This case involves a 64-year-old male patient with a history of urinary incontinence who had his prostate gland surgically removed. He presented to a urologist for a bulking agent injection to help with his incontinence. The day after the procedure, the patient experienced severe abdominal pain and returned to the urologist’s office. He was diagnosed with an obstructed urethra. The urologist attempted to pass a catheter through the patient’s urethra several times to break through the obstruction, but each attempt failed. Because of the significant force used to insert the catheter, the patient suffered severe trauma to his urethra. An expert in urology was sought to review the facts of the case and determine whether or not the attending urologist performed the procedure in question according to the standard of care.
Question(s) For Expert Witness
- 1. Please describe your background in urology.
- 2. Do you routinely treat patients like the one described above?
- 3. Have you ever had a patient sustain this injury due to improper catheter insertion? What was the result?
Expert Witness Response E-009659
I have performed over 500 radical prostatectomies and I am very familiar with the complication of urinary incontinence. I routinely treat patients for prostate cancer with radical prostatectomy. And I take care of any of my patients who have urinary incontinence as a result. Bulking agents are FDA approved treatments for this condition. The patient seems to have had the well-documented complication of urinary retention. However, the degree of damage caused by catheter insertion is unusual. Every urologist has experienced (or caused) urethral trauma during catheter insertion. However, trauma leading to irreversible damage, or damage requiring extensive surgery, is and should be very rare. It also calls into question the technique used, and whether catheter insertion should have been stopped and another technique (e.g., cystoscopy, or suprapubic tube insertion) should have been employed.