Summary of background

In 1992, the defendant trust deemed it necessary for the claimant to undergo a procedure involving transurethral resection of the prostate (TURP) or bladder neck insertion, following his complaints of needing to urinate very frequently. On 16th March 1995 the claimant underwent surgery to the neck of his bladder, at the defendant hospital. Surgery was complicated by a persistent erection and a cut being accidentally made in the prostatic urethra near to the bladder, which caused damage to his bladder. A catheter was not inserted during the procedure. That evening it was noted that the claimant was unable to pass urine. The treating practitioners decided that the claimant should undergo surgery for a catheter to be inserted. Three days later the operation took place and on 22nd March 2004 the claimant was discharged from hospital.

Three days after being discharged, the claimant was readmitted to hospital and underwent surgery to clamp the catheter. Six days later he was discharged from hospital to return home. The claimant attended outpatient appointments, when he continued to complain of urgency of urination. He was subsequently advised that he might have developed stenosis of the bladder neck.

On 22nd December 2004, the claimant was admitted to the defendant hospital and underwent an operation involving cystoscopy, urethrotomy and TURP. During the operation the claimant lost a lot of blood through his urethra. Following surgery, he continued to suffer retention of urine and so underwent a further cystoscopy and a catheter was inserted. During the operation it was noted that the bulbar urethra was impassable. The claimant contracted MRSA and had to stay in the high-dependency unit. On 29th December 2004 he was discharged from hospital.

The claimant's condition did not improve over the following months and he was referred to an expert urologist at a different hospital for treatment which commenced in March 2005. Revision operations were performed and it was found that his original symptoms had been due to an overactive bladder.

In 2007, the claimant was informed that no further surgery could be performed and that he would require a suprapubic catheter for the rest of his life.

Claimant's case

The claimant sustained injury and brought an action against the defendant alleging that it was negligent in (i) failing to provide sufficiently experienced staff; (ii) failing to correctly diagnose his condition; (iii) performing the bladder neck insertion procedure unnecessarily; (iv) performing the surgery at a substandard level as performing the TURP was illogical and unnecessary, the after-care provided by the defendant hospital caused or permitted the urethra to be further damaged and there was a delay in first performing the cystoscopy and in referring the claimant to an expert urologist at a different hospital.
 
Defendant's case

A letter of claim was sent to the Defendant Trust on 6th January 2009 and a letter of response received from the Trust's solicitors on 30 November 2009 in which it was admitted that there was insufficient clinical evidence of bladder outflow obstruction to warrant the decision to carry out bladder neck incision surgery in March 1995. It was acknowledged that the Claimant ought to have undergone further urodynamic preoperative investigations and had this happened on the balance of probabilities these would have revealed that the Claimant did not have a bladder obstruction that required surgery. These admissions related to the procedure performed in 1995 and it was also admitted that the decision not to insert a postoperative catheter amounted to a failure of care.

In respect of the 2004/2005 admission it was acknowledged that the claimant should have been more thoroughly investigated preoperatively but it was not accepted that had this happened on the balance of probabilities the claimant would not have proceeded to prostatectomy. It was however admitted that further damage to the urethra was caused as a result of the procedure performed on 22nd December 2004.

It was accepted that the above admissions caused scaring to the urethra and complicated the prostatectomy procedure but no admissions were made in respect of alleged continuing bladder symptoms.

Settlement

The claim reached an out of court settlement in the sum of £75,000.

Breakdown of General Damages:- £40,000;
Future loss of earnings:- £7,500;
Future medical treatment:- £3,000.

Breakdown of Special Damages:
Past loss of earnings:- £21,500;
Past gratuitous care costs:- £1,500;
Past travel and incidental expenses:- £1,500.