Urogynaecology

Lucy had a vaginal hysterectomy with anterior repair in 2011. She was readmitted two weeks later with a pelvic haematoma, and returned to theatre to have this evacuated. After this she developed a Vesico-Vaginal Fistula, requiring three further operations. She alleged that the vaginal hysterectomy and repair was performed negligently. PMS Expert Report concluded that Lucy's problems were the result of recognised complications of surgery. However, it also pointed out that the process of consent was poor for the two initial procedures, so it is unlikely Lucy was warned of

Imogen had a vaginal hysterectomy in September 2006. An injury to the rectum was identified and closed with a loop colostomy during the procedure. Her post-operative recovery was stormy, with problems developing after another operation for closure of the loop colostomy, as well as neurological problems following epidural analgesia after the original hysterectomy. PMS Expert Report concluded that bowel injury is a recognised complication vaginal hysterectomy. This case involved the unusual circumstances of distortion of the normal anatomy and unexpected adherence of the rectum to the vagina. The damage to

Ruth presented with urinary incontinence following a bladder injury sustained during laparoscopic assisted vaginal hysterectomy with anterior repair. After investigations, she was found to have a vescio-vaginal fistual, and was treated by a laparoscopic repair of the fistula with stenting of both ureters. The bladder healed well, but Ruth continues to suffer significant urge incontinence. Ruth alleged that the hysterectomy was performed in a negligent manner, and that the care she received for her urinary incontinence fellow below an acceptable standard. PMS Expert Report concluded that there was no evidence

Hermione suffered intra-abdominal bleeding following a vaginal hysterectomy and posterior repair in April 2010. She returned to theatre, required a massive blood transfusion and spent 2 days in the Intensive Care Unit after the operation. During this time she was given Cyclizine, a drug she is known to be allergic to. PMS Expert Report concluded that the LigaSure electrosurgical device used probably failed to seal off the blood vessels. The unusually high level of bleeding should have been recognised by the doctor, and steps should have been taken to control

Minnie had a vaginal hysterectomy in April 2010 to prevent her heavy periods. She was readmitted 12 days later with abdominal pain, fever, vomiting and constipation. She was discharged 2 days later following treatment in intravenous antibiotics.12 days later she was readmitted with severe abdominal pain and vomiting, and 4 days later underwent a laparotomy to drain abscesses identified in an ultrasound and CT scan and wash out the abdomen. Minnie is left is an unsightly lower midline scar. PMS Expert Report concluded that although the vaginal hysterectomy was performed

Aileen was 45 when she presented with stress incontinence and voiding difficulty in 2005. After investigation and conservative treatment, she underwent an anterior and posterior vaginal repair. The next day she developed retention of urine and returned to theatre for urethral dilation. She was still unable to pas urine, and so was taught intermittent self-catheterisation. A further urethral dilation was performed a month later, but the bladder was still not emptying fully. Aileen was concurrently suffering chronic constipation which was treated with a number of laxatives. She continued to complain

Flora was 65 when she presented with an uterovaginal prolapse and dyspareunia. After unsuccessful conservative treatment, Anterior Repair and Scrospinous Fixation were performed. Unfortunately, Flora's prolapse symptoms reoccurred, and so she underwent a Total Abdominal Hysterectomy and Bilateral Salpingo-oophrectomy With Sacrocolpopexy and Paravaginal Repair. Two years on, she could still feel a vaginal lump, and so underwent a further Anterior Repair and Sacrospinous Fixation. Flora continues to complain of frequency and the sensation of prolapse. She also remains unable to have sexual intercourse. The defendants admitted that a vaginal hysterectomy

Martina developed a visicovaginal fistula following a hysterectomy in 2008. PMS Expert Report concluded that her bladder was damaged during the operation, and the injury should have been recognised at the time. Failing to recognise and heal the injury constitutes negligence. Physically Martina is restored, but her psychological condition deteriorated as a result of this negligent treatment.The case settled and Martina received compensation.

Stephanie underwent a Total Abdominal Hysterectomy (TAH), left salpingo oophorectomy (LSO) and sacrocolpopexy in 2004 in order to treat painful periods and prolapse symptoms. In 2005 she presented with a bearing-down feeling and urinary urgency, and was found to have a cystocoele. She underwent a para-vaginal repair but continued to have prolapse symptoms and bowel problems. In 2009 she was referred to a colorectal surgeon who diagnosed a rectocoele and performed a STARR procedure. PMS concluded that it was negligent to perform the TAH, LSO and sacrocolpopexy. There were a

Tape erosion following the insertion of mid-urethral tapes Lee underwent a TVTO procedure with a pelvic floor repair in September 2008. After six months she developed increasing incontinence problems, precipitated by lifting a heavy box at work. She is also pursuing a case against her employers. PMS Expert Report concluded that the decision to insert the TVTO tape was reasonable, and the occurrance of a tape erosion is a recognised complication of all such procedures. The main breach of duty was a failure to fully investigate Lee's unusual urinary symptoms following

Voiding difficulty as a result of the insertion of mid-urethral tapes Hannah underwent a TVTO procedure combined with a pelvic floor repair in June 2010. She suffered post operative voiding dysfunction, unable to clear her bladder properly. A suprapubic catheter was inserted 3 days after the operation. 2 weeks later she was taught to self catherise and the catheter was removed. Her voiding difficulties failed to improve, and she was readmitted in December to loosen the TVTO tape. PMS Expert Report concluded that voiding dysfunction following a tight TVTO tape is

Eve was 38 when she presented with mixed urinary incontinence and heavy painful periods. A Total Abdominal Hysterectomy (TAH) and Colposuspension were performed in January 2007, followed by an external anal sphincter repair in May. She continues to suffer with both urinary and faecal incontinence. Eve raised concerns about the recommendation for and performance of TAH and Colposuspension. In particular, she felt that alternatives to surgery and risks of the procedures were not explained. PMS Expert Report concluded that it was negligent to perform a TAH and Colposuspention in this

