the area of visceral and subcutaneous adipose tissue calculations were performed. Patients were evaluated for trifecta outcomes and surgical magrin status on univariate and multivariate analyses. Subgroup analysis was performed for prostate volume, body mass index (BMI) and D'Amico risk classification. Results: The age of the patient, pre-operative prostate specific antigen value, symphysis pubis angle and the ratio of width of prostate to bony femoral width (prostate/femoral width), demonstrated significance for trifecta outcomes (P < 0.05). Soft tissue index (ratio of soft tissue width of narrowest distance between the levator muscles to apical depth of the prostate) was statistically significantly lower when prostate volume > 60 cm3 (P < 0.05). Visceral adipose tissue area and prostate/femoral width showed significance when BMI < 25 kg/cm2 (P < 0.05). In the low risk group of D?Amico classification, prostate/femoral width was significantly lower (P < 0.05). The age of the patient, pre-operative prostate specific antigen value, prostate volume and width of prostate demonstrated significance for surgical magrin status (P < 0.05). On multivariate analyses pre-operative prostate specific antigen value, symphysis pubis angle demonstrated significance for trifecta outcomes (P < 0.05) and pre-operative prostate specific antigen value demonstrated significance for surgical magrin status (P < 0.05). Conclusions: Narrow symphysis angle is an independent risk factor for trifecta failure. Pelvic biometric measurements and visceral fat area might help preoperative planning and management of radical prostatectomy.