The plaintiff was a 72 year old male with history of prior urethral obstruction, which was addressed through the surgical placement of an artificial urinary sphincter (“AUS”). The AUS consists of three main components: a cuff that encircles the urethra, a pump placed in the scrotum, and a pressure-regulating balloon in the abdomen. When the cuff is inflated, it compresses the urethra, preventing urine leakage. When it’s time to urinate, the patient squeezes the pump, which moves fluid from the cuff into the balloon, deflating the cuff and allowing urine to flow. After urination, the fluid returns to the cuff, re-inflating it and closing the urethra. It is used primarily for patients like the plaintiff, who are experiencing stress urinary incontinence, often after prostate surgery, when other treatments haven’t been effective.
On January 22, 2013, the plaintiff underwent placement of artificial urinary sphincter at NY Presbyterian Hospital by urology surgeon, for incontinence. In the surgeon’s operative report of that date, he detailed specifically where the “balloon” for the AUS was placed. He wrote “The rectus muscle was exposed. We blunt dissected gently a pocket underneath the [right] rectus muscle, for which was placed the balloon later.” The plaintiff’s expert would testify that this entry in surgeon’s report, which good and accepted medical care required the defendant to review prior to the surgery which he performed upon the plaintiff, provided the defendant with precise information as to where the abdominal reservoir was placed, so that he could avoid injuring it during surgery.
On July 14, 2016, the plaintiff was admitted to Northern Dutchess Hospital where he underwent robotic assisted left inguinal hernia repair, and primary repair of umbilical hernia with mesh by the defendant, for left inguinal hernia and umbilical hernia. Intra-operatively, in his
surgical report, the defendant misidentified the AUS reservoir as a “large cyst” in the lower abdomen under the umbilical hernia and entered the sidewall. The defendant wrote in his operative report:
“We then noticed a large cyst in the lower abdomen under the umbilical hernia. Assistant was suspected and we entered the side wall. The cyst with robotic scissors, large amount of fluid was drained and suctioned. We then continued to notice further drainage. We opened the cyst even further. It was at this point, we noticed that we had entered a plastic silicone looking apparatus that looks like a balloon. I suspected this was the bladder reservoir. We sutured closed with 4-0 and 5-0 Prolene sutures in an interrupted fashion. No leakage was found. We then closed the wall using a 2-0 V lock suture.”
There was no effort intra-operatively nor post operatively, to immediately seek a urologist’s opinion and potentially replace the destroyed sphincter reservoir. There is no indication in the medical records that the defendant advised the plaintiff, that he destroyed the AUS reservoir.
On July 21, 2016, the plaintiff returned to his urologic surgeon, who placed the AUS, reporting that since the hernia repair, his sphincter was not functioning and he continued to leak despite using the sphincter. The urinary incontinence and the non-functioning of the AUS, both were new onsets after the defendant’s hernia repair surgery. It then was discovered that the defendant, during the hernia repair, had completely destroyed the AUS, requiring that the plaintiff undergo yet another operation, for the placement of yet another AUS, which ultimately was accomplished.
The plaintiff’s damages included persistent urinary incontinence, the destruction of the AUS, and the need for revision and replacement of AUS on 09/26/2016.
Despite the above surgery, the plaintiff had persistent incontinence and as per the last office visit with Dr. Purohit dated 10/29/2018, he had incontinence on standing up which he did not have after the initial AUS implantation in 01/2013 and nocturnal urinary leakage. Thus, his condition was much worse after the defendant’s negligence that it was before, and it could not be resolved through AUS replacement. This was caused in part, because scar tissue interfered with the functioning of the newly implanted cuff and explains why the patient was having persistent incontinence.
As indicated above, the case resolved for $225,000.00.
