This Month in Pediatric Urology

Abstract

You have accessJournal of UrologyThis Month in Pediatric Urology1 Jul 2020This Month in Pediatric Urology Julian Wan Julian WanJulian Wan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001040AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail A new perspective can cause a new appreciation of even a well-known topic. This issue includes 2 articles that share this common theme. Telemedicine for Pediatric Urology Postoperative Care Finkelstein et al (page 114) from Boston, Massachusetts examined the use of telemedicine applied to pediatric urology postoperative followup in a comparison of 107 virtual vs 100 in-person visits.1 There was no difference in terms of appointment compliance and clinical outcomes. Time spent travelling and waiting to be seen accounted for 98% of the time spent for an in-person visit and led to a twentyfold difference in the cost per minute compared to a virtual visit. Shorter wait times, decreased absence from school and loss of time from work were all found to be benefits of video visits. The economic aspect of telemedicine, particularly with regard to the cost of medical care and how it could be contained and curbed, has been a foremost concern for decades. Telemedicine seemed a solution that would make it easier for quality care to be accessible. That all changed after the coronavirus outbreak became pandemic. The ability to conduct medical care virtually is no longer just an economic issue but also a public health issue. We are now entering a new practice environment where virtual visits may become a routine part of our clinical practice. We might see beneficial unintended consequences with greater cooperation between distant sites and practitioners, as well as an increase in the development of tele presence tools to conduct physical exams. Malignancy after Augmentation Enterocystoplasty Garnier et al (page 136) from France performed a nationwide study of the natural history and well-known risk of neoplasms after augmentation enterocystoplasty and found 16 cases.2 Routine lifelong followup of these cases has been recommended by many experts even while acknowledging the difficulty of sorting out if the augmentation is an independent risk factor for cancer or an inherent risk arising from the congenitally abnormal bladder. The authors note the difficulty of achieving an early diagnosis and the sparse knowledge about the long-term prognosis. Of the 16 cases 13 were already at an advanced stage at diagnosis with local positive lymph nodes or distant metastases. The retrospective nature of the study may have affected the recall and capture of the more severe cases. Tumor specimens with analyzable DNA were available in 9 cases, including 4 wild-type mutations and 5 with missense abnormalities in libraries of known oncodriver genes. While these findings offer research avenues to expand the list of known oncogenes associated with augmentation enterocystoplasty neoplasia, the fundamental need to have consistent lifelong followup may suggest another important role for transitional urology and the concept of congenitalism.