Real-world experience with steerable ureteroscopic renal evacuation using the second-generation CVAC system in a large multicenter institution

Daniel M. Klyde^*, Tareq Aro, Zeph Okeke, David M. Hoenig, Zachary E. Tano, Arun Rai, Jared S. Winoker
Smith Institute for Urology, Northwell Health, Lenox Hill Hospital, 130 E 77th Street, Black Hall 5th Floor, New York, NY, USA
* Corresponding Author: Daniel M. Klyde. Email: email

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.079115

Received 15 January 2026; Accepted 01 June 2026; Published online 24 June 2026

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Abstract

Objectives: The landscape of ureteroscopic surgery is rapidly evolving with the emergence of suction-based technologies. We sought to evaluate the effectiveness, safety, and surgeon experience for steerable ureteroscopic renal evacuation (SURE) using the second-generation CVAC^® System. Methods: We reviewed all patients who underwent SURE with the CVAC 2.0 system after initial launch at a large, multicenter academic institution between February 2024 and February 2025. Postoperative adverse events within 30 days after treatment were reported. Stone burdens were measured by computed tomography (CT)-based stone volume and cumulative maximal stone diameter. Surgical effectiveness was evaluated by CT-based stone-free rates, percentage of stone clearance, and residual stone volume. Results: 179 patients underwent SURE by 16 surgeons of varying experience and subspecialty expertise. No intraoperative complications or device malfunctions were reported. The overall complication rate was 4.5%, including five (2.8%) infectious complications. Of the 53 renal units (47 patients) with postoperative CT imaging, the median baseline stone burden was 15 mm [Interquartile range (IQR), 10–22] and 417 mm³ [IQR, 205–722]. Overall stone clearance was 99.5% and the CT-based zero stone free rate was 73.6%, improving to 90.6% for fragments ≤2 mm. Conclusion: Our institutional experience performing SURE with the second-generation CVAC System demonstrates its safety and effectiveness across a wide range of stone burdens and surgeon experience. This large report of real-world practice patterns and outcomes offers valuable insight for early and prospective adopters of this novel technology.