While penile prostheses are generally considered an effective treatment for erectile dysfunction (ED), cases of malpractice litigation do occur at times. Recently, researchers from the Rutgers New Jersey Medical School and Wake Forest School of Medicine discussed such cases in The Journal of Sexual Medicine.
Urology has been ranked 8th out of 25 specialties for number of malpractice claims, the researchers noted. They added that during an average urologist’s career, he or she will be sued at least twice.
Using the Westlaw legal database, they identified cases involving penile prostheses that occurred between January 1990 and December 2013. Forty cases were analyzed.
Overall, about 58% of the cases were found in favor of the defendant. The rest ended with an indemnity payment to the plaintiff. For two cases settled out of court, the mean payment was $335,500. For cases that went to trial, average compensation to the plaintiff was $831,050.
Surgical decision-making errors accounted for almost 49% of breach-of-duty cases. About 32% of the cases involved informed consent and 13% involved postoperative infection.
The authors highlighted several areas for implanters to consider:
• Breaches of duty. Some defendants made errors in implant sizing and placement. For example, one case involved cylinders that were not equal in length. One surgeon inserted the reservoir into the patient’s bladder. Another case ended with a partial penectomy.
• Managing patient expectations. Some plaintiffs experienced penile shortening and/or numbness after implantation. Others discovered that once the surgery was complete, other ED therapies would no longer be an option for them. It may be helpful to thoroughly counsel patients on these and other possible outcomes.
“While there is no guaranteed way to prevent dissatisfaction among patients, unrealistic expectations and subsequent disappointment may potentially be lessened by proper preoperative counseling using language appropriate to a patient’s level of education and understanding,” they wrote.
Implanters might also consider other surgical techniques that could decrease the likelihood of these outcomes, they added.
• Skill level. The researchers pointed out that frequent implanters tended to have lower incidence of complications. Advanced implantation skills, the ability to make quick decisions during procedures, and preventing/managing infection could make litigation less likely.
• Device selection. Thirty percent of the reviewed cases identified the type of prosthesis used. Of these, 58% involved malleable implants. Almost 43% of malleable implant cases were decided in favor of the plaintiff. In contrast, all cases involving inflatable prosthesis were found in favor of the defendant.
Past studies have shown that patients with malleable implants tend to be less satisfied. Surgeons might consider using inflatable devices more often, if appropriate.
The review was first published online in July in The Journal of Sexual Medicine.
The Journal of Sexual Medicine
Sunaryo, Peter L., MD, et al.
“Penile Prostheses and the Litigious Patient: A Legal Database Review”
(Full-text. July 29, 2014)