Clinical Safety Recommendations for Testicular Torsion: Analysis of 101 Claims Settled with Compensation in Spain and France.

INTRODUCTION: The study aimed to analyze testicular torsion (TT) claims settled with compensation to have data available as the basis for making recommendations to decrease clinical risk and prevent claims. TT is a urological emergency with a high rate of orchiectomy, representing one of the main reasons for urological claims. METHODS: Data were analyzed from personal majority policy and from the public sector of Catalonia (Spain), as well as data from the main medical civil liability insurance firm at healthcare centers in France in the period from January 1, 2000 to December 31, 2018. RESULTS: Fifty Spanish and 51 French cases were analyzed. Statistical differences were logged in the two settings analyzed in performing ultrasounds, in the area where primary care was provided and with regard to settlement amounts. Diagnosis was late in 76.2% of cases. DISCUSSION: The medical action time from the onset of symptoms and Doppler testicular ultrasound in cases of questionable differential diagnoses is key to prognoses to save the testicles. Properly filling out the emergency report and the rest of medical records are essential for receiving correct medical care and defending possible claims.

[Medico-legal aspects and professional liability of telemedicine in urology.] / Aspectos médico-legales y responsabilidad profesional médica de la telemedicina en urología.

Recientemente, Carrión et al. (1) publicaban un acertado análisis sobre el uso de la telemedicina (TM) en urología en el contexto de la pandemia por COVID-19. El escenario de emergencia durante la pandemia debida al SARS-CoV-2 ha propiciado un uso exponencial de la TM que ha permitido mantener el acceso y la continuidad de la atención a los pacientes y apoyar a los profesionales de primera línea, optimizando los servicios presenciales y minimizando las infecciones por transmisión del COVID-19 (2).

Recientemente, Carrión et al. (1) publicaban un acertado análisis sobre el uso de la telemedicina (TM) en urología en el contexto de la pandemia por COVID-19. El escenario de emergencia durante la pandemia debida al SARS-CoV-2 ha propiciado un uso exponencial de la TM que ha permitido mantener el acceso y la continuidad de la atención a los pacientes y apoyar a los profesionales de primera línea, optimizando los servicios presenciales y minimizando las infecciones por transmisión del COVID-19 (2).

[Malpractice in Urology: lessons of clinical and legal safety.] / Malpraxis en Urología: lecciones en seguridad clínica y jurídica.

OBJECTIVES: Data about urology malpractice claims in our environment are scarce and should be considered a potential opportunity to "learn from errors". METHODS: We analyzed every claim for alleged malpractice in Urology managed by the Council of Medical Colleges of Catalonia between 1990 and 2012, and specifically evaluated the clinical and medicolegal features of those cases with medical professional responsibility. RESULTS: We identified 182 cases in 22 years, but only the 25,74%showed professional liability. Testicular torsion misdiagnosis, pregnancies after vasectomy and complications of lithiasis should be noted for their frequency of claims and rate of liability. 246 physicians were involved, 89% were males and mean age was 45.6 years. Most cases (n=137, 75.27%) were processed in the courts. DISCUSSION: Urology has a medium risk of claims, with a moderate rate of medical professional liability and amount of compensation. There are specific actions that would lead to clinical safety improvements, particularly in testicular pathologies, vasectomy and lithiasis. Finally, more attention should be paid to proper patient information.

Malpraxis en Urología: lecciones en seguridad clínica y jurídica / Malpractice in Urology: lessons of clinical and legal safety

OBJETIVO: La información disponible sobre reclamaciones por presunta responsabilidad profesional médica (RPM) en urología es limitada en nuestro entorno y supone una fuente potencial para aprender del error. MÉTODOS: Se analizaron las reclamaciones por presunta mala praxis en Urología gestionadas en el Consejo de Colegios de Médicos de Cataluña entre 1990 y 2012 evaluando específicamente las características clínicas y médico-legales de los casos con RPM. RESULTADOS: Se hallaron 182 casos en 22 años, con una tasa de RPM del 25,74%. Destacan por su frecuencia y tasas de RPM el error diagnóstico en torsión testicular, el embarazo postvasectomía y las complicaciones de las litiasis. Fueron reclamados un total de 246 facultativos, un 89% varones y con una edad media de 45,6 años. La mayoría de expedientes (n=137, 75,27%) se tramitaron por vía judicial. DISCUSIÓN: La Urología posee un riesgo medio de reclamación, con una tasa de responsabilidad profesional médica y cuantía en las indemnizaciones moderada. Existen actuaciones específicas susceptibles de mejoras en seguridad clínica, fundamentalmente en patologías del área testicular, vasectomías y litiasis, debiendo obligatoriamente intensificarse la atención a la adecuada información al paciente

