Medical professional responsibility for postvasectomy pregnancy

Informed consent in urology

Appropriate professional practice includes the diagnostic and treatment process of urologic pathology, as well as patient information and respect for patient autonomy in decision making. Informed consent is the gradual process of providing information to the patient and their subsequent decision making. The informed consent document (ICD), when required, demonstrates that information has been provided sufficiently in advance to allow for the patient's deliberation. The dual need for simple yet complete documents make the preparation of adequate ICDs extremely difficult. If the information process is not carried out properly, the professional may incur a medical malpractice liability that is treated as a loss of opportunity. To avoid such situations, the work of scientific societies in the preparation, accessibility, and dissemination of ICD models is fundamental.

[E-Cadherine and GATA-3 are useful in the confirmation of the vas deferens in vasectomy specimens]

INTRODUCTION AND OBJECTIVES

Urologists often submit the resected tissue from vasectomies for histopathological examination in order to confirm the presence of the vas deferens. Microscopy is simple and based on haematoxylin-eosin staining; however, sample artefacts can sometimes cause confusion and immunohistochemistry can be used to identify the vas deferens.

MATERIALS AND METHODS

We investigated the utility of immunohistochemical analysis using E-cadherin and GATA-3 to confirm the presence of vas deferens epithelium in 110 vasectomy sections with different artefacts, using monoclonal antibodies and a multimer conjugated with peroxidase based technique; 5 renal arteries and 5 renal veins were stained as negative controls.

RESULTS

Membrane staining was observed for E-cadherin, which was moderate (2.7%) or strong (97.3%) in the vas deferens epithelium in all cases: 35 without artefacts, 7 with denuded epithelium, 56 with compressed/distorted epithelium, 8 with detached epithelium and 4 with displaced epithelium. GATA-3 showed moderate (31%) or strong (69%) nuclear staining in all cases, including the 76 with artefacts. In the control group, arteries and veins were negative for both markers in the endothelium, but GATA-3 occasionally stained lymphocytes in the blood vessel wall.

CONCLUSIONS

E-cadherin membrane positivity and GATA-3 nuclear expression are useful for the identification of the vas deferens in vasectomy samples containing artefacts. Vascular endothelium is negative for both markers and any possible GATA-3 staining of the lymphocytes in the blood vessel wall should not be misinterpreted.

Medical malpractice liability and its consequences

INTRODUCTION

Urology is a specialty of medium risk of claim. Receiving a claim for medical professional liability is a stressful experience with significant repercussions. The objective of this study was to assess the impact of these claims on Spanish urologists.

METHODOLOGY

A survey on medical professional liability in urology was designed. The Spanish Association of Urology and the Urological Research Foundation approved the questionnaire, generated by the PIEM online tool.

RESULTS

The total number of responses obtained was 202 (11.6% rate), of which 25.24% reported having been claimed, 88% reported mood changes after being claimed, 100% in criminal proceedings. The level of emotional involvement reported was the highest at the beginning of the process and progressively decreasing until its resolution. An affected doctor-patient relationship was considered in 67.9% of cases and 71.4% acknowledged increased defensive medicine in their professional practice. A percentage of 6.7% considered leaving the profession.

DISCUSSION

The response rate obtained and the medical acts motivating the claims were comparable to those obtained in a similar survey conducted in the United States. The fact that claims are perceived as very stressful situations and may give rise to the phenomenon of the second victim or to the clinical judicial syndrome is clear, so efforts should be devoted to develop training in this matter and programs that address the consequences derived from these situations.