Charley was 60 when she presented with urinary incontinence. After conservative treatment and urodynamic studies, a Trans-Obturator Tape procedure (TOT) was performed in 2005. Her leakage worsened, but nothing happened until 2010, when her doctor diagnosed detrusor overactivity and her symptoms improved with anticholinergic drugs. She expressed concern about the recommendation for and performance of TOT procedure. PMS Expert Report concluded that it was inappropriate to carry out a TOT procedure, and that instead she should have been offered anticholinergic medication in 2006. As a result of the operation, she suffered from worsened

Nancy was 48 years old when she complained of heavy painful periods due to fibroids. A laparoscopically assisted vaginal hysterectomy with removal of the ovaries was performed in 2010, but a few days after the operation, she started leaking urine all the time. Investigations revealed a vesico-vagina fistula (hole between the bladder and vagina) and two further operations were performed to repair this. PMS Expert Witness Report concluded that the surgeon had damaged the bladder by negligently stitching it to the vagina. As a result, the Hospital admitted liability and the

Yvonne had a long history of urinary incontinence, starting with the birth of her son in 1997. She underwent treatment in 1998, with urethropexy and bladder neck injection. In 2004 she presented with further urinary incontinence. In 2006 she attended theatre. A TOT procedure was planned but had to be abandoned due to a bladder perforation. She returned for the TOT procedure three months later, and subsequently reported that the incontinence was much worse. A cystoscopy revealed that mesh from the TOT was clearly visible in the urethra. A further

Nala presented with symptoms of vaginal prolapse and urinary incontinence in 2007. She underwent Anterior and Posterior Vaginal Repair a few months later. After this Nala complained that her vagina was too narrow, making intercourse impossible. A series of treatments over next four years were unsuccessful and pain and tenderness persisted. In 2011 she underwent a Vaginal Flap Operation. She alleged that the initial vaginal repair was negligent. PMS Expert Report concluded that the initial vaginal repair was probably conducted negligently. An excessive amount of tissue was removed and the

Molly was 29 when she underwent a vaginal hysterectomy and bilateral oophorectomy in 2004. In 2007 she presented with lower abdominal pain and weight loss. A diagnostic laparoscopy showed adhesions and a possible ovarian remnant in the pelvis, and so she underwent a laparoscopic adhesiolysis and left salpingo oophorectomy. Following this, her symptoms resolved. Molly alleged that her left ovary was not totally removed in 2004, resulting in her symptoms and further surgery, but PMS Expert Report concluded that there was no evidence of negligence. The standard of surgery was

Pam was admitted for a Tension-free Vaginal Tape (TVT) operation in 2001. During the operation the needle passed through the left external iliac artery, causing profuse haemorrhage. She was taken back to theatre and the artery was repaired with good results. However, Pam alleged that she was left with some physical disability and depression due to negligent injury to her artery. PMS Expert Report considered that Pam's problems were a direct result of the arterial perforation. Although such a mistake would be considered negligent if done by an experienced surgeon,

Larissa suffered from recurrent urinary tract infections following a Tension Free Vaginal Tape (TVT) procedure. She underwent a cystoscopy in order to investigate, but failed to attend for follow up. She alleged negligence in her doctor's recommendations for and performance of the TVT procedure. PMS Expert Report concluded that the decision to perform a TVT procedure was reasonable, given that conservative treatment had already been tried without success. It was also concluded that Larissa was given enough information to make her consent valid and appropriate, and there was no evidence

Frieda was 53 when she complained of problems since a Trans-Obturator Tape (TOT) with Posterior Vaginal Repair was performed in 2008. She suffers from constipation and difficult evacuation of the bowel. She has also been unable to have sexual intercourse due to narrowing of the vagina. PMS investigated her treatment, and concluded that it was negligent to advise Frieda to have anterior repair without first trying conservative treatment. These operations are usually reserved for older women, especially given that vaginal narrowing is a very common complication. Therefore the TOT and

Barbara was thought to have anaemia as a result of heavy periods, and so a vaginal hysterectomy was performed in 1993. Subsequently she developed urinary incontinence, and following urodynamic studies underwent a colposuspension in 1995. Barbara complained for persistent pain in the wound and urinary incontinence. Between 1998 and 1999, she underwent 2 urethral dilations but no improvements showed. In 2001 she was finally prescribed anticholinergic drugs. PMS Expert Report could not find evidence of medical treatment prior to the decision to perform a vaginal hysterectomy, which is a breach

Mesh erosion into bowel Susan suffered from recurrent vaginal vault prolapse and underwent a sacrocolpopexy with mesh.

Rachel underwent a vaginal sacrospinous fixation (VSSF) with anterior repair to treat a vaginal prolapse.  She presented with a urinary fistula 3 weeks later, and had to undergo major surgery to reimplant the right ureter. The PMS report stated that the injury to the ureter was caused by the sutured used in the VSSF procedure, although this is a rare complication of the procedure. The defendants denied that the ureter was obstructed at the end of the procedure and postulated different cause for the damage to the ureter. However, there was

Julie developed right sided pelvic pain, 10 weeks after the insertion of a Tension-free Vaginal Tape – Obturator (TVT-O). She alleged that the operation had been performed in a negligent manner, and had caused the chronic pain. The PMS report noted that the operation had been performed in the correct manner with no immediate problems.  We stated that right iliac fossa fossa pain was a rare complication of TVT-O procedure. Furthermore, this lady had undergone a number of investigations, which had failed to reach a diagnosis of the cause of the