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A 28 year old laborer presented to his primary care physician with slow onset low grade pain in his left testicle for one week. On examination the left testicle was swollen and tender. Urinalysis showed 5-10 white cells. There was a past history of undescended testis on the left which had been repaired in childhood. He was referred to a urologist for further evaluation and treatment. The urologist confirmed that the testicle was swollen and made a clinical diagnosis of epididymo-orchitis. The patient was given a prescription for Bactrim and told to return in 3 weeks. On return visit, the pain and tenderness was resolved. On physical examination, the testicle remained enlarged and swollen. The antibiotic was changed to tetracycline. No other specific action was taken by the urologist. On followup 6 weeks later the situation was unchanged and the patient was becoming concerned about the enlargement of the left testicle. A second opinion was obtained by the patient and the consultant physician made a diagnosis of probable testicular cancer. The patient underwent a left orchiectomy which confirmed the diagnosis of embryonal carcinoma of the testis and was referred to a tertiary cancer center for treatment of metastatic disease in his retroperitoneum and lungs. I was brought into the case as an expert witness for plaintiff and testified at trial that the standard of care required one to consider a diagnosis of testis cancer due to past history of undescended testis, enlargement of the testis, lack of acute pain and lack of response to antibiotics over 6 weeks. Further, the standard of care required a scrotal imaging to rule out torsion or tumor. The case was decided in favor of the plaintiff.

A 48 year old woman complained of prolapse without stress urinary incontinence and consulted her gynecologist. On examination, he found a grade 2 prolapse of the bladder. The recommendation was for a vaginal hysterectomy with repair of bladder prolapse. Preoperative urodynamic studies indicated a weak detrusor contraction. At surgery, the gynecologist felt that a sling operation should also be done to prevent any stress incontinence that might develop after the repair operation. He performed a tension free cadaveric sling operation. Postoperatively, the patient did well but was unable to void spontaneously and had to remain on self catheterization. Two months postoperatively, she had incision of the sling but still was unable to void her bladder. I was brought in as expert witness for the defendant. My analysis indicated that the placement of the sling was performed correctly and that her postoperative voiding difficulties could have been due to the sling but were more likely due to her weak bladder muscle. The case was decided in favor of the defendant.