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

• Medical Probability: 5 / 10
• Medical Error Summary: It is not clear if the original CT scan done while the patient was in the hospital was ordered by the consultant urologist or another physician. In situations like this, the physician who orders the C...
• Causation Probability: 5 / 10
• Causation Summary: On the original CT scan in 2020, when the patient was hospitalized during an acute infection, the CT identified very subtle non-specific abnormalities involving the urothelial wall thickening and mild...
• Expert Summary: Board certified urologist with fellowship training in endourology
• Similar Summary: In my current practice, I am frequently consulted for inpatients treated for acute urologic infections. Many, if not all of these patients obtain imaging studies which oftentimes identify multiple inc...

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

• Medical Probability: 6 / 10
• Medical Error Summary: The surgical technique as documented in the operative note was meticulous without any obvious errors. Whether or not the surgeon had measured the ureteral length by some means preoperatively, there wa...
• Causation Probability: 5 / 10
• Causation Summary: Regrettably, in this case the outcome was less than optimal nor expected and the patient lost the kidney. Based on review of the operative record, the surgery was performed within accepted standards o...
• Expert Summary: I have over 15 years experience performing robotic assisted laparoscopic urologic surgery, as well as hundreds of cases of robotic surgeries, including robotic assisted laparoscopic pyeloplasty.
• Similar Summary: I routinely perform anywhere between two to four robotic assisted laparoscopic pyeloplasties per month in my practice.

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

• Medical Probability: 8 / 10
• Medical Error Summary: On the immediate post-op visit, I think appropriate care was given and the patient was provided reassurance; most of his symptoms could be attributed to post-operative swelling and pain. However, I th...
• Causation Probability: 6 / 10
• Causation Summary: It is impossible to know when the testicle suffered infarction, the most likely etiology for the injury happened in the perioperative when severe pain was reported by the patient. It is very unlikely ...
• Expert Summary: I am a general urologist and have been in practice for over 17 years. I have a keen interest in Endourology with fellowship training as well as urologic trauma. I work at a high volume tertiary hospit...
• Similar Summary: While I haven't dealt with this exact complication in the past, I am a high volume urologic surgeon and my radar is always on the lookout for post-operative complications. This case represented a perf...

Acute scrotal swelling (Case #480)

• Medical Probability: 2 / 10
• Medical Error Summary: Based on the history provided, this patient had developed a reactionary hydrocele and/or anasarca of the scrotum. The urinalysis is grossly unremarkable but may be indicative of superimposed scrotal ...
• Causation Probability: 2 / 10
• Causation Summary: A reactionary hydrocele and/or anasarca of the scrotum is completely unrelated to the patients cause of death. The patient died from sepsis and/or septic emboli involving his aortic valve. The scrotal...
• Expert Summary: I am a senior urologic consultant with >17 years of experience. I work in a thriving private practice and community hospital serving more than 500,000 member patients in a large metropolitan area. I h...
• Similar Summary: I am on primary call at least twice per month either during weekday or weekend calls, and I see multiple scrotal pathology cases on a routine basis.

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

• Medical Probability: 6 / 10
• Medical Error Summary: The post ablation cystoscopy reveals that the external urinary sphincter as well as verumontanum were included and ablated within the surgical field. This indicates the surgeon did not appropriately m...
• Causation Probability: 6 / 10
• Causation Summary: If the ablation field damaged critical structures verumontanum as well as external urinary sphincter, this would cause post-op stress urinary incontinence. It is well known that stress as well as urge...
• Expert Summary: I am a high volume endourologic surgeon with expertise in BPH surgery as well as kidney stone surgery. I perform at minimum 100 TURP and other BPH MIST surgeries at an outpatient ambulatory surgery pr...
• Similar Summary: Earlier in my career, I had some patients who experienced stress urinary incontinence after TURP, after adjusting my technique and becoming more expert at this operation, I no longer see this complica...