ANUS – What can it show us…..?
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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
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Definition…
• >4mm @ any stage of gestation?
• >5mm @ any stage of gestation?
• >7mm @ 30 weeks?
• >10mm……?
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Diagnoses…..• normal – 90%• VUR• NONRMU • VUJ obstruction• posterior urethral valves• MCD kidney• duplication anomalies • PUJ obstruction• …….!
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ANUS
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Post natal ultrasound (PNUS)
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PNUS
• Day 0 – underestimates c/w ANUS– early management of severe abnormality
• 6 week– definitive scan– will be “worse” than day 0
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VUR
• “dilating” reflux only• more likely to get better c/w PNDx
• Plan:– Antibiotic prophylaxis– MCUG– DMSA
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Hyroureteronephrosis
• VUR• VUJ obstruction• Non obstructing non refluxing megaureter
• Plan– MCUG– MAG3 (age >3 months)– Antibiotic prophylaxis (until VUR excluded)
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NONRMU vs VUJ ….?
• exclusion essentially• cytsocopy and retrograde – “rats tail”
• clues:– increasing HUN– reduced function
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NONRMU vs VUJ ….?• Plan:
– observe– JJ stent insertion
•diagnostic +/- therapeutic
– TUU– reimplant
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Posterior Urethral Valves
• bladder outflow obstruction• unilateral (good) or bilateral (bad) HUN
• oligohydramnios (bad)
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Posterior Urethral Valves
• Plan:– MCUG +/- catheter– bloods– optimised fluid management – antibiotic prophylaxis– valve resection +/- vesicostomy
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Multicystic dysplastic kidney
(MCDK)
• failure of fusion of ureteric bud and developing kidney
• 0% Function on DMSA
• risks minimal
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Multicystic dysplastic kidney
(MCDK)
• Plan– PNUS– DMSA
– Default is non-operative
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PUJ “obstruction”
• dilatation obstruction
• isolated hydronephrosis
• aetiology– intrinsic– extrinsic
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PUJ “obstruction”
• Plan:– PNUS
– MAG3 ->3 months
– no need for prophylaxis
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Options?
• observe– serial USS– occasional renogram– DMSA more accurate for function
• operate
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Dilated pelvis
Tortuous ureter
kidney
ureter renal pelvis
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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
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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
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