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A retrospective review of 61 patients undergoing pelvic lymphadenectomy was performed to assess possible predisposing factors for lymphocele development. The procedure was done to facilitate staging of prostatic carcinoma in all of the patients. The complication occurred in 9 patients (14.8 per cent). Analysis revealed a statistically significantly higher incidence of lymphoceles in patients without drainage (p less than 0.05) and in patients whose lymph nodes had no metastatic disease (p less than 0.025). Furthermore, 9 patients (without drainage and with nodes that were free of tumor but who received mini-dose heparin therapy) as a subgroup had the highest incidence of lymphocele formation. Although these individual factors have been attributed to this complication after lymphadenectomy they may act synergistically.

Piperacillin is a new semisynthetic penicillin with a broad spectrum of in vitro activity against common gram-negative urinary tract pathogens. We compared the efficacy and safety of piperacillin versus carbenicillin in patients with complicated urinary tract infection. A total of 56 adult patients (mean age 55 years) in stable medical condition with 1 or more structural genitourinary abnormalities entered the study. Of these patients 27 were evaluated for antibiotic efficacy. There were 20 lower tract and 7 upper tract infections, of which 17 were acute and 10 were chronic. Patients were randomized into 2 groups: 17 patients with 18 organisms received single agent treatment with 181 mg. per kg. intravenous piperacillin daily for 6 days and 10 patients with 11 organisms received 270 mg. per kg. intravenous carbenicillin daily for 6 days. Infecting organisms were Escherichia coli 45 per cent, Proteus mirabilis 14 per cent, Klebsiella pneumoniae 14 per cent. Enterobacter species 10 per cent, Pseudomonas aeruginosa 7 per cent and so forth. Antimicrobial susceptibility assessed by measurement of minimal inhibitory concentration and disk diffusion zone size demonstrated superior activity of piperacillin over carbenicillin for most micro-organisms tested. All patients responded clinically. The bacteriologic cure rate was 72 per cent at 5 to 9 days after therapy in both groups. Three patients who received piperacillin had urosepsis and were cured. No resistance emerged during therapy. Superinfections developed in 5 patients on carbenicillin (50 per cent) and in 4 patients on piperacillin (24 per cent), and none was resistant to piperacillin. Superinfections were attributed to catheterization and structural genitourinary abnormalities. The over-all incidence of adverse effects in patients on piperacillin was less than that of those on carbenicillin, 31 and 51 per cent respectively. Side effects in both groups were mild and did not require discontinuation of therapy. There were no significant alterations in fluid and electrolyte balance, or hematologic or renal function.

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In this controlled, randomized clinical trial we compared piperacillin and carbenicillin in the treatment of complicated urinary tract infections. 24 patients received piperacillin 150 mg/kg/day for 7.2 ± 2.75 days and 17 patients received carbenicillin 200 mg/kg/day for 7.5 ± 2.90 days. Patients were evaluated for clinical and bacteriologic responses and tolerance to therapy. Although the clinical cure rate significantly favored carbenicillin treatment (p < 0.01), the sum of the percentages of cases with clinical cure and clinical improvement were similar between groups: 91.6% for piperacillin and 88.2% for carbenicillin. The bacteriologic cure rates for piperacillin and carbenicillin patients (54.1 and 47.0%, respectively) were not significantly different (p > 0.05). The low cure rates in our study were probably the result of uncorrected/uncorrectable genitourinary tract abnormalities. Superinfections developed in 12.5 and 17.6% of piperacillin and carbenicillin patients, respectively, and were due to Klebsiella pneumonia, Proteus mirabilis, Citrobacter diversus, and Pseudomonas aeruginosa. Overall, side effects were mild, reversible, and did not require discontinuation of treatment. However, carbenicillin caused elevations in liver enzymes more frequently than piperacillin (p < 0.05). Based on our data, we recommend reserving piperacillin monotherapy for patients who are poor candidates for aminoglycosides, or are on severe sodium restriction, and have serious complicated urinary tract infections due to susceptible organisms. We do not recommend piperacillin alone for empiric treatment of complicated urinary tract infections.