The global prevalence of nephrolithiasis has risen, increasing demand for effective treatments that maximize stone-free rates (SFR) while minimizing complications. Surgical treatment aims to remove kidney stones completely to avoid residual fragments, which can cause pain, infection, or necessitate further procedures. Ureteroscopy (URS) often yields SFRs of around 49.6% for renal stones, but larger stones usually require percutaneous nephrolithotomy (PCNL), a more invasive procedure. For patients unable to undergo PCNL, alternative methods are limited. The CVAC™ calculus vacuum aspiration catheter, a steerable ureteroscopic renal evacuation (SURE) device, was designed to enhance stone-free outcomes after laser lithotripsy by removing smaller stone fragments. This study reports on the safety and efficacy of SURE in treating nephrolithiasis.
A retrospective review was conducted on patients who underwent SURE at our center between January 2022 and August 2023. During each procedure, URS with laser lithotripsy reduced stone fragments to under 2 mm before using the SURE device. Postoperative imaging with CT or ultrasound was performed within two months to assess stone-free status, defined as residual fragments under 2 mm. In total, 104 SURE procedures were performed on 91 patients, with an average stone burden of 931 mm³. Among 62 patients with follow-up imaging, 51.6% achieved SFR under 2 mm, 11.3% had 2-4 mm fragments, and 37.1% had fragments over 4 mm. Complications were minimal, including two cases of minor ureteral tears managed with stents and eight postoperative complications. Five patients (5.5%) developed sepsis, two had urinary tract infections, and one experienced stent migration requiring a secondary procedure. Additionally, 12% required a second-stage procedure.
These findings suggest that the SURE device is a safe and effective adjunct for URS, achieving SFR comparable to conventional URS with low morbidity, even for patients with high stone volumes.
