Ureteral injury to blame for bladder cancer, death?

A 50-year-old Kentucky woman underwent a left nephro-ureterectomy in 2009, which was performed by a urologist, for a golf ball-sized tumor in her kidney. Nine days later, the patient required surgery to repair the right ureter, which had been injured during the initial procedure.

About a year later, she was diagnosed with metastatic bladder cancer by a different urologist. She underwent aggressive intervention, including chemotherapy, but died in 2012, after filing a lawsuit against her original urologist and assistant surgeon.

The claim alleged negligence in injuring the right ureter with a retractor during the original operation, and also claimed that the physicians were negligent in opening the bladder when removing part of the left ureter without performing a biopsy first. It was alleged that this failure allowed microscopic bladder cancer cells to seed and grow undiagnosed for a year.

The physicians denied any negligence, arguing that the right ureter injury was a known complication of the initial operation. They also claimed that the cancer was most likely already present in the urinary tract and so was probably incurable at the time of the original procedure. Further, they maintained the patient had some contributory fault by continuing to smoke. A defense verdict was returned.

LEGAL PERSPECTIVE: In a delay to diagnosis of cancer malpractice suit, the claim is often made that the time delay did not ultimately make a difference in the long-term outcome for the patient, and this is usually argued between the medical expert witnesses. In this case, even though the patient alleged fault in opening the bladder and seeding the area with cancer cells, the defense prevailed in arguing that it was probably incurable at that time anyway.

The claim that the right ureter injury was from a retractor was supported by the urologist’s operative report from the second surgery. During the litigation, the physician alleged it was due to small-vessel disease or tubular necrosis, but that even if it was injured by a retractor it is a known complication and was treated appropriately.

Next: Prostate cryotherapy blamed for complications

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Prostate cryotherapy blamed for complications

An Illinois man was diagnosed with prostate cancer with a Gleason score of 7 in 2005. Several months later, he went to a urologist regarding possible cryosurgery, but the procedure could not be performed until almost 10 months later due to the patient’s other medical issues.

The operation was a prostate cryotherapy ablation procedure with insertion of a suprapubic catheter. The patient had three follow-up visits over the next month with some swelling and pain, and at the last visit the physician removed the suprapubic catheter and told the patient to return in 6 weeks.

A week later, the patient was admitted to a hospital under the care of another physician and diagnosed with a prostatic abscess and septic shock. He was hospitalized again 3 months later with a recurrent prostatic abscess. He now has a permanent suprapubic catheter for urination due to bladder dysfunction.

The man sued the original urologist and alleged negligence in the use of an excessive number of cryoprobes (12) during the surgery. He claimed the rectal wall became involved, which created an area of necrosis and infection. He also claimed the physician failed to suspect an infection in his postoperative visits despite his complaints of scrotal swelling, pain at the penis tip, fever, sweating, and chills.

The urologist denied that the patient complained of fever, sweating, and chills during any of the postoperative period, and he maintained that swelling and pain are normal after this operation. He argued that the use of 12 cryoprobes was proper. He also claimed that the prostatic abscess developed after his last visit with the patient, and blamed subsequent treating physicians for any negligent care that caused the patient’s current situation. A defense verdict was returned.

Loss of testicle following inguinal hernia repair

A Louisiana man underwent a bilateral inguinal hernia repair in 2005 that was performed by a surgeon. The patient was discharged the next day and noticed that he could not feel his right testicle.

He returned to see the surgeon but he was not in and the patient was referred to a urologist. The urologist felt that the condition would improve as the swelling reduced.

The condition did not improve, and a year later the patient underwent a surgical repair. The testicle could not be salvaged. The patient now suffers from a permanent testosterone deficiency and requires testosterone replacement.

The man sued the surgeon and claimed he failed to check the position of the testicle at the time of the initial surgery, arguing that if the testicle's position had been noted at the time it could have been saved. A defense verdict was returned.

Next: Alleged failure to diagnose bladder cancer

Alleged failure to diagnose bladder cancer

An Ohio man was admitted to the emergency department of a VA hospital in 2007 due to hematuria. A computed tomography urogram showed two renal cysts in the right kidney and a filling defect of the bladder.

The next month, a cystourethroscopy was performed that reported a possible wall tumor. The patient had a cystoscopy 2 months later, which saw a very large clot in the bladder but no tumor. He then had six more cystoscopies in the next 3 months. No biopsies were performed and no other procedures were recommended other than cystoscopy.

A few days after the last procedure, the man was admitted to another hospital for Clostridium difficile colitis and sepsis, which necessitated emergency exploratory laparotomy, total abdominal colectomy, and end ileostomy. He had a diagnosis of septic shock and toxic megacolon and 2 months later required more surgery, which included a bladder biopsy that showed an invasive papillary transitional cell carcinoma (grade III).

The man filed a lawsuit against the VA hospital, alleging negligence in the failure to perform a biopsy of the bladder and diagnose and treat the bladder cancer in a timely fashion. He died of his disease during the pendency of the malpractice suit. The jury returned a verdict for the man’s estate and awarded $385,000.

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