A 40-Year Litigation Review of Transurethral Surgeries for Benign Prostatic Hyperplasia

Legal Outcomes of Litigation After Iatrogenic Genitourinary Trauma

OBJECTIVE

To evaluate plaintiff and defendant characteristics associated with iatrogenic genitourinary (GU) trauma litigation and outcomes of closed claims.

METHODS

LexisNexis was queried in April 2023 using terms related to GU organs and injury, and manually reviewed for iatrogenic cases. Case details including defendant, organ involvement, and legal outcome were obtained. Multinomial regression analysis was performed to identify factors associated with outcome.

RESULTS

Four hundred ten cases involving 611 defendants were identified, with the ureter the most commonly affected organ (202/410, 49.3%). Most cases involved adult plaintiffs (380, 92.7%) and resulted in favor of the defense (227, 55.4%). Injuries resulted most frequently from gynecologic surgeries (179, 43.7%). Defendants were most commonly obstetricians/gynecologists (243/611, 39.8%) and urologists (168, 27.5%). Penile (OR 6.3 [95% CI 2.5-16.1]) and urethral (OR 4.8 [2.0-11.7]) injuries were associated with greater odds of a plaintiff verdict relative to ureter injury. A plaintiff verdict was also more likely when defendants were academic hospitals compared to individual practitioners (OR 4.3 [1.9-9.9]). In cases ruling in favor of the plaintiff, indemnity payments were larger when the defendants were comprised of individual practitioners compared to a hospital or medical group (median $549,613 vs $250,000, P <.001).

CONCLUSION

Urologists may be involved in medical malpractice lawsuits for iatrogenic injury even when they are uninvolved in the index procedure. Most cases that reach litigation result in defense verdicts regardless of the GU organ injured. Defendant characteristics associated with plaintiff verdicts are more nuanced, and providers should be aware of potential downstream effects of litigation.

Minimally invasive techniques in quest of Holy Grail of surgical management of enlarged prostates: a narrative review

PURPOSE

Past decade has seen a renewed interest in minimally invasive surgical techniques (MISTs) for management of enlarged prostate. This narrative review aims to explore newer MIST for benign prostatic hyperplasia (BPH) which are not yet integrated into established societal guidelines.

METHODS

We conducted a literature search across PubMed, Google Scholar, and FDA ClinicalTrials.gov databases on June 1st, 2023, to identify studies published within the past decade exploring various MISTs for BPH. Additionally, we gathered insights from abstracts presented in meetings of professional associations and corporate websites. We broadly classified these procedures into three distinct categories: energy-based, balloon dilation, and implant/stent treatments. We collected detail information about the device, procedure details, its inclusion and exclusion criteria, and outcome.

RESULTS

Our review reveals that newer energy-based MISTs include Transperineal Laser Ablation, Transurethral Ultrasound Ablation, and High-Intensity Focused Ultrasound. In the sphere of balloon dilation, Transurethral Columnar Balloon Dilation and the Optilume BPH Catheter System were gaining momentum. The noteworthy implants/stents that are on horizon include Butterfly Prostatic Retraction Device, Urocross Expander System, Zenflow Spring System, and ProVee Urethral Expander System.

CONCLUSION

The exploration of various MISTs reflects ongoing efforts to enhance patient care and address limitations of existing treatments. This review provides a bird-eye view and valuable insights for urologists and researchers seeking to navigate the dynamic landscape of MISTs in the quest for effective and minimally invasive solutions for enlarged prostates.

Exploring the Legal Implications of Benign Prostatic Hyperplasia Surgeries in the United States: A Comprehensive Analysis of Two Decades of Lawsuits

INTRODUCTION AND OBJECTIVE

The United States (US) currently faces a medical malpractice crisis, and a survey done in 2006 informed that 63% of urologists faced an average of 2.1 medical malpractice lawsuits. Surgery for benign prostatic hyperplasia (BPH) is performed by 95% of US urologists. Hence, we postulated that these procedures might be responsible for a substantial number of medical malpractice lawsuits. We examined claims related to BPH surgery in various US courts.

MATERIALS AND METHODS

Data were collected from Westlaw and LexisNexis databases using the keywords "benign prostatic hyperplasia," "enlarged prostate," "surgery," and "malpractice" to search for cases from the entire US from January 2000 to December 2021. We extracted details such as the type of procedure, the plaintiff and defendant, the nature of the allegation, the alleged complications, the verdict, and the compensation amount.

RESULTS

We found 30 cases in which the most common procedure was transurethral resection of the prostate (37%), with inadequate postoperative care as the most frequent reason for claims (33%). Urologists were the most frequently processed professionals (57%). The postsurgical outcomes that resulted in lawsuits were urinary incontinence (23%), erectile dysfunction (13%), and urinary retention (13%). Interestingly, 43% of the patients were inmates. Plaintiffs won only two (7%) cases: colon perforation after interstitial laser coagulation with Indigo laser and recto-urethral fistula after transurethral microwave therapy.

CONCLUSION

Most lawsuits were related to postoperative incontinence and erectile dysfunction, with the verdict favoring the defendant in most cases. Inmates were the plaintiffs in a relatively high percentage of cases. Only two cases resulted in a plaintiff victory, wherein both cases presented unexpected and serious postsurgical complications.