An endometrial ablation procedure left a middle-aged woman with severe renal complications, causing her to litigate against her gynecologist. After undergoing the endometrial ablation, the woman began to complain of spotting and chronic pain, which further investigation revealed to be scarring around the uterus and adenomyosis, or the growth of endometrial tissue into the uterine wall. A total laparoscopic hysterectomy was recommended, after which the woman suffered pelvic pain and multiple UTIs until a scan revealed that she has experiencing excess fluid in her kidney and severe left renal atrophy. When the doctor’s actions were brought to trial, an expert was needed to review records and opine on the standard of care.
Question(s) For Expert Witness
1. How often do you perform laparoscopic hysterectomies?
2. What are the safeguards available to prevent genitourinary complications post hysterectomy?
3. Can genitourinary complications be a result of something other than the surgery?
4. How can you determine if the physician caused a ureteral injury or a similar type of injury?
Expert Witness Response E-138301
I am a board-certified OB/GYN at an academic medical center with almost ten years of experience in a busy OB/GYN academic practice. I perform 30-40 laparoscopic hysterectomies per year. Routine cystoscopy at the conclusion of a laparoscopic hysterectomy is one way to avoid urinary tract injuries, and identify them early if they occur. It is unlikely that a genitourinary tract injury would happen outside of surgery, but it is possible. Trauma, sexual intercourse, pelvic mass, scar tissue from surgery, delayed changes related to surgery and forced sexual intercourse are other unlikely ways for genitourinary tract injuries to occur. In addition, talking with the patient and physician would help to figure out if the injury was related to the surgery.
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