Prostatectomy in factor XI deficiency

Factor XI deficiency, an uncommon inherited coagulopathy characterized by an absence of bleeding history but bleeding after an operation or trauma, has not been reported previously in urologic patients. The diagnosis is made by a specific factor assay after an abnormal partial thromboplastin time and the treatment is fresh frozen plasma. Four patients with factor XI deficiency underwent open prostatectomy and all experienced excessive postoperative bleeding and prolonged hospitalization. Treatment with fresh frozen plasma controlled bleeding in 3 patients, 1 of whom suffered congestive heart failure from the fluid load imposed. The fourth patient bled heavily despite fresh frozen plasma and required several additional procedures and 29 units of blood and packed cells.