Urology · 2026
Ureteroscopic Aspiration Dynamics and Stone Fragment Evacuation: In Vitro Comparison of the Second-generation CVAC System and Direct In-scope Suction.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Corsi Nicolas, Gonzalez Ashley, Johnson Brett
Аннотация
OBJECTIVE: To compare the aspiration efficiency and fragment evacuation performance of the second-generation CVAC aspiration system with direct in-scope suction (DISS) devices.
METHODS: Synthetic stones (Begostone) were sieved into 5 size groups (63 µm-3.3 mm). The CVAC catheter (7 Fr lumen) was tested against 2 DISS ureteroscopes (Pusen 3.6 Fr and 5.1 Fr). Standardized trials were performed using a Thermedx irrigation system (160 mmHg) and Neptune suction (155 mmHg). Endpoints included aspiration efficiency (g/min), clearance success within 180 seconds, time to clearance (Kaplan-Meier analysis), and clogging incidence.
RESULTS: CVAC achieved significantly higher aspiration efficiency than DISS across all fragment sizes (P <.01), with rates up to 41× greater (group 4 vs Pusen 3.6 Fr). Complete clearance within 180 seconds was achieved in 100% of CVAC trials for groups 1-4 and in 25% of group 5 runs, whereas both Pusen devices failed consistently in groups 3-5. Kaplan-Meier analysis confirmed faster and more complete clearance with CVAC (median 49 seconds, 95% confidence interval [CI]: 44-90 seconds), while neither the Pusen device reached median clearance. Cox modeling showed the probability of clearance with Pusen devices was <25% that of CVAC. Only CVAC maintained partial or complete clearance when clogs occurred.
CONCLUSION: The CVAC system outperformed DISS in aspiration efficiency, clearance rates, and time to clearance across multiple fragment sizes. These findings highlight the advantages of a dual-channel simultaneous irrigation-aspiration design compared to DISS systems. Further ex vivo and clinical studies are warranted to confirm these results in vivo.
METHODS: Synthetic stones (Begostone) were sieved into 5 size groups (63 µm-3.3 mm). The CVAC catheter (7 Fr lumen) was tested against 2 DISS ureteroscopes (Pusen 3.6 Fr and 5.1 Fr). Standardized trials were performed using a Thermedx irrigation system (160 mmHg) and Neptune suction (155 mmHg). Endpoints included aspiration efficiency (g/min), clearance success within 180 seconds, time to clearance (Kaplan-Meier analysis), and clogging incidence.
RESULTS: CVAC achieved significantly higher aspiration efficiency than DISS across all fragment sizes (P <.01), with rates up to 41× greater (group 4 vs Pusen 3.6 Fr). Complete clearance within 180 seconds was achieved in 100% of CVAC trials for groups 1-4 and in 25% of group 5 runs, whereas both Pusen devices failed consistently in groups 3-5. Kaplan-Meier analysis confirmed faster and more complete clearance with CVAC (median 49 seconds, 95% confidence interval [CI]: 44-90 seconds), while neither the Pusen device reached median clearance. Cox modeling showed the probability of clearance with Pusen devices was <25% that of CVAC. Only CVAC maintained partial or complete clearance when clogs occurred.
CONCLUSION: The CVAC system outperformed DISS in aspiration efficiency, clearance rates, and time to clearance across multiple fragment sizes. These findings highlight the advantages of a dual-channel simultaneous irrigation-aspiration design compared to DISS systems. Further ex vivo and clinical studies are warranted to confirm these results in vivo.