This is an interesting study from Italy. The mechanism by which urine is transported from the kidney to the bladder via the upper urinary tract (UUT) remains poorly understood and elusive. For many years, pyeloureteric rhythmicity is thought to arise in active smooth muscle cells (SMC). However, increasing evidence indicates that interstitial cells of Cajal like cells (ICC-LC) are present in the pelvi-ureteric junction (PUJ) of a number of mammals. In congenital PUJ obstruction, there is altered action / distribution of ICC-LC, leading to defective generation of pacemaker activity. These cells play a significant role in propagation, co-ordination and modulation of upper tract peristalsis. The take home message is: remember interstitial cells of Cajal. 

Pacemakers in the upper urinary tract.
Benedetto AD, Arena S, Nocotina PA, et al.
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Arun K Sharma

West Herts NHS Trust (Watford General Hospital)

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