(339) Malpractice Litigation Related to Management of Varicocele: A Legal Database Review
Authors: Zhou E , Sellke N , Sun H , Tay K , Mortach S , Abou Ghayda R , Loeb A , Thirumavalavan N 
Published: February 2024

Abstract

Introduction
Varicocele may be associated with pain and subfertility which comes with a range of treatment options, from observation to pain management to surgical correction. Urologists are defendants in more malpractice suits than the average physician and litigation may be a concern when determining their management strategy.

Objective
The purpose of the study was to investigate the factors associated with malpractice litigation surrounding the management of varicoceles.

Methods
Using the Casetext online legal database, we searched for cases with the query “(Malpractice and (Varicocele or Varicocelectomy)).” Cases were only included if they were related to varicocele management. We documented the following variables: date of case, whether the plaintiff was incarcerated, alleged breaches of duty, alleged damages, and legal outcome. Data were analyzed using descriptive characteristics.

Results
Our database search yielded a total of 26 cases. Of these, 10 were related to the management of varicocele and included in our analysis. The cases occurred between the years 1931 and 2022, with 60% (6/10) having happened since 2013. 60% (6/10) of the cases involved an inmate as the plaintiff. The alleged breaches of duty included violation of the 8th Amendment (50%, 5/10), with all those cases involving inmates; negligence (40%, 4/10); and disability discrimination (10%, 1/10). The most common alleged damages included pain (80%, 8/10), infertility (30%, 3/10), and loss of testicle (30%, 3/10). A urologist was included among the defendants in half the cases. Other defendants included prison wardens, healthcare institutions, prison complexes, and other physicians. The verdict in 90% (9/10) of these cases favored the defendant. The lone case which favored the plaintiff occurred in 1951, included a urologist in the defense, and involved a retained drain inside the scrotum which led to infection and ultimately orchiectomy. 100% (6/6) of the cases involving inmates favored the defendant.

Conclusions
There have been relatively few legal cases on varicoceles, and most of them involved inmates. This may reflect differences in approach or treatment of urologic issues in inmates amongst medical care facilities. Violation of the 8th Amendment, which prohibits cruel and unusual punishment, was a common breach of duty alleged by incarcerated plaintiffs. However, all those cases favored the defense, with the explanation of these decisions often stating that the act of treating the varicocele, even if not successful, was proof that sufficient efforts were made. Most of the alleged damages involved pain because of insufficient or negligent treatment. Infertility as well as loss of testicle were less common claims. A major limitation of this study is that it does not capture cases which settled prior to trial. Nonetheless, providers should be reassured that malpractice claims regarding varicoceles are uncommon and that most cases are ruled in favor of the defense.

Disclosure
No.