ANUS – What can it show us…..?

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Presentation transcript:

ANUS – What can it show us…..? Chris Driver RACH

Definition… >4mm @ 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 6 week 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 TUU reimplant 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 ¹ obstruction isolated hydronephrosis aetiology intrinsic extrinsic

PUJ “obstruction” Plan: PNUS MAG3 ->3 months no need for prophylaxis

Options? observe operate 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19mm – 5% come to surgery (unpublished) but ……around 3% deteriorate over time usually 1st 2 years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 disadvantages 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

Any Questions….?