Novel Use of a Ureteroscopic Stone Entrapment Device to Prevent Antegrade Stone Migration During Percutaneous Nephrolithotomy

Abstract

The Accordion stone management device is a hydrophilic microcatheter-based tool that blocks stone migration. This instrument has been described for use during ureteroscopy to prevent retropulsion of stone fragments. We used this device during percutaneous nephrolithotomy (PCNL) in 30 patients to prevent antegrade migration of stone fragments (group 1), and find that the device is easily inserted and deployed, preventing antegrade stone fragment migration in all but one patient. When compared with 30 patients who were undergoing PCNL without the Accordion device (group 2), our results suggest that the device prevents antegrade stone fragment migration during PCNL, permits targeting larger stones, reduces the use of ureteral stents, and facilitates tubeless procedures. The Accordion device has proven to be a valuable time and morbidity-saving adjunct to PCNL at our institution.

New instrumentation in percutaneous nephrolithotomy

“…[1718] Wosnitzer et al . retrospectively evaluated the ability of the Accordion ® to prevent antegrade stone migration during PCNL[19] The authors retrospectively reviewed a PCNL database and compared PCNL surgery in 30 patients with the device (Accordion ® group) and 30 patients without the device (PCNL group) who were matched for stone size and composition. For the Accordion ® group, a ureteral catheter was placed thru a 17F cystoscope, and the device placed and deployed at the level of the ureteropelvic junction and proximal ureter.…”

Retropulsion During Intracorporeal Lithotripsy: What’s Out There to Help?

“…Perhaps due to the relatively recent launch of the device there are a lack of reports on clinical experience in the ureter to assess safety and efficacy, but Wosnitzer et al . [12] reported on results that suggest the device prevents antegrade stone fragment migration during percutaneous nephrolithotomy.…”

Drainage Characteristics of the 3F MicroStent Using a Novel Film Occlusion Anchoring Mechanism

“…27 Because many patients receive a stent after ureteroscopy, these patients may undergo ureteroscopy with a MicroStent device in place, which would serve a dual purpose of preventing retrograde stone migration and facilitate antegrade passage of stone fragments during and after the procedure. Postoperatively, the stent would be able to provide drainage of the upper tract.…”