ObjectivesTo present the national outcomes for New Zealand of over 9 000 stone cases treated with SWL at 21 centres over a 20 year period. Subjects/patients and methodsStone cases treated with SWL on board the Mobile Medical Technology (MMT) vehicle between 19 June 1995 and 1 December 2014 were identified, and data collection undertaken prospectively for patient, stone and treatment characteristics, and retrospectively for treatment outcomes. The primary outcome was treatment success, defined as complete stone clearance or clinically insignificant residual fragments (CIRFs) of ≤4mm. Secondary outcomes were stone free rate, complications and auxiliary procedures, and all statistical analyses were descriptive. Results9 538 stone cases (7 769 patients) were included. The overall, cumulative success rate was 58.7%; this included 45.1% that were stone free and 13.5% in which there were CIRFs ≤4mm. Success rates varied widely by stone size and location. Overall rates of urinary tract infection, perinephric haematoma, hospital admission and ureteral stent placement were 1.1%, 0.2%, 6.8% and 4.1%, respectively. Variations in SWL protocols across centres limits the overall reliability of our findings. ConclusionSWL remains a low morbidity management option requiring careful patient selection. This study provides valuable data for patient counseling and the formation of evidence based guidelines in SWL. The MMT SWL service has demonstrated that is it possible to deliver a high volume specialist stone service without requiring patients to travel further for treatment. KeywordsKidney stones, Nephrolithiasis, Lithotripsy IntroductionUrolithiasis comprises a significant and growing proportion of urological practice, with international epidemiological data demonstrating a global increase in its incidence and prevalence in recent decades [1][2][3]. This has important economic implications for healthcare services: a recent analysis estimated that the cost of stone disease will be >$5 billion per annum by 2030 in the USA [4]. Since its inception in the 1980s, shock wave lithotripsy (SWL) has become a well established treatment option for urolithiasis, demonstrating superior outcomes in morbidity and postoperative recovery than surgery, with relatively few contraindications [5,6]. The European Association of Urology (EAU) guidelines recommend SWL as the first line management option for proximal ureteral stones <10mm, and an equivalent first line option to endourology for renal stones <20mm, proximal ureteral stones >10mm and distal ureteral stones <10mm [7]. In spite of this, reports indicate that the rate of SWL use has plateaued or decreased in recent years alongside a surge in the use of ureteroscopy with the holmium laser [8][9][10][11], and despite evidence suggesting similar success rates between management options [7]. The current evidence examining the use of SWL demonstrates wide variation in clinical outcomes, with overall stone free rates (SFRs) ranging from 40.2% to 96.8%, and is limited to studies reporting small coho...

Large cell neuroendocrine carcinoma (LCNEC) of the urinary bladder are rare. We present a case of a 72-year-old man who presented with back pain and acute renal failure. Ultrasound showed a soft tissue mass in the base of the bladder causing bilateral ureteric obstruction. Subsequent biopsy of this mass demonstrated neuroendocrine carcinoma. He was commenced on neoadjuvant chemotherapy (carboplatin/etoposide) and proceeded to a radical cysto-prostatectomy. Histology revealed a LCNEC involving the bladder, T4a with invasion through to adipose tissue and posteriorly at perivesical resection margins. In addition, there was a Gleason score 9 prostatic adenocarcinoma, distinct from the neuroendocrine carcinoma. Following surgery, the patient developed gross local-regional recurrence and refused further systemic therapy. However, 1 year following referral to palliative care, a further CT-PET showed complete spontaneous remission of his disease. There are only few case reports of LCNEC of the urinary bladder therefore the pathogenesis and treatment protocol are still unclear. This case report highlights the unpredictable nature of this disease.

Routine antibiotic prophylaxis was not associated with a reduction in clinical UTI after SWL in this cohort of over 10,000 stone cases in New Zealand.

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Quartz stones are often considered to be of non-human origin or factitious, although in some cases, they may have a biological aetiology. X-ray diffraction (XRD) spectroscopy was used to analyse fragmented renal stones from a 61-year-old lady who presented with bilateral nephrocalcinosis. Analysis of the calculi from the left kidney showed a mixed composition: 50% calcium oxalate monohydrate and 50% quartz. This case highlights the usefulness of XRD in the differentiation of authentic from possibly factitious renal calculi.