Nerve injury during sling procedure prompts suit

A Connecticut woman suffered from non-stress-related urinary incontinence. She underwent placement of a retropubic midurethral sling, which was performed by her urologist. She subsequently sued the urologist, claiming that the surgery was improperly performed and that her obturator and femoral nerves were injured and caused her lumbar back pain and weakness in her legs. She had additional surgery to remove the original implant and place another.

The physician claimed that the operation was properly performed, that the patient did not sustain nerve damage to the extent she claimed, and that any nerve damage was due to her inflammatory response to the surgery. He maintained that the patient recovered from her nerve-related complaints, and her back and leg problems were unrelated to the surgery. A defense verdict was returned.

LEGAL PERSPECTIVE: In medical malpractice cases, the usual damages claimed are actual economic expenses related to the injury caused by the negligence of the practitioner(s) and non-economic damages to the extent allowed by state laws. Alleged damages from the injury must be shown to be proximately related to the negligence, however, and some states have a cap on the amount that can be awarded for non-economic claims.

In the case above, the woman claimed her damages from the negligent nerve injury included pain and weakness in her legs and a second operation to replace the sling. She also claimed that the negligent performance by the physician caused lumbar back pain, requiring placement of a sacral neuromdulation device (InterStim) for pain. She additionally alleged the leg weakness and back pain caused her to fall and fracture an ankle, which required open reduction with internal fixation, all adding to the amount she was seeking for damages, asserting that proper performance of her initial operation would have avoided the pain and suffering from all these injuries. The physician was able to convince the jury that either no negligence occurred or that her injuries claimed were unrelated to the operation.

Alleged failure to treat kidney stone results in sepsis

A 71-year-old Virginia woman began seeing a urologist in 2008. The physician found a 6-mm kidney stone and told the patient it should pass. The next month, she went to an ER with renal colic due to the stone blocking the ureteral junction. Over the next 10 months, the patient was seen in the urologist’s office nine times, each time treating her for a urinary tract infection. In late 2008, the patient inquired about lithotripsy, but the urologist advised her that she could pass the stone.

Five months later, the patient went to an ER writhing in pain, and a magnetic resonance imaging scan disclosed severe hydronephrosis with an 8-mm stone completely blocking flow to the ureter. She was given pain medication and told to follow up with her physician, which she did the next morning. The urologist reviewed the MRI and ER reports and told her the stone was too big to pass and that drainage of the kidney, with placement of a double-J stent followed by lithotripsy, was needed.

He did not have privileges to perform these procedures, and the patient was sent home with instructions to continue the pain medication and an antibiotic. His office personnel contacted another urologist to do the procedure but were told there were no openings for over a month. No other attempts were made to schedule the procedure sooner or provide further instructions to the patient.

The patient’s condition deteriorated, and she was emergently transported to a hospital and admitted with systemic sepsis. The kidney was immediately drained, but the woman suffered severe vasoconstriction and subsequent necrosis of her fingers and toes from the medications used to maintain her blood pressure. She was hospitalized for 3.5 months and underwent amputations of the tips of 19 of her digits. She also had dysgeusia from protracted intubation and required more than a year of outpatient physical and occupational therapy.

The woman sued the original urologist and alleged negligence in the treatment of her kidney stone, arguing that she should have been referred emergently for treatment when the stone was found to be blocking flow to the ureter. The physician denied any negligence, but the jury returned a $2.7 million verdict for the patient. This was reduced to $2 million according to the state’s cap on damages.

Complications follow laser prostatectomy

In 2006, a 61-year-old Illinois man went to a urologist and underwent a laser prostatectomy due to a long history of BPH. He subsequently had total urinary incontinence and underwent two cystoscopies, which both found the sphincter in a fixed open position. A second urologist performed a cystoscopy and found not only a fixed open position of the sphincter, but a cut in the sphincter that could only have been caused by the laser. The patient required two operations to implant an artificial urinary sphincter. He claimed he suffered severe depression and sexual dysfunction due to the incontinence.

The man sued the urologist who performed the laser surgery, alleging negligence in the failure to identify the external urinary sphincter before activating the laser and cutting the urinary sphincter with the laser, causing it to become completely non-functional.

The physician argued that the cut was not present during the first two cystoscopies and maintained that the urinary incontinence was due to a traumatic Foley catheter inflation in the urethra that blew out the sphincter when the catheter balloon was inflated in the urethra instead of the bladder. A defense verdict was returned.UT