Editorial to 'Intraoperative inspection of the ureteropelvic junction during pyeloplasty is not a sufficient way to distinguish between extrinsic and intrinsic causes of obstruction: Correlation with histological analysis'.
In cases of symptomatic hydronephrosis with purely extrinsic PUJ obstruction, the laparoscopic transposition of lower-pole crossing vessels (LPCV) (the ‘vascular hitch’ technique) has recently gained enthusiastic popularity as an alternative to dismembered pyeloplasty [1]. It has, however, raised concerns regarding the difficult selection of indications, and the possibility of misdiagnosing a concurrent intrinsic stenosis. In this paper, the authors genuinely stated that the aim of their study was to show that similar immuno-histological alterations could be observed in specimens of PUJ harvested from both intrinsic and extrinsic obstruction groups. They studied the presence of interstitial Cajal cells (through CD117 immunostaining) and gapjunction proteins (Connexin Cx43), both deemed to reflect disordered peristaltism and intramuscular innervation defects. Unfortunately, histological findings were scarcely described, and the lack of control group, although difficult to obtain, represented a major limitation for the interpretation of the results. It is likely that an ancillary study also focusing on collagen density and neuronal distribution patterns would have given a more precise and specific picture of the PUJ wall changes. As a main result, the authors only reported similar staining patterns between the two groups, which may have simply indicated that the observed wall changes were nonspecific. If the histological changes observed in intrinsic stenosis could be explained by premature arrest, it is difficult to explain why secondarydegenerative alterationsdue toextrinsic causes would produce similar histological patterns. A major flaw of the present study was the definition of the so-called ‘intrinsic’ and