Urothelial carcinoma with lymph-vascular invasion (Case #141)

• Medical Probability: 3 / 10
• Medical Error Summary: It is unlikely there was an error. Currently, there is no standard of care, with regard to chemo or radiation therapy for urothelial cancer, however neoadjuvant chemotherapy is commonly used in many...
• Causation Probability: 4 / 10
• Causation Summary: In the absence of a standard of care, I think it could easily be argued that surveillance postoperatively would benefit this patient more than adjuvant therapy. However, if there was poor postoperativ...
• Expert Summary: I am actually published in the medical literature regarding robotic nephroureterectomy for Urothelial carcinoma. In addition I run our urology tumor board on a monthly basis, so I am very familiar wit...
• Similar Summary: In our group we probably see 1 to 2 upper tract urothelial carcinoma’s requiring nephroureterectomy a year.

Post-vasectomy hematoma resulting in loss of flow to left testicle, infarct, orchiectomy, and post-orchiectomy infection. (Case #319)

• Medical Probability: 9 / 10
• Medical Error Summary: A vasectomy, performed properly should not result in loss of the testis. The testis has three arteries, the testicular artery, the artery to the vas, and the cremasteric branches. It is common to in...
• Causation Probability: 9 / 10
• Causation Summary: The entire sequence began with an error in the initial procedure leading to the hematoma. This is a known and accepted complication. Once the hematoma led to both infections and loss of testis, the sn...
• Expert Summary: I am a practicing urologist and chief of the division for the past 13 years.
• Similar Summary: Rarely. This is a common procedure, and loss of testis is very rare. Hematoma is relatively rare, but happens at a reasonable rate.

Delayed diagnosis of transitional cell carcinoma of ureter (Case #339)

• Medical Probability: 4 / 10
• Medical Error Summary: Without looking at the original images, it is difficult to say truly if there was a process going on in the right ureter. Sometimes when looking at the images, our suspicion does either go up or go do...
• Causation Probability: 4 / 10
• Causation Summary: I would only say that his outcome would be worse if indeed, he had metastatic disease. Then the delay in diagnosis certainly lead to a worsening outcome. Either way, I think his kidney and ureter woul...
• Expert Summary: I am a board-certified urologist, and in my community I do both run our urology tumor board and perform major open surgery.
• Similar Summary: I see cases of ureteral or renal pelvic tumors probably 2 to 3 times annually.

61yo Female has pyeloplasty for UPJ obstruction, has stent migration and eventually loss of kidney. (Case #378)

• Medical Probability: 7 / 10
• Medical Error Summary: Clearly, the patient had a recurrence of her iridal pelvic junction obstruction. This is known to happen at a relatively low rate. This is likely secondary to a technical problem with the anastomosis,...
• Causation Probability: 8 / 10
• Causation Summary: Although her left kidney was compromised, it was salvageable with a pilot plasty, which was performed. Unfortunately, after her stent removal, she had persistent pain, which was due to chronic obstruc...
• Expert Summary: As a generally urologist, we do see patients with the pelvic junction obstructions on a regular basis. I have cared for these patients and understand the issue with stent placement at the time of surg...
• Similar Summary: My group probably does 3 to 4 similar procedures annually.

Urologic Surgery, Emergency Evaluation, and Postoperative Management (Case #464)

• Medical Probability: 8 / 10
• Medical Error Summary: In my opinion, when the patient returned to the emergency department several days after scrotal surgery with severe pain, my concern would include possible infarction of the testis, possible infection...
• Causation Probability: 9 / 10
• Causation Summary: Clearly, all this patient’s issues happened after his surgical procedure. The loss of the left testicle that was noted about a month afterward likely presented during his ER visit. It is possible th...
• Expert Summary: As chief of my division, I regularly perform scrotal surgery and commonly review departmental cases which have complications.
• Similar Summary: Yes, we review all cases of complication, including minor complications that do not require intervention. We certainly have seen cases where patients are status post hydrocelectomy have hematomas. Alm...

Robotic Assisted Transurethral Aquablation of prostate for dysuria & ED results in loss of control of bladder sphincter requiring bladder reconstruction. (Case #485)

• Medical Probability: 8 / 10
• Medical Error Summary: The fact that the bladder neck and verumontanum were ablated notes that the procedure was performed incorrectly. Both should be preserved to maintain continence and ejaculation.
• Causation Probability: 9 / 10
• Causation Summary: These anatomic landmarks should not be disturbed. This is the reason the patient has stress incontinence.
• Expert Summary: I perform at least 30 BPH surgeries annually. I am well aware of the need to maintain these anatomical landmarks to preserve continence regardless of the procedure. This has been the way since the old...
• Similar Summary: Rarely. That’s because I don’t like aquablation. It’s an operation with no surgeon control.