Dawn Collins, JDA 68-year-old California man with a diagnosis of prostate cancer underwent a surgical procedure to remove all of the prostate gland and some of the tissue around it. During the operation performed by his urologist, a surgical stapler misfired and caused a 1-inch tear in the rectal wall. This caused bleeding necessitating a blood transfusion. The urologist repaired the tear with a two-layer closure and placement of cadaveric fascia.
Also by Dawn Collins, JD: Patient dies after prostatectomy; is his urologist at fault?
Following the operation, the patient was able to urinate almost normally, but developed a rectal fistula as well as a bladder neck contracture and now has erectile dysfunction.
The patient sued those involved with the operation, alleging they failed to consult a general surgeon. The patient claimed the urologist could not distinguish between the prostate and the rectum, resulting in the rectal tear, and that he should have called a surgeon before attempting the repair. The patient further alleged that the use of cadaveric tissue aided in the breakdown of the repair and development of the fistula.
The physician argued that the standard of care was met, that this was a known complication of the procedure and the patient accepted the risk, and that despite the complications the operation removed all the cancer, and the patient’s cancer is cured. A defense verdict was returned.
LEGAL PERSPECTIVE: In this case, the patient also made a lack of informed consent allegation regarding the “non-nerve-sparing” aspect of the operation. Often, this additional claim is made and supported by a lack of documentation in the medical record of any informed consent discussion. Here, however, the urologist successfully defended this claim by arguing that the “non-nerve-sparing” aspect was discussed by showing that a risk/benefit discussion took place with both the patient and his wife on two separate occasions. It is prudent to document this risk/benefit discussion in the chart and include alternative treatment options, and that the patient consented to the operation.
Next: Sepsis after urologic surgery
A 47-year-old Massachusetts man underwent surgery performed by his urologist. He developed a postoperative infection that caused megacolon, which resulted in sepsis and ultimately his death.
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A lawsuit was filed against the urologist on behalf of the patient’s estate and alleged the urologist allowed the infection to spread as a result of continuing to administer prophylactic antibiotics in excess of the recognized 24-hour window, which delayed the diagnosis of infection and sepsis.
The urologist denied liability and disputed that anything he did or did not do caused the infection, and said that the infection was fatal despite any delay in diagnosis.
The parties agreed to a $2.5 million confidential settlement prior to trial.
A 60-year-old Arkansas man underwent a second penile implant surgery in 2008. He had had erectile dysfunction since his early 40s, and his first implant had become infected. The previous implant was removed and the second one inserted.
Prior to discharge from the hospital, the patient had a bowel movement and noticed blood. He was examined by a resident, who documented that the blood appeared to come from his scrotum. The patient went to his postoperative visit with complaints of pain, and the urologist performed a urethroscopy and discovered infection and erosion of the tissue. The urologist removed the penile implant and found part of the implant in the patient’s rectum.
He then underwent a debridement to remove the necrotizing flesh from his penis and address the scar tissue that had developed. Due to the scar tissue, he cannot have another implant and has permanent erectile dysfunction.
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The patient sued the urologist and alleged he was negligent in puncturing the rectal wall during the second implant operation, and negligent for not detecting the perforation immediately post-op. He alleged the bleeding was from the punctured rectal wall and could have been detected by performing a rectal exam, which would have changed the course of the patient’s outcome.
The physician argued that the implant was complicated due to the patient’s excessive scar tissue and that nothing happened in the operation to make him believe that he perforated the rectal wall. He claimed that performing a digital rectal exam would have been extremely painful for the patient. The jury found for the patient and awarded $400,000 in damages.
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