We have attempted to lessen blood transfusion requirements during radical retropubic prostatectomy. The influence of temporary occlusion of the hypogastric arteries, anesthetic techniques and autologous blood transfusions were studied in 93 men undergoing radical retropubic prostatectomy with pelvic lymph node dissection. Operations performed with the patient under general or regional anesthesia with hypogastric artery clamping required significantly less blood replacement than those performed without hypogastric artery clamping (1.8 plus or minus 0.3 versus 3.5 plus or minus 0.3 units, respectively, mean plus or minus standard error). Preoperative autologous banking of blood eliminated the need for heterologous transfusions in 10 of 15 patients in whom any autologous blood was banked (2 to 4 units per person). We conclude that temporary hypogastric artery clamping can reduce significantly the need for blood product replacement in radical retropubic prostatectomies during the perioperative period. We also are encouraging the preoperative banking of autologous blood to lessen further exposure to heterologous blood products with their attendant risks.