title: Prevention of stone migration with the Accordion during endoscopic ureteral lithotripsy.
abstract: OBJECTIVE
  Endoscopic lithotripsy is often prolonged secondary to the retrograde migration of calculous fragments. Various balloons, baskets, and other devices have been used to prevent this migration. Our purpose is to analyze the effect of the Accordion(®) on stone migration and overall efficiency during lithotripsy.
  
  
  METHODS
  We prospectively evaluated 21 patients with a total of 23 distal ureteral stones. Patients underwent lithotripsy using an endoscopic impact lithotriptor. The Accordion was randomly used in 11 of these 21 patients. Data were collected regarding stone migration, stone size, stone ablation, ureteral clearing, and lengths of time for various stages of each procedure.
  
  
  RESULTS
  Patients who were treated with the Accordion device experienced significantly less retrograde migration during fragmentation (P=0.0064). When stone volume was taken into account (but not on a per stone basis), ablation and ureteral clearing were also expedited, and fewer lithotripter "hits" and basket "sweeps" were needed.
  
  
  CONCLUSIONS
  The Accordion device is effective in preventing the migration of stone fragments during endoscopic ureteral lithotripsy. Our data suggest that this device may also increase efficiency of the fragmentation and clearance of ureteral calculi.
authors.affiliation: Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Pagnani
authors.forename: Magdy
authors.initials: M
authors.lastname: El Akkad
authors.forename: Demetrius H
authors.initials: DH
authors.lastname: Bagley
mesh_terms: D000328:Adult; D004724:Endoscopy; D004864:Equipment and Supplies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008096:Lithotripsy / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014513:Ureter / Q000473:pathology* / Q000601:surgery*; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*