Litigation in paediatric urology within the National Health Service (NHS) England: an analysis of costs and causes

OBJECTIVE: To provide a national evaluation of contemporary litigation trends within Paediatric Urology within National Health Service (NHS) England by examining long-term trends, the financial burden and the underlying causes of successful claims over the last 19 years. MATERIALS AND METHODS: Litigation data were obtained from NHS Resolution through a Freedom of Information (FOI) Act 2000 request, from 2006/2007 to 2024/2025. For all paediatric urology cases (patients < 18 years), information was collected on the total number of claims, the number of which were successful, and the associated costs of damages and legal fees. Successful claims were reviewed according to the recorded primary cause and the primary injury sustained. RESULTS: In total, 216 litigation claims were submitted in Paediatric Urology during the study period, of which 134 (62%) were successful. Damages paid amounted to £5.32 million. The number of claims rose 3.6-fold over the 19-year-period. Damages increased 2.2-fold, from £195,750 in 2010/2011 to £441,410 in 2024/2025. The leading causes of successful claims were failure or delay in diagnosis (29.1%, 39/134), failure or delay in treatment (24.6%, 33/134), and inappropriate treatment (4.4%, 6/134). Operative factors accounted for 9.7% (13/134), while non-operative causes represented 66.41% (89/134). The most common primary injuries were removal of a testicle (36.5%, 49/134), additional or unnecessary procedures (17.1%, 23/134), unnecessary pain (8.9%, 12/134), and renal damage or failure (6.2%, 9/134). CONCLUSION: Both total and successful Paediatric Urology claims have progressively risen steadily across NHS England. Most stem from non-operative issues potentially influenced by extended waiting times. Improving clinician education, promoting learning from avoidable incidents, and ongoing monitoring are essential to mitigate risks, improve patient outcomes, and reduce medicolegal costs.