Urinary tract abnormalities in association with oesophageal atresia

Abstract

We would like to make two comments about the above article [ 1]. Firstly, the incidence of bilateral renal agenesis and/or multicystic dysplastic kidneys is quoted as 3%. This is a high figure, and not substantiated by the data where only 5 out of 499 patients, or 1%, appear in the tables. Secondly, the paper advocates the routine use of micturating cystourethrography (MCU) to look for vesicoureteric reflux in all patients with oesophageal atresia. We would disagree with this strategy since MCU is associated with complications and can be restricted to use in those patients with oesophageal atresia and an associated anorectal anomaly. We found an anorectal anomaly in 13/73 (l 6.5 %) of our infants with oesophageal atresia [6], which is similar to other series [3-5]. Investigation of the renal tract in infants with anorectal anomalies is known to be productive [2, 7], and this sub-group of patients with oesophageal atresia have both a higher incidence and greater severity of renal abnormalities. We advocate that this group be investigated with MCU; in those patients without an associated anorectal anomaly MCU need not be routine, but should be requested appropriately on the findings of renal ultrasonography or urine culture.