M&M Sinai Grace Hospital

1. M&MSinai Grace Hospital Brent Zamzow DO

2. Intra-op Consult • 54 female – “No urine output” • Open cholecystectomy • Normal pre-op renal function • Intra-op fluids • 1900cc blood loss • 4L LR • 2u PRBC, 2u FFP, 10 platelets • Urine output = 0 • Foley placed by surgery resident pre-op & irrigated

3. Course of events • Foley removed & replaced • Irrigated easily • Sent to PACU • Bladder scan in PACU – 800cc • Flexible cysto in PACU

4. Results • Anatomy • Duplicated Left Ureter • Ectopic ureter inserting into urethra • Poorly functioning left upper pole kidney • Flexible cysto • Scoped left upper pole ureter • Wire/Council catheter placed into bladder – 800cc • What happened? • Foley placed into ectopic ureter intraop

8. Terminates bladder neck or distally More common in females (2.9:1) >80% in females associated w/ duplicated system Female Urethra 35% Vestibule 34% Vagina 25% Cervix or uterus 5% Other <1% Male Posterior urethra 60% Seminal vesicle 33% Prostatic utricle 10% Ejaculatory duct 5% Vas deferens 5% Ectopic Ureter

9. END