I was invited to write an article about potential medical malpractice situations in Urology. I thought about several areas of urology and what the common denominators were. The two I see most frequently are … failure to diagnose and/or treat appropriately and failure of communication in an understandable and comprehensive manner with the patient and designated second (if appropriate). I have chosen to discuss the failure to diagnose, evaluate and treat hematuria (blood in urine) in an appropriate manner.
Hematuria may occur in an isolated field (no associated symptoms) or associated with urgency, frequency, dysuria, abdominal pain. Fever is variable. Abdominal distention (swelling or bloating) is also variable. Usually, the first physician seen is the PCP who will usually institute treatment for a UTI. He should obtain a urine culture as the minimal workup along with a urinalysis. If this treatment does not work or the bleeding recurs in a short period of time, a referral to a urologist is indicated.
Common causes of hematuria include urinary tract stones, cancer of any organ in the urinary tract, vascular abnormalities, medical kidney problems (including Cysts), medications, and idiopathic causes.
Urological workup should include urinalysis, urine culture, a study of the cells in the urine sediment for abnormal (potentially malignant) cells, and a radiological study of the urinary tract. Cystoscopy is a vital part of the workup.
If cancer, the most common sites are bladder and kidney. Ureter and urethra are uncommon. Workup should include the aforementioned urine studies, cystoscopy (visualization of the bladder and urethra, x-rays or direct visualization of the lining of the ureter and kidney), ct scan of the urinary tract, and biopsy of the mass, if at all possible. Treatment methods will be discussed at a later time.
If stones, type, size, and location within the urinary tract are vital. Any type of visualization of the urinary tract is important as this will be a major determinant in the type of treatment indicated. Associated infection can be very serious. Prolonged obstruction of the urinary tract can lead to parenchymal destruction. Malignancies can be associated with stones.
Vascular abnormalities are most commonly hemangiomas. Angiomyolipomas of the kidney are benign tumors of the kidney but have a propensity for sudden, potentially fatal massive hemorrhage. Idiopathic hematuria is a diagnosis made only by ruling out other causes of hematuria. Inappropriate workup and/or treatment is where negligence or malpractice enters the arena.
I hope this information is useful. If there are questions or concerns, do not hesitate to contact us.