First in-vivo multicenter experience with the novel CVAC 2.0 ureteroscope with simultaneous irrigation and aspiration functionality

Advancements in ureteroscopy (URS) technology aim to reduce postoperative residual stone burden. A steerable ureteroscope renal evacuation (SURE) procedure using the CVAC® steerable aspiration catheter (Calyxo Pleasanton, CA) has shown safety and efficacy in a prior prospective, randomized multi-center trial. The newer CVAC 2.0 system is a single-use ureteroscope that combines laser lithotripsy, vacuum, irrigation, aspiration, and stone collection. We report the first in-vivo multicenter experience using the new CVAC 2.0 system. A multicenter analysis of a prospectively maintained database from two tertiary centers (5 surgeons) of patients who underwent URS with the CVAC 2.0 system between March 2024 to January 2025 was performed. Adult patients with at least one renal stone on CT imaging were included. Patient demographics, intraoperative data, peri-operative complications, and stone-free status based on volumetric and single-dimension stone clearance were recorded. Patients with incomplete imaging or nephrocalcinosis were excluded from volumetric analysis. A total of 84 cases were included, with 44 eligible for volumetric stone clearance analysis. 81 (96.4%) had no intra-operative complications, 3 had Clavien-Dindo (CD) I and 10 had CDII post-operative complications. Median preoperative stone volume for eligible patients was 835 mm3 (diameter 20.5 mm) and post-operative volume was 14.5mm3 (diameter 3.35 mm), resulting in an absolute stone volume reduction of 796.6mm3 with relative stone clearance of 98.4%. Pearson correlation analysis showed no increase in residual volume as preoperative stone volume increased. The new CVAC 2.0 system is safe and allows effective extraction of stone burden, especially in patients with higher stone volumes.