Legal Aspects of Men's Genitourinary Health

J. Henning; S. Waxman

Disclosures

Int J Impot Res. 2009;21(3):165–170 

In This Article

Erectile Dysfunction

Treatments for erectile dysfunction have become very popular in the past several decades due to advances in pharmacotherapy and surgery. All these treatments, however, have significant potential for complications, thus leading to claims of malpractice. Phosphodiesterase 5 inhibitors account for a multibillion dollar industry worldwide.[36] Physicians and their patients must be aware of the potential side effects and dangerous cardiac interactions with these drugs. Adverse events including death have resulted in earlier claims against health-care providers. Intracorporal injection of vasoactive substances remains popular with the potential complications of priapism, fibrosis and penile curvature. Again, providing patients with realistic expectations before embarking on invasive therapy can save one from future claims of failing to give informed consent.

The implantation of a penile prosthesis is usually entertained after the failure of one or more of the above-mentioned modalities. Although there have been advances in the devices, man-made prosthetics can still become infected or fail, resulting in reoperation and possible removal, resulting in recurrent impotence.[37] Many of the candidates for prosthesis may have diabetes, necessitating tight control of blood sugars in the perioperative period so as to lessen the chance for infection. Meticulous technique is crucial to avoid contamination of the prostheses at the time of implantation. The infrequent implanter will likely be attacked by plaintiffs experts should the claim deal with complications characteristic of surgeon inexperience. All prospective penile prosthesis patients must be counseled regarding the potential for chronic pain, deformity and penile shortening even in properly functioning devices. There is always the potential that a device may have to be removed without the possibility for replacement, leaving the patient permanently impotent.

Peyronie's disease (which causes curvature of the penis) is usually self-limiting, but may require reconstructive procedures or placement of a penile implant. It is important to first try conservative management before embarking on potentially irreversible surgical procedures. Claims resulting from the surgical management of Peyronie's disease are typically related to pain, deformity, shortening, numbness and impotence.[17] Preoperative counseling and thorough documentation are crucial in preventing and defending against subsequent claims of malpractice and lack of informed consent.

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