Legal Aspects of Men's Genitourinary Health

J. Henning; S. Waxman

Disclosures

Int J Impot Res. 2009;21(3):165–170 

In This Article

Prostate Treatment

Other claims involving prostatic disease are usually related to complications from treatment. Transurethral resection of the prostate (TURP) is still performed using electrical or laser energy in many men worldwide. All surgical procedures can result in the complications of bleeding and infection. Retrograde ejaculation, urethral stricture and urinary retention can all follow TURP. TURP can additionally result in injury to the ureteral orifices, urinary sphincter or erectile mechanism resulting in renal injury, incontinence or impotence.[15] Although laser TURP has become increasingly popular and has a decreased risk of bleeding, all complications described earlier for standard TURP are possible with the laser.[16] Preoperative counseling, documentation and informed consent are important not only in creating reasonable patient expectations, but also in avoiding and defending against claims should they arise.

Radical prostatectomy for prostate cancer is a commonly performed operation by urologists. Regardless of the surgical approach (retropubic, perineal or robotic), the risks of stricture, impotence and incontinence are possible and need to be discussed with the patient preoperatively. Rectal injury is a rare, but serious, complication of radical prostatectomy. All potential complications should be discussed preoperatively as they can result in a claim if the patient was completely unaware that such a complication was a possibility of the operation.[17]

With all procedures, informed consent is a discussion between provider and patient, which is usually memorialized in writing. The document varies from one hospital to another; however, it should contain evidence that a discussion took place explaining the risks that both a reasonable patient would want to know and that a reasonable provider would want to convey. Although a consent form will not stop a claim just because it states the complication, which in fact occurred, the more procedure specific and complete the document, the easier to defend. Unfortunately, in the absence of any guidelines, the content of what is discussed for any procedure is variable. There is a lack of consensus among surgeons as to which risks are significant for each operation.[18]

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