OBJECTIVES: Data about urology malpractice claims in our environment are scarce and should be considered a potential opportunity to "learn from errors". METHODS: We analyzed every claim for alleged malpractice in Urology managed by the Council of Medical Colleges of Catalonia between 1990 and 2012, and specifically evaluated the clinical and medicolegal features of those cases with medical professional responsibility. RESULTS: We identified 182 cases in 22 years, but only the 25,74% showed professional liability. Testicular torsion misdiagnosis, pregnancies after vasectomy and complications of lithiasis should be noted for their frequency of claims and rate of liability. 246 physicians were involved, 89% were males and mean age was 45.6 years. Most cases (n=137, 75.27%) were processed in the courts. DISCUSSION: Urology has a medium risk of claims, with a moderate rate of medical professional liability and amount of compensation. There are specific actions that would lead to clinical safety improvements, particularly in testicular pathologies, vasectomy and lithiasis. Finally, more attention should be paid to proper patient information

[Urological diseases most frequently involved in medical professional liability claims]. / Patologías urológicas más frecuentemente implicadas en las reclamaciones por responsabilidad profesional médica.

Clinical safety and medical professional liability are international major concerns, especially in surgical specialties such as urology. This article analyzes the claims filed at the Council of Medical Colleges of Catalonia between 1990 and 2012, exploring urology procedures. The review of the 173 cases identified in the database highlighted the importance of surgical procedures (74%). Higher frequencies related to scrotal-testicular pathology (34%), especially testicular torsion (7.5%) and vasectomy (19.6%), and prostate pathology (26 %), more specifically the surgical treatment of benign prostatic hyperplasia (17.9%). Although urology is not among the specialties with the higher frequency of claims, there are special areas of litigation in which it is advisable to implement improvements in clinical safety.

Patologías urológicas más frecuentemente implicadas en las reclamaciones por responsabilidad profesional médica / Urological diseases most frequently involved in medical professional liability claims

La seguridad clínica y la responsabilidad profesional médica son prioridades en el ámbito internacional, especialmente en lo referente a especialidades quirúrgicas como la urología. El presente artículo analiza las reclamaciones por presunto defecto de praxis interpuestas ante el Consejo de Colegios de Médicos de Cataluña entre los años 1990 y 2012, y se exploran los procedimientos correspondientes a la especialidad de urología. La revisión de los 173 casos identificados en la base de datos subrayó la importancia de los actos quirúrgicos (74%). Las frecuencias más elevadas de reclamación correspondieron a la patología escrototesticular (34%), especialmente la torsión testicular (7,5%) y la vasectomía (19,6%), y a la patología prostática (26%), más específicamente el tratamiento quirúrgico de la hiperplasia benigna de próstata (17,9%). Si bien la urología no es una de las especialidades de mayor frecuencia de reclamación, hay áreas especialmente litigiosas en las que resulta recomendable implementar mejoras en materia de seguridad clínica (AU)

Clinical safety and medical professional liability are international major concerns, especially in surgical specialties such as urology. This article analyzes the claims filed at the Council of Medical Colleges of Catalonia between 1990 and 2012, exploring urology procedures. The review of the 173 cases identified in the database highlighted the importance of surgical procedures (74%). Higher frequencies related to scrotaltesticular pathology (34%), especially testicular torsion (7.5%) and vasectomy (19.6%), and prostate pathology (26 %), more specifically the surgical treatment of benign prostatic hyperplasia (17.9%). Although urology is not among the specialties with the higher frequency of claims, there are special areas of litigation in which it is advisable to implement improvements in clinical safety (AU)