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.