1. M&M Sinai Grace Hospital Brent Zamzow DO

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

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

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

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

9. END END