EDITORIAL COMMENT for: The Minimal Utility of Analyzing Ureteropelvic Junction Tissue at the Time of Pyeloplasty, Has Been Accepted for Publication in JU Open Plus

Certain practices long ingrained in routine surgical practice have changed. Early in my practice, it was routine to send foreskin after circumcision or a hernia sac after a hernia repair or orchiopexy for pathological analysis. The exceedingly low incidence of any relevant pathology—especially any findings that would alter patient outcomes—led to the abandoning of such practice. This paper highlights yet another “routine” step that deserves similar cessation—sending a ureteropelvic junction (UPJ) specimen for pathology evaluation.1 Although many in pediatric urology do not routinely send UPJ specimens for evaluation, this study is important in highlighting not only the universally benign findings associated with these specimens but also for honestly declaring that more than $100,000 dollars would have been saved over 8 years by not having the specimens evaluated. Moreover, the study is interesting in its cohort comparisons between adult and pediatric patients: The higher incidence of surgery is in women in adults which is reversed in children, and the higher incidence of crossing vessels is the cause of UPJ obstruction in adults compared with children (61% vs 40%). The take-home message remains that as surgeons and important stewards of our health care system, we must constantly reevaluate legacy practices that we consider “routine,” realizing that following a protocol because “that is the way it is always been done” is likely an excellent practice or protocol worth further interrogating.