Circumcision error leads to Peyronie’s disease

Dawn Collins, JD

A 59-year-old New York man underwent a circumcision in 2008. The procedure was intended to relieve an inflammation of the glans and was performed by a urologist.  

The patient later claimed the procedure was performed improperly and resulted in Peyronie’s disease, with a 90-degree curvature during erection that caused sexual dysfunction and emotional distress for both him and his wife. Surgical correction had been recommended to the patient, but he chose not to have the operation.

The man and his wife sued the urologist and his group, and claimed the urologist failed to properly locate one of the two incisions for the circumcision and that they were not properly sutured. He argued the urologist unknowingly applied a 90-degree rotation of the skin and dorsal vein, which caused tethering to occur during erection.

The urologist contended the circumcision was properly performed and the patient’s curvature was due to a previously asymptomatic Peyronie’s condition, which was exacerbated after the circumcision procedure. The patient countered this, stating he had only minor plaque that could not have caused the large curvature. The jury returned a verdict for the patient and his wife and awarded $1,475,000.

LEGAL PERSPECTIVE: In this case, the parties had reached a high/low agreement prior to the jury’s verdict. In a high/low agreement, a limit is set on the amount of money the plaintiff will receive if the jury finds for the plaintiff, regardless of the amount they award in damages. A “low” amount is also agreed upon as compensation to the plaintiff, even if the verdict is for the defense. This guarantees the patient will get something, in return for limiting the amount to be paid if he wins the case. This type of arrangement is used to ensure a reasonable amount of monetary recovery for a plaintiff, instead of risking a “runaway” jury decision that awards a highly inflated amount in damages. In the case above, the high/low agreement was a $1 million/$125,000, so the recovery for the plaintiff was the agreed-upon $1 million.

Continue to next page for additional cases, including ones involving infection following prostate biopsy; complications following repair of penile pump malfunction; and overwhelming sepsis after diagnosis of renal stones.

Infection following prostate biopsy

A 73-year-old Illinois man had a repeat PSA level drawn in 2006, and it revealed a level of 3.92 ng/mL, which was an increase from his 2005 level. The patient was referred to a urologist, who 1 month later recommended a transrectal ultrasound-guided biopsy of the prostate.

A 12-sample biopsy was performed a month later and the pathology report came back as normal. The patient, however, had developed an infection in his urinary tract, which was found to be Escherichia coli and was resistant to the antibiotic that was given after the procedure.  The infection spread, and he was found to have an abscess in his spine and developed osteomyelitis. Emergency surgery was performed, but the patient did not recover and died 2 months after the biopsy was performed.

In the lawsuit that followed the man’s death, the claim was that the urologist was negligent in failing to offer to repeat the PSA test and to confirm the result and rate of rise. The contention was that the biopsy was unnecessary because the chances of the patient dying from prostate cancer were not very high, and he was not a good candidate for the biopsy due to his age, morbid obesity, congestive heart failure, diabetes, hypertension, sleep apnea, diverticulitis, Barrett's esophagus, high cholesterol, glaucoma, and taking warfarin (Coumadin) for atrial fibrillation.

The urologist claimed that the patient was properly informed of the risks of the biopsy and informed consent was obtained. She also argued that both the patient and his daughter rejected an offer to repeat the PSA test and requested the biopsy. A $1,808,075 verdict was returned in favor of the man’s estate.

Rupture of prostate abscess

A Missouri man was admitted to a hospital in 2009 with a diagnosis of prostate abscess. He was seen by a urologist, who prescribed antibiotics for treatment.

Seven days later, the abscess ruptured, and the patient subsequently developed a gangrene infection of the penis, scrotum, perineum, and pelvis. He was hospitalized for a month, and while he recovered, he now suffers erectile dysfunction, post-void dribbling, and pain.

The man sued the urologist and his group, claiming the urologist was negligent in failing to drain the abscess when it failed to respond quickly to antibiotic treatment.

The urologist contended that antibiotic treatment was proper and once the culture results were back, the antibiotics were changed according to the sensitivity report. He also claimed that when the patient’s clinical condition worsened, he had developed pneumonia of unclear etiology, which made anesthesia for a drainage procedure more dangerous. The jury found the urologist 100% at fault and awarded $4.3 million.

Complications following repair of penile pump malfunction

A 46-year-old man with diabetes was treated by a urologist for erectile dysfunction. The patient underwent a penile hydraulic pump insertion in 2001.

In 2009, he complained that the pump was not working properly, and his urologist performed a repair surgery that replaced the pump but left the original reservoir tip. The penile pump did not work properly after this operation, and an additional repair was done a month later, during which the physician noted that the tubing in the implant was damaged and repaired it. The patient developed a scrotal infection related to leakage from the implant, which caused ongoing numbness and pain and some erectile dysfunction.

The man sued the urologist and alleged negligence in not testing the reservoir for leakage before finishing the operation.

The urologist claimed that the hole in the tubing developed in an unknown manner that was not due to negligence and that the infection was a known risk of the surgery. He also claimed that the risk of infection was higher for the patient due to his having diabetes. A defense verdict was returned.

Renal artery transected during lymph node dissection

A 61-year-old New York man, who was a nephrologist, underwent a procedure to remove a cancerous kidney at a New York medical center. Subsequently, he required a lymph node dissection in the retroperitoneal region to address any metastasis. The procedure was performed by his urologist, who attempted a minimally invasive laparoscopic approach. The operative area could not be adequately accessed, so the operation was converted to an open procedure, which was performed by a second urologist assisted by an oncologist and a resident. The renal artery was transected during the procedure and was repaired by two additional surgeons. Two days, later the patient suffered a fatal myocardial infarction.

A lawsuit was filed on behalf of the patient’s estate against all of those involved with his care and claimed the death was due to the trauma from the damage to the renal artery. The case ultimately went to trial against only the second urologist who was involved with the artery laceration. The claim was that he used a midline incision that did not allow proper visualization of the renal artery and that a lateral incision through the 10th rib should have been used.

The physician claimed that the operation was performed properly and that the artery injury was a known risk of the procedure that was recognized and repaired immediately. A defense verdict was returned.

Overwhelming sepsis after diagnosis of renal stones

A 38-year-old Louisiana woman went to an emergency room with lower left flank pain, nausea, and vomiting. She was seen by a resident, who diagnosed bilateral kidney stones causing obstructive uropathy. He started her on a renal stone protocol, which included naproxen (Naprosyn), oxycodone/acetaminophen (Percocet), and promethazine (Phenergan). The patient was discharged and told to follow up with a urologist in a week and to return to the emergency room if her symptoms did not improve or worsened.

She continued to have the same symptoms and her husband called the hospital the next day. He was told she should drink fluids. He called again the next day when her condition worsened and was told to bring her to the hospital. The patient was taken to another hospital, where she was diagnosed with sepsis and multi-organ system failure. She required a lengthy hospitalization and surgical treatments.

The patient sued those involved with her care and alleged negligence in the failure to administer antibiotics when she was first seen in the emergency room and claimed she should have been admitted for observation and further treatment at that time.

The defense claimed that there was no evidence of infection when she was first seen and that she should have returned to the hospital sooner as instructed, and a defense verdict was returned.UT

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