Urology Expert Comments on Patient’s Inability to Walk After Prostatectomy

This case involves a middle aged patient who underwent a prostatectomy in order to treat prostate cancer. A last resort after failed prostate brachytherapy treatment, the procedure had been done several years ago and caused the patient significant trouble walking ever since. The plaintiff claimed that his difficulty walking was caused by the procedure. Specifically, it was alleged that a surgical retractor may have been left on one of the nerves in his leg for too long, causing permanent nerve damage and leading to a corresponding decrease in his mobility, requiring long-term locomotive training in order to facilitate his recovery.

Question(s) For Expert Witness

1. Do you routinely treat patients similar to the one described in the case?

2. Have you ever had a patient develop the outcome described in the case?

3. What could be some of the common complications from the retractor being placed on the femoral nerve too long?

Expert Witness Response E-014220

Femoral nerve traction/compression injury is a known, but rare, complication of open pelvic surgery (i.e. open prosatectomy or cystectomy). The problems this gentleman developed following open prostatectomy surgery can be a result of trauma to the femoral nerve during the surgery. The injury to the nerve is usually ischemic (decrease blood flow) or physical tearing or shearing of the nerve. There are number of factors that can increase risk of pelvic nerve injury, which include type of surgery, duration of procedure, positioning of the patient, type of retractors used, and the form of retraction. The majority of my practice involves the evaluation, management, and surgical treatment of prostate cancer. I see over 250 men with prostate cancer per month, most are localized prostate cancer. Many of them I treat surgically with radical prostatectomy. I perform about 180 to 200 prostatectomies per year.