Inquest into the Death of John HOUGHTON

72y · Male·Metastatic bladder cancer; likely mechanism pulmonary embolism from combined effect of cancer and hip surgery

A 72-year-old male underwent hip replacement despite undiagnosed metastatic bladder cancer. Following referral from his GP in May 2014 for an ultrasound showing bladder wall irregularities suspicious for cancer, urologist Dr S. did not consider cancer likely and arranged a flexible cystoscopy to exclude this diagnosis. However, no cystoscopy date was obtained before the hip replacement on 23 June 2014. The patient deteriorated post-operatively and was diagnosed with aggressive metastatic bladder cancer on 3 July 2014, dying 8 days later. Expert opinion differed on whether earlier diagnosis would have changed outcomes, but consensus held that cystoscopy should have been prioritised before elective surgery. System delays in obtaining diagnostic procedures in the public system contributed to this adverse outcome.