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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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Presentation Transcript
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