Re: Differences between Intrinsic and Extrinsic Ureteropelvic Junction Obstruction Related to Crossing Vessels: Histology and Functional Analyses

PEDIATRIC UROLOGY

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Pediatric Urology Re: Evidence for a Delay in Diagnosis of Wilms’ Tumour in the UK Compared with Germany: Implications for Primary Care for Children K. Pritchard-Jones, N. Graf, H. van Tinteren and A. Craft University College London Institute of Child Health, London and Department of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom, Department of Paediatric Oncology/Hematology, Saarland University Hospital Homburg, Homburg, Germany and Head Biometrics Department, Netherlands Cancer InstituteeAntoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands Arch Dis Child 2016; 101: 417e420. doi: 10.1136/archdischild-2015-309212

Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26948824 Editorial Comment: Patients from the United Kingdom and Germany with Wilms tumor were treated in the same clinical trial during the last decade. The authors found that Wilms tumors are significantly larger in volume and have a more advanced stage at diagnosis in the United Kingdom compared to Germany. There was also a small difference in the event-free and overall survival rates between the 2 countries favoring the German series. The authors believe that in either system once the general practitioner has suspicion of an abdominal mass, they should refer promptly and the system will provide rapid access to diagnostic investigation and treatment. However, it appears that a greater proportion of children with renal tumors in Germany are diagnosed while still asymptomatic. One difference is that in the United Kingdom less than 50% of general practitioners who undertake primary care for children receive any formal pediatric training beyond general practice training. By comparison, in Germany the bulk of primary health care for children is provided by primary care pediatricians. These practitioners are office based and often have ultrasound machines in their offices. If these data are substantiated in subsequent studies, a more standardized approach to general pediatric care throughout Europe may evolve. Douglas A. Canning, MD

Re: Differences between Intrinsic and Extrinsic Ureteropelvic Junction Obstruction Related to Crossing Vessels: Histology and Functional Analyses V. Ellerkamp, R. R. Kurth, E. Schmid, S. Zundel, S. W. Warmann and J. Fuchs Department of Pediatric Surgery and Pediatric Urology, and Institutes of Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany World J Urol 2016; 34: 577e583. doi: 10.1007/s00345-015-1645-x

Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26219514 Editorial Comment: The conventional wisdom is that children who present later with crossing vessels have “secondary” obstructions. Those who present earlier without an apparent crossing vessel have an intrinsic aperistaltic ureteral segment. These authors retrospectively reviewed 139 patients with ureteropelvic junction obstruction and found no differences in fibrosis, muscular hypertrophy or chronic inflammation between those presenting early with presumed intrinsic obstruction and those presenting later with a crossing vessel. Maybe the pathophysiological process is the same. Douglas A. Canning, MD

Re: Changes in Cajal Cell Density in Ureteropelvic Junction Obstruction in Children C. Senol, M. Onaran, S. Gurocak, I. I. Gonul and M. O. Tan Departments of Urology and Pathology, Gazi University School of Medicine, Ankara, Turkey J Pediatr Urol 2016; 12: 89.e1ee5. doi: 10.1016/j.jpurol.2015.08.010