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

2. Definition… >4mm @ any stage of gestation?
30 weeks?
>10mm……?

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

4. ANUS

5. Post natal ultrasound (PNUS)

6. PNUS Day 0 6 week underestimates c/w ANUS
early management of severe abnormality
6 week
definitive scan
will be “worse” than day 0

7. VUR “dilating” reflux only more likely to get better c/w PNDx Plan:
Antibiotic prophylaxis
MCUG
DMSA

9. Hyroureteronephrosis
VUR
VUJ obstruction
Non obstructing non refluxing megaureter
Plan
MCUG
MAG3 (age >3 months)
Antibiotic prophylaxis (until VUR excluded)

10. NONRMU vs VUJ ….? exclusion essentially
cytsocopy and retrograde – “rats tail”
clues:
increasing HUN
reduced function

11. NONRMU vs VUJ ….? Plan: observe JJ stent insertion TUU reimplant
diagnostic +/- therapeutic
TUU
reimplant

12. Posterior Urethral Valves
bladder outflow obstruction
unilateral (good) or bilateral (bad) HUN
oligohydramnios (bad)
                             

13. Posterior Urethral Valves
Plan:
MCUG +/- catheter
bloods
optimised fluid management
antibiotic prophylaxis
valve resection +/- vesicostomy

14. Multicystic dysplastic kidney (MCDK)
failure of fusion of ureteric bud and developing kidney
0% Function on DMSA
risks minimal

15. Multicystic dysplastic kidney (MCDK)
Plan
PNUS
DMSA
Default is non-operative

16. PUJ “obstruction” dilatation ¹ obstruction isolated hydronephrosis
aetiology
intrinsic
extrinsic

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

18. Options? observe operate serial USS occasional renogram
DMSA more accurate for function
operate

19. Dilated pelvis
Tortuous ureter
kidney
ureter
renal pelvis

20. 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19mm – 5% come to surgery (unpublished)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

21. 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

22. Any Questions….?