ANUS – What can it ANUS – What can it show us…..?show us…..?

ANUS – What can it ANUS – What can it show us…..?show us…..?

Chris DriverChris Driver

RACHRACH

Definition…

• >4mm @ any stage of gestation?

• >5mm @ any stage of gestation?

• >7mm @ 30 weeks?

• >10mm……?

Diagnoses…..• normal – 90%• VUR• NONRMU • VUJ obstruction• posterior urethral valves• MCD kidney• duplication anomalies • PUJ obstruction• …….!

ANUS

Post natal ultrasound (PNUS)

PNUS

• Day 0 – underestimates c/w ANUS– early management of severe abnormality

• 6 week– definitive scan– will be “worse” than day 0

VUR

• “dilating” reflux only• more likely to get better c/w PNDx

• Plan:– Antibiotic prophylaxis– MCUG– DMSA

Hyroureteronephrosis

• VUR• VUJ obstruction• Non obstructing non refluxing megaureter

• Plan– MCUG– MAG3 (age >3 months)– Antibiotic prophylaxis (until VUR excluded)

NONRMU vs VUJ ….?

• exclusion essentially• cytsocopy and retrograde – “rats tail”

• clues:– increasing HUN– reduced function

NONRMU vs VUJ ….?• Plan:

– observe– JJ stent insertion

•diagnostic +/- therapeutic

– TUU– reimplant

Posterior Urethral Valves

• bladder outflow obstruction• unilateral (good) or bilateral (bad) HUN

• oligohydramnios (bad)

                

             

Posterior Urethral Valves

• Plan:– MCUG +/- catheter– bloods– optimised fluid management – antibiotic prophylaxis– valve resection +/- vesicostomy

Multicystic dysplastic kidney

(MCDK)

• failure of fusion of ureteric bud and developing kidney

• 0% Function on DMSA

• risks minimal

Multicystic dysplastic kidney

(MCDK)

• Plan– PNUS– DMSA

– Default is non-operative

PUJ “obstruction”

• dilatation obstruction

• isolated hydronephrosis

• aetiology– intrinsic– extrinsic

PUJ “obstruction”

• Plan:– PNUS

– MAG3 ->3 months

– no need for prophylaxis

Options?

• observe– serial USS– occasional renogram– DMSA more accurate for function

• operate

Dilated pelvis

Tortuous ureter

kidney

ureter renal pelvis

ANUS and PUJO – Is size important?

• GOSH data on PNUS– >35mm comes to surgery eventually

• when can we leave alone?– unclear– <10 mm – surgery rare– <19mm – 5% come to surgery (unpublished)

• but ……around 3% deteriorate over time– usually 1st 2 years

ANUS

• advantages– permits early detection of renal pathology– ?intervening early improves overall outcome?

• disadvantages– no evidence base for criteria for intervention

– no consensus for early discharge– increased parental anxiety