The high mortality from septic shock in urologically ill patients can only be diminished by early diagnosis and treatment of the sepsis. However, there is no defined, steady sign from which the precise diagnosis septic shock can be established. Therefore the critical patient has to be controlled by a system that covers numerous signs that contribute to the diagnosis. Once septic shock is established its outcome depends on how early the failure of the microcirculation can be eliminated. The therapeutic approach is based on an improved cardiac output achieved by adequate volume therapy and positive inotropic drugs. For this reason the actual circulatory failure has to be defined and each therapeutic step has to be controlled using the Swan Ganz thermodilution catheter. The microcirculatory failure can be treated directly with dextran 40 and with specifically chosen vasoactive drugs. Disorders of the blood gases and base excess have to be corrected immediately. Treatment of acute renal and respiratory failure is mentioned.