title: The accordion antiretropulsive device improves stone-free rates during ureteroscopic laser lithotripsy.
abstract: OBJECTIVE
  The Accordion is a novel endoscopic device that prevents retropulsion of ureteral stones and their fragments during ureteroscopic laser lithotripsy. We describe our experience with its use focusing on three main endpoints: operating time, fluoroscopy time, and stone-free rates.
  
  
  METHODS
  Of 308 consecutive cases of unilateral ureteroscopic laser lithotripsy from 2006-2010, we analyzed 235 cases of ureteral stones. Chart review was performed to document patient demographics (age, sex, and race), stone characteristics (stone size, density, laterality, location, and multiplicity), operative characteristics (use of preoperative and/or postoperative stents, ureteral balloon dilators, ureteral access sheaths, the Holmium laser, and the Accordion device), and surgical outcomes (operative time, fluoroscopy time, stone-free status, and complications).
  
  
  RESULTS
  The baseline characteristics between the Accordion and non-Accordion group were statistically similar. In univariate nonparametric tests of medians, Accordion device usage was not associated with a significant reduction in fluoroscopy time (median 1.68 vs. 1.95 minutes, p=0.28) or operating time (median 52.5 vs. 61 minutes, p=0.19). However, the stone-free rate for the Accordion group was significantly higher compared to the non-Accordion group (84.2% vs. 53.6%, p=0.001). In multivariate generalized linear models, Accordion usage was not associated with decreased operating or fluoroscopy times. Accordion use was associated with statistically significant greater odds of stone-free status (odds ratio 4.35, 95% confidence interval 2.36-8.00). Complication severity and rates were comparable between the two groups.
  
  
  CONCLUSIONS
  The Accordion antiretropulsive device improves stone-free rates during ureteroscopic laser lithotripsy. Prospective studies are needed to validate these results.
authors: Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA. jonathan.ai.wu@gmail.com
authors: Jonathan A
authors: JA
authors: Wu
authors: Tin C
authors: TC
authors: Ngo
authors: Judith C
authors: JC
authors: Hagedorn
authors: Liam C
authors: LC
authors: Macleod
authors: Benjamin I
authors: BI
authors: Chung
authors: Rajesh
authors: R
authors: Shinghal
mesh_terms: D000328:Adult; D015331:Cohort Studies; D023381:Endpoint Determination; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D017602:Lithotripsy, Laser / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000628:therapy*; D018666:Ureteroscopy / Q000295:instrumentation*