Litigation in the management of urinary stone disease.

To present common technical and non-technical issues leading to medicolegal litigation, illustrated by a series of 54 cases, with the aim of using these examples to prevent harm to patients and to prevent surgeons from having to experience the stress of litigation.

A series of 78 medicolegal litigation cases reviewed by a single expert witness over 13 years from 2008-2021 were analysed by 2 reviewers. 29 cases were identified as having a non-technical learning point and 25 were identified as having a technical learning point. These are discussed using illustrative examples and the steps that could have avoided these issues.

All major issues and themes are illustrated with cases demonstrating the errors that lead to litigation and the often simple steps that can be taken to avoid them. Out of 29 non-technical issues, 13 involved consent issues (45%), 8 involved delays in treatment (28%) and 8 involved failure to provide adequate safeguarding advice (28%). Out of 25 technical issues, 13 cases involved intraoperative problems (52%) including 9 ureteric injuries, 8 involved errors or omissions in the immediate pre-operative period (32%) and 4 resulted from decisions around emergency decompression of the obstructed infected kidney. These emergency cases featured complications of amputation (2 out of 4; 50%) and death (1 out of 4; 25%). These decisions are complex and there are many subtleties to these cases which are discussed in detail.

We hope that this case series highlights the potentially catastrophic outcomes of even small errors of judgment, and allow the careful stone surgeon to learn from the experiences of those unfortunate others without having to encounter these situations themselves.

BJU international. 2022 Apr 13 [Epub ahead of print]

Bingyuan Yang, Louise Goldsmith, Ben Turney, John Reynard

Nuffield Department of Surgical Sciences, University of Oxford, UK., Department of Urology, Charing Cross Hospital, UK., Department of Urology, Churchill Hospital, UK.

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