A case of hydrocele repair: Legal aspect of consenting and post-operative complication

Abstract

Introduction: The duties of a doctor are not only limited to providing medical treatment or surgical interventions to patients but also involve appropriate communication with them. Providing adequate information, addressing patients’ concerns, and respecting their decision making is all part of a doctors’ work ethics. The case describes a patient who had a hydrocele repair and developed early post-operative complications. The concern raised is whether adequate information regarding the procedure was given to the patient. Case Report: A 45-year-old medically healthy man was referred to the urology department by his general practitioner for an enlarging right-sided hydrocele. The main reason for seeking treatment was cosmetic. Due to the coronavirus (COVID-19) pandemic, he had a non-face-to-face urology clinic appointment only a few months later. After having discussed the various management options with the urologist, he opted to have a hydrocelectomy. On the day of the surgery, several months later, the operating surgeon consented the patient whereby he again explained the procedure and the associated risks. The surgery itself was uneventful, unfortunately, he developed early post-operative complications. He presented with increasing scrotal pain and swelling, features suggestive of an infected hematoma. He was managed conservatively with oral analgesia and antibiotics after which his symptoms improved. However, a Doppler ultrasound scan performed two weeks later, showed an avascular right testicle. He was immediately admitted to the hospital and was taken to theater for a scrotal orchidectomy. The outcome of the procedure was unexpected and even more undesirable cosmetically. The patient was dissatisfied and eventually lodged a formal complaint in the Patient Advice and Liaison Service (PALS). Conclusion: Post-operative complications can occur. However, providing patients with timely and adequate information ensures that the standard of care is met.