Background: Open simple prostatectomy has long been associated with large blood
losses; hence allogeneic blood transfusion in this procedure is a standard practice
world over. A review of literature suggests significant association between perioperative
blood loss accompanying open simple prostatectomy and certain patient
factors.. The shortage of blood and blood products in our blood transfusion centres
as well as the alarming risks of transfusion reactions and disease dissemination
demanded a review of these factors with the aim of reducing morbidity associated
with peri-operative blood loss and blood transfusion.
Objectives: To assess blood loss, determine blood transfusion rate, and define some
of the factors associated with peri-operative blood loss and blood transfusion in open
simple prostatectomy.
Design : A prospective cohort study.
Settings: The urology units of Kenyatta National Hospital, Kenya.
Results: Ninety five patients who underwent open simple prostatectomy for benign
prostatic hyperplasia were enrolled into the study. Their median age was 70 years
(Range 50 to 97). The mean decrease in haemoglobin concentration, which was the
main indicator of peri-operative blood loss, was 2.1g/dl (± 1.4). The peri-operative
blood transfusion rate was 36.8%. Twenty four (68.6%) of the patients who received
either one or two units of blood had a pre-operative haemoglobin level above 13.5g/
dl and a post-operative haemoglobin level above 11.5g/dl, while 11 (31.4%) had
severe peri-operative bleeding, that necessitated immediate surgical re-intervention.
A total of 68 units of blood was transfused, 42 (61.8%) allogeneic and 26 (38.2%)
autollogous blood. The post-operative median hospitalisation time was eight days
(Range 4 to 35). There were two (2.1%) post-operative deaths and both patients had
intractable intra- and post-operative bleeding, massive blood transfusion and
disseminated intravascular coagulopathy. The factors that were significantly
associated with peri-operative blood loss and blood transfusion in open simple
prostatectomy were patient’s aged above 70 years, pre-operative use of acetylsalicylate
or warfarin sodium, pre-operative systolic blood pressure above 140mmHg,
general anaesthesia, Freyer’s (transvesical) technique and the weight of resected
prostatic tissue above 70 grams.
Conclusion: Open simple prostatectomy performed under spinal anaesthesia using
Millin’s (retropubic) technique is associated with minimal blood loss. The perioperative
blood transfusion rate was 36.8%.


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