This tube is called the urethra.
This man's unfortunate journey began when he started having difficulty urinating. He saw a a urologist (a specialist who treats diseases of the urinary system) who, after examining him, told him that he had abnormal scar tissue (called a "stricture") in his urethra that needed to be cut open. This procedure is known as a "urethrotomy."
The doctor inserts a tube into his penis and then once the tube is in the correct place, then inserts a knife within the tube to cut away the scar tissue. The problem with this procedure is that the scar tissue is virtually guaranteed to return weeks or months later. Why? Because this procedure is a band-aid.
Three months later, my client was back in the urologist's office with the same exact complaints: Difficulty urinating, straining and pain. The doctor again recommended the same "cold-knife urethrotomy." Despite the doctor's attempts to get rid of the scar tissue, the same problems came back a few months later. Here's where things started to go wrong.
After the second procedure, when the urolological symptoms returned, he should have been sent to a urologist who specializes in reconstructive surgery. Had the happened, he would have had a simple two hour surgery to remove the section of urethra with the scar tissue and replace it with skin from the inside of his mouth, known as a "buccal mucosa skin graft."
Instead, the original treating urologist told my client he required a unique device known as a "stent" to be inserted into his penis, into an area called the "bulbar urethra." This stent is a coiled steel mesh, that when placed into the urethra, springs open to hold the urethra open. Unfortunately for this young man, this clearly was the wrong device to use.
First, the stent was not meant for young men.
Rather, it was meant for old men who no longer have erections. The reason is that in a young healthy man who still gets erections a stent will cause excruciating pain. In an elderly man who no longer is able to achieve an erection, the stent may be the right fix. Second, this stent was not meant to be used for the amount of scar tissue that my client had- in fact the manufacturer's own guideline clearly indicated it was not to be used for strictures that were as long as my client's stricture.
The problem is that these stents are designed to be permanent. Once inserted, layers of skin tissue grow over the stents to hold them in place. They literally become embedded within the urethra.
When the doctor went to remove the stents, he had to pull the wire filaments out one by one since they do not come out in one piece. Unfortunately, when he removed the stents, he destroyed the inside of this man's urethra. Instead of removing the stents and allowing the urethra to heal, this doctor decided that instead he'd insert two new stents during the same procedure right back into the the urethra, in a slightly different location, thinking that would do the trick. However, the only 'trick' it caused, was a total destruction of my client's urethra.
He obtained a second and third medical opinion, this time with a reconstructive urological surgeon. My client was told that his urethra was totally obliterated and he needed massive reconstructive surgery to fix it.
Two surgeries, 17 months apart. The first surgery took 12 hours. The embedded stents had to be painstakingly removed. Since the urethra needed to heal for more than a year, there had to be another location where the urine would exit from his body during this time. The surgeon created something called a "urinary diversion," which is exactly what it sounds like. The urine is diverted from the urethra and out the penis, to a different location.
The only place for this alternate way to urinate was to make a surgical hole between his scrotum and his anus. Every time he needed to urinate, he'd have to sit down on the toilet, like a woman, and wipe every time. This was totally humiliating for him. He also had to have a huge section of skin taken from his thigh to use as a skin graft inside his penis for his new urethra.
After almost 17 months of healing, with no sex and no ability to go swimming during this time, he had his second corrective surgery. The urinary hole next to his scrotum was finally closed. His urethra was reattached to his bladder and now urine flowed correctly out through his penis. After two months, he was remarkably better.
Putting the stents in, taking them out, and putting two new ones in destroyed his entire urethra. Had the original urologist done the right thing and sent the patient to a reconstructive urological surgeon after the second urethrotomy procedure, this young man never would have needed such an extensive reconstructive procedure known as a "rescue urethroplasty."
The defense claimed that it was appropriate to use these stents and that he still would have required a "urinary diversion" regardless of when the corrective surgery took place. The problem with this reasoning was that the defense failed to take into account that before his urethra was totally destroyed, he could have had a simple urethroplasty procedure with no need to divert his urine.
It was only through hard-fought negotiation on both sides and with the help of an experienced mediator, were we able to reach a settlement that was agreeable to both sides.