Bacteriaemia and bacteriogenic shock in district hospital urological practice.

The incidence of bacteriaemia and bacteriogenic shock was studied in 2 series of patients undergoing urological procedures. In the first series (A), 52 of 4333 urological patients had symptoms of bacteriogenic shock. Twenty-five of these had a positive blood culture, giving an incidence of shock with proven bacteriaemia of 0.58%. In the second series (B) 628 patients had blood cultures taken after urological procedures with an incidence of bacteriaemia of 12.7%. Bacteriaemia is most common after prostatic surgery (transurethral prostatectomy 2.7%, retropubic, prostatectomy 37%, prostatic biopsy 20%), and is usually due to Esch. coli, Proteus species and Ps. aeruginosa. In hospital practice these organisms are unlikely to be sensitive to common antibiotics and initial therapy with an aminoglycoside is justified, while awaiting the results of blood culture.

Intravesical epodyl in the management of bladder tumors: combined experience of the Yorkshire Urological Cancer Research Group.

Of 48 patients with bladder tumors treated with intravesical epodyl 17 have shown a complete remission at some stage of treatment, although several have relapsed later. Partial remission occurred in 20 patients and 11 have shown no improvement or the lesions have progressed. Epodyl is used best as an adjunct to transurethral resection or diathermy of T1 bladder lesions. Even in patients who do not show complete remission epodyl may reduce the incidence of recurrence and the number of lesions. It is useful when rapid recurrence of T1 bladder tumors prevents control by resection or diathermy and it also is beneficial as an emergency measure to control hematuria. Complications are not infrequent and may be severe occasionally. Bone marrow depression has been seen in 2 patients whose bladders showed extensive carcinoma in situ.