Content area
Full Text
Urol Res (2010) 38:4146DOI 10.1007/s00240-009-0232-2
ORIGINAL PAPER
EYcacy and safety of the Accordion stone-trapping device: in vitro results from an artiWcial ureterolithotripsy model
Peter Jochen Olbert Christian Keil Jost Weber Andres J. Schrader Axel Hegele Rainer Hofmann
Received: 7 July 2008 / Accepted: 4 November 2009 / Published online: 27 November 2009 Springer-Verlag 2009
Abstract One of the challenges of intracorporeal ureterolithotripsy is undesired stone migration. Stone-trapping devices have been designed to prevent this quite common phenomenon. These devices have to be eVective in terms of ureteral obstruction and safe in terms of resistance to the action of commonly used lithotriptors. This work was conducted to evaluate the eYcacy and safety of the recently approved Accordion stone-trapping device in vitro. In a rigid, submerged ureteral model with two diVerent diameters (8 and 10 mm), artiWcial stones were positioned in direct contact with the engaged Accordion device. A deWned number of pneumatic pulses of the LithoClast master at diVerent performance levels was applied and the migration distance of the stone was measured after each single pulse. As a control, the same series was repeated without the stone-trapping device. Secondly, the Accordion device was exposed to a previously deWned number of pneumatic or Ho:YAG-laser pulses, in direct contact with the lithotripsy probe, up to a total activation time of 2 min. At diVerent time points, the device was controlled for damage and functionality. The mean stone migration distance without the Accordion device was between 39.2 and 52.8 mm and between 37.8 and 75.4 mm in the 8 and 10 mm tubes, respectively. In comparison, the stone or fragment travelling distance with the device was in the 02 mm range. This diVerence was highly signiWcant.
Both pneumatic and laser lithotriptor did not aVect the functionality of the Accordion device. The Ho:YAG laser causes small perforations of the Wlm without aVecting the devices stability. The Accordion device appears to be highly eYcient and safe in vitro. Clinical trials will have to assess its value in endourological practice. Randomised comparative trials comparing diVerent stone-trapping devices are needed.
Keywords Ureter Lithotripsy Stone migration Stone trapping In vitro
Introduction
Today, there is a wide range of indications for ureteroscopic management of ureterolithiasis. Calculi of the mid and upper ureter may be...