MS COLLINS is an attorney specializing in medical malpractice in Long Beach, California. She welcomes feedback on this column via e-mail. Click on the envelope icon to email.
"At trial, the urology expert testified that the defendant urologist failed to offer the patient alternative treatments before proceeding with the drastic option of removing the testicle," writes Dawn Collins, JD.
In 2013, a 54-year-old Pennsylvania man presented to his urologist with pain in his right testicle. An ultrasound showed damage to the testicle, including scarring and atrophy. He had a history of being accidentally kicked in that testicle by his daughter, who has cerebral palsy, 15 years earlier. He suffered from hypogonadism and took testosterone supplements to treat his sexual dysfunctions. He encountered severe pain during intercourse (and subsequent loss of erection) if any contact with the right testicle occurred.
The urologist determined that the man would benefit from a right orchiectomy and removal of the right spermatic cord and vas deferens. The procedure was done a few weeks later, and the next day the patient was informed that the wrong testicle may have been removed.
Also see: BPH patient injured during prostatectomy
An ultrasound was later performed and confirmed that the right testicle remained. After this ultrasound, the man did not return to the urologist and was seen by his primary care physician. After the swelling diminished from the operation, the pain and discomfort returned to the right testicle, and the incidences of severe pain during intercourse increased. The man was fearful of undergoing another operation as it would require him to use hormone therapy for the rest of his life.
The patient sued the urologist and the hospital involved with the surgery. At trial, the urology expert testified that the defendant urologist failed to offer the patient alternative treatments before proceeding with the drastic option of removing the testicle. The expert stated that oral medication, spermatic cord injections, and micro surgery were all less invasive options that he should have considered and pursued before orchiectomy. The expert testified that the urologist removed the wrong testicle because he failed to track or palpate the right spermatic cord up into the body, which he admitted he failed to do. The expert concluded that the urologist was reckless when he assumed that he cut the right spermatic cord without confirmation.
An operating room nurse testified that she looked at the pathology report that noted the specimen removed was the left testicle. She then checked the consent form, which noted a right orchiectomy. To reconcile the discrepancy, she returned to the operating room to show the report and consent form to the urologist, who then backed away from the operating table and sat down for a time period. He eventually got up and put on new gloves and completed the operation. The nurse testified that this was when the urologist realized he removed the wrong testicle, also citing the postoperative report, which stated, “At this point, it appeared that the left testicle and cord may actually have been removed instead of the right one.”
The urologist admitted that he breached the standard of care for removing the left testicle when the right testicle had been planned to be surgically removed. He did dispute, however, the operating nurse's account of the procedure. He argued that he noticed there was a problem when he attempted to perform the left vasectomy and the left testicle was missing. He maintained that he removed the testicle that was on the right side of the scrotum and the testicle had a spermatic cord that led to the left side of the body. The defense expert in pathology noted that the testicle that was removed contained fibrous tissue, which may be caused by trauma and may cause pain.
The plaintiff’s expert in urology refuted the explanation that the left spermatic cord crossed with the right and opined that is anatomically impossible, since the scrotal septum prevents the testicles from moving to different sides, in addition to the fact that the spermatic cords are not long enough to allow such an occurrence. The jury returned a verdict in favor of the patient for $870,000.