Dear ${PATIENT},
In the course of the procedure to remove the tumor near your prostate, it was found that a second incision was necessary near the penis in order to safely remove the tumor without rupturing it. This requires the manipulation of one or both testicles as well as the penis which will be accomplished with the assistance of a certified operating nurse's left forefinger and thumb. Your previous consent form which you signed and approved this morning did not inform you of this as it was not known at the time that such a manipulation would be required. Out of respect for your bodily autonomy and psychological well-being the procedure was aborted and all wounds were closed to the maximal possible extent without violating your rights as a patient. If you would like to continue with the procedure please sign and date the bottom of this form and return it to our staff. You will then be contacted at a later date about scheduling another procedure.
Please be aware that you are under no obligation to continue the procedure. You may optionally request the presence of a clergymember from a religious denomination of your choice to be present for the procedure but they will be escorted from the operating room once the anesthetic has been administered.