Medical Malpractice and Nephrolithiasis: U.S. Appellate Cases from 2001 to 2018.

INTRODUCTION: Kidney stones are one of the most litigated diagnoses in urological practice. To better understand the cause for and outcomes of medical malpractice cases related to nephrolithiasis we analyzed United States medical malpractice appeals court cases from 2001 to 2018. METHODS: We searched LexisNexis for "kidney stone/nephrolithiasis" and "malpractice" from 2001 to 2018. Individual case data were compiled and analyzed with descriptive statistics, including involved parties, outcome of the initial case/appeal, alleged physician negligence, monetary awards granted and size of awards. RESULTS: Our search yielded 45 cases, of which 33 met criteria for analysis. The patient/spouse was the plaintiff in 23/33 (69%) cases, and the patient's estate was the plaintiff in 10/33 (30%) cases. A urologist was a defendant in 19/33 (57%) cases and nonurological providers were named in 10/33 (30%) cases. A hospital was named in 21/33 (64%) lawsuits. A total of 30/33 (91%) suits cited an error in treatment as the primary negligence. Of all cases, 10% were reversed on appeal and the majority of cases were found in favor of the defendant initially and on appeal. Overall, the defendant prevailed in 21/33 (63%) of cases. Four trials involved payment to a plaintiff and the average payout was $1,075,439 (range $193,000-$3,000,000). CONCLUSIONS: The majority of nephrolithiasis malpractice suits involve a verdict in favor of the urologist, physician or hospital, even after appeal. Errors in treatment are much more commonly litigated than errors in diagnosis. Although the prevalence of plaintiff payout was low, awards granted averaged over a million dollars per case.

Novel Education and Simulation Tools in Urologic Training.

PURPOSE OF REVIEW: Postgraduate medical training has evolved considerably from an emphasis on hands-on, autonomous learning to a paradigm where simulation technologies are used to introduce and augment certain skill sets. This review is intended to provide an update on surgical simulators and tools for urological trainee education. RECENT FINDINGS: We provide an overview of simulation platforms for robotics, endoscopy, and laparoscopic practice and training. In general, these simulators provide face, content, and construct validity. Various educational and evaluation tools have been adopted. Simulation platforms have been developed for technical and non-technical surgical skills, educational bootcamps, and tools for evaluation and feedback. While trainees find the opportunity to practice their skills beneficial, there may be difficulty with access due to cost and availability. Additionally, there is a need for more objective metrics demonstrating improvement in skill or patient outcome.