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M&M Sinai Grace Hospital. Brent Zamzow DO. 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.

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M m sinai grace hospital

M&MSinai Grace Hospital

Brent Zamzow DO


Intra op consult
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


Course of events
Course of events

  • Foley removed & replaced

    • Irrigated easily

    • Sent to PACU

    • Bladder scan in PACU – 800cc

    • Flexible cysto in PACU


Results
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


Ectopic ureter

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



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