Ureter injured during colostomy reversal

September 23, 2014

Other cases discussed in this installment of "Malpractice Consult" include chronic testicular pain following vasectomy and a claim that a spinal tumor should have been found during treatment for post-vasectomy urinary problems.

 

Dawn Collins, JDMs. Collins

A 63-year-old Pennsylvania woman went to the emergency room in 2010 due to nausea and vomiting. An abdominal/pelvic computed tomography scan revealed a constricting lesion in the sigmoid colon, possibly indicative of malignancy or diverticulitis. 

Related - Bowel perforation follows TCC surgery, leads to suit

A surgeon was consulted and the patient underwent an open sigmoid resection, decompression of the colon, and colostomy. She was discharged after about a week, and was seen within the next month by a nurse for ostomy-related in-home care.

The following month, the patient returned to the hospital with complaints of abdominal pain for 4 days after she had moved some heavy luggage. A CT scan revealed a large parastomal hernia, but no evidence of obstruction.

Eleven days later, she was seen by her surgeon, who noted a mild hernia next to the colostomy. The patient was given information regarding colostomy reversal and 6 days later she underwent this procedure, including a repair of the hernia. Postoperatively, the patient was diagnosed with a ureter injury that required a cystoscopy and ureteroscopy with placement of a nephrostomy tube. A few months later, a ureterolysis and ureteral reimplantation were performed.

The woman sued the surgeon and claimed that actions should have been taken to protect the ureter due to her prior surgeries, including placement of a stent prior to surgery by a urologist.

The physician argued that injury to the ureter is a known complication of the procedure and the patient was informed of this prior to the operation. A defense verdict was returned.

 

Next: Chronic testicular pain following vasectomy

More Malpractice Consult

Penile implant extrusion prompts litigation

Circumcision error leads to Peyronie’s disease

Missed follow-up leads to stage IV renal cancer, death

 

Chronic testicular pain following vasectomy

A 34-year-old New York man underwent a vasectomy in 2008, performed by his urologist. The patient developed chronic testicular pain, a spermatocele, and a hydrocele. He underwent removal of the hydrocele and a portion of the spermatocele in 2010, but continues to have pain.

The man sued his urologist and claimed lack of informed consent in that he was not told of the risk of chronic testicular pain syndrome.

The urologist argued that chronic testicular pain syndrome is not a significant risk of a vasectomy procedure and a defense verdict was returned.

LEGAL PERSPECTIVE: The standard of care for a risk/benefit discussion in obtaining informed consent does not require the disclosure of all possible risks and complications ever known to be associated with the particular procedure. Most states use a reasonable person standard; that is, a reasonable amount of information that a reasonable person would need to make a decision whether or not to have a procedure. In this case, the patient claimed that chronic testicular pain should have been discussed since “30% of vasectomies” result in this syndrome. As published recently in Urology Times ("How to manage testicular/groin pain: medical and surgical ladder"), it is estimated that some chronic pain is present in 1% to 15% of men following vasectomy. The urologist explained that the syndrome is not a significant risk and need not be specifically disclosed, and was successful in defending this case.

Claim that spinal tumor should have been found 2 years earlier

A Missouri man underwent a vasectomy in 2008, which was performed by his urologist. The patient had continuing urinary problems for years and eventually underwent prostate surgery 2 years later.

His problems with urinary and bowel incontinence worsened and he went to another urologist, who referred him to a neurosurgeon. A spinal tumor was found and the neurosurgeon performed an operation to remove it in 2012.

The man sued his first urologist and claimed he should have diagnosed the tumor 2 years earlier during treatment for his urinary symptoms.

The physician claimed the patient’s urinary retention was normal 4 months after his prostate surgery, and the patient failed to return for a follow-up appointment after that exam. He argued that the patient did not seek a second opinion for another 15 months, over which time his symptoms had worsened and the spinal tumor was then diagnosed. A defense verdict was returned.UT  

Subscribe to Urology Times to get monthly news from the leading news source for urologists.