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    Complications bring out urologists’ ‘human’ feelings

     

    His pain persists to this day. I’m perplexed. I don't know what I did wrong. I don’t know if I did anything wrong. Did I make some small technical mistake during the case that resulted in his ongoing pain, or did I simply have the diagnosis wrong from the beginning? I don’t know. In retrospect, the only thing I would have done differently is to obtain a renal scan before the operation. I do know that every time a patient walks into my office with flank pain, this particular patient comes to mind.

    ALSO SEE - Attention thought leaders: How is new-onset flank pain evaluated?

    In no way am I saying that I don’t make mistakes. I tell everyone who asks that I am nothing more than a small-town overpaid plumber. The biggest mistake I have yet made in medicine (at least that I am aware of) occurred as a junior resident when I missed a calf compartment syndrome following a robotic prostatectomy (J Endourol 2010; 24:1597-601). That case seems more straightforward to me; I had never heard of a compartment syndrome after a robotic prostate, and that diagnosis was simply not on my differential until it was too late.

    Case 2: Young man with rock-hard prostate

    The second case that brought home to me the reality of what we do is a bit different. A college-aged man came to my office reporting that about 6 months prior, he had an episode of urinary retention. He went to his local college ER and had a catheter placed and then removed a few days later. He had no problems voiding after the catheter was removed, and he didn’t seek follow-up care. About 2 months later, he went to the ER again in retention and this time the ER doctor couldn’t insert a catheter. The local urologist was contacted and also failed to get in a catheter, but did place a suprapubic tube.

    Cystoscopy the next week showed a bulbar urethral stricture with a possible polyp near the stricture. The urologist did manage to get a small catheter past the stricture to drain the bladder. He was scheduled for urethroplasty, but his insurance company then decided that he needed to do that procedure at home and not at college, as it wasn’t an emergency. After some other delays taking about 4 months, he came to my office.

    Given that 4 months had passed, I was curious if he could void on his own, so I removed his urethral catheter, clamped the SP tube, and set him up for a combined retrograde urethrogram and voiding cystogram to define the stricture before considering surgery. I asked him to come back in a few days once the imaging was done.

    NEXT: "I remember going home that night and being bothered by the case."

    Henry Rosevear, MD
    Dr. Rosevear, a member of the Urology Times Clinical Practice Board, is in private practice at Pikes Peak Urology, Colorado Springs, CO.

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