Patient's unnecessary operation

What happened

Mr J was first seen by the Trust's urology department in autumn 2011 for examination of haematuria (blood in his urine). An ultrasound scan of his kidneys showed no abnormality, but a CT scan showed several tiny stones in his left kidney. Mr J was offered a cystoscopy (a telescope examination of the bladder) to check whether the haematuria was bladder related, but he did not want to undergo this procedure.

Mr J continued to experience problems and was referred to the Trust again. He was seen by a consultant urologist in late spring 2012 and X–rayed on the same day. The consultant urologist's clinic letter said Mr J was still experiencing left loin to groin pain (although Mr J said he had left sided pain) and his X–ray showed he may have a stone in the lower ureter. He was therefore booked in for left ureteroscopy (a tube to investigate) and lithotripsy (to break up stones) under general anaesthesia. The X–ray was formally reported nine days after it was taken.

Mr J completed a consent form and had his operation a month later. The Trust did not find a stone in Mr J's ureter but during the operation examined his urethra, bladder and prostate. Mr J complained over a month later that his kidney stones were not treated as he thought they would be (as shown in the earlier CT scan) and that further examinations of his bladder, prostate and urethra were carried out that he did not consent to. Mr J raised further issues when he tried to get the matter resolved locally.

What we found

The Trust's explanation of why it operated on Mr J was reasonable, however the Trust should have X–rayed Mr J again, before the operation, to make sure he still needed it. The consultant urologist had looked at the abdominal X–ray taken in late spring 2012 and thought he could see 'a small calcified speck within the line of the left ureter'.

However, when the X–ray was formally reported nine days later, it was normal and there was nothing in the ureter. Essentially the consultant urologist had relied on a CT scan taken eight months previously and the unreported X–ray of late spring to propose an investigation.

We agreed that it is good practice to avoid subjecting patients to unnecessary radiation exposure by taking another X–ray, due to the small risk of causing cancers. However, the consultant urologist failed to balance this against the potential risks and complications of an operation.

The surgeon who carried out the operation should also have questioned whether it was needed, and he should have at least carried out a further X–ray to see if the stone was still there. There were several weeks between the X–ray being taken and the operation taking place, and the stone could have passed naturally. This would have avoided a needless operation. Mr J suffered unnecessary stress and inconvenience from undergoing an operation that was not needed.

While the operation was not needed, it was not unreasonable to check Mr J's urethra, bladder and prostate while doing it. The Trust carried out the operation Mr J had consented to and we found no failings in the other clinical issues Mr J raised.

While we did not agree with the Trust's view that it was reasonable to operate on Mr J, overall his complaint was dealt with reasonably.

Putting it right

The Trust paid £1,000 to Mr J to address the stress and inconvenience he suffered, and apologised for the failing we had found. We also recommended that the Trust show what it had learnt from our findings.