Study results show CVAC 2.0 is safe, efficacious for wide range of kidney stones

A recent study presented at the American Urological Association 2025 Annual Meeting in Las Vegas, Nevada, detailed real-world outcomes with the CVAC 2.0 system for treating kidney stones.¹ In an interview with Urology Times®, investigator Jared S. Winoker, MD, discussed the study.

“To provide some context, the emergence of suction- based technologies has really taken our field by storm. Among the most promising of these is the CVAC system for simultaneous endoscopic stone treatment and aspiration. With the goal of evaluating efficacy and safety of this device in a large, real-world cohort, we performed a retrospective review of all CVAC cases performed in our institution, beginning with the very first case, which was performed in February 2024, through February 2025. In total, we had more than 200 patients who ultimately underwent CVAC by 21 different surgeons. [A total of] 163 patients had complete pre- and post-op data, so those were the ones that were ultimately included in the analysis. Most notably, we found that the procedure was both very safe and highly effective for stone removal in a wide range of stone burdens, even amongst a variety of urologists with varying expertise,” said Winoker, director of endourology and director of the Center for Kidney Stone Disease at Lenox Hill and an assistant professor of urology at The Zucker School of Medicine at Hofstra/Northwell in New York, New York.

In the interview, Winoker also addressed the wide range of stone burdens treated by the CVAC system for the study.

“Not surprisingly, we observed the highest stone-fre. e rates in the smallest group, with really just a minimal decline in stone-free rate for larger stone burdens in that 20- to 29- mm group, before we really saw some more considerable drop-off in clearance of stone in the largest group, and that included many staghorn stones,” Winoker said.

“Interestingly, there was a noticeably lower CT-based stone-free rate in that 10- to 19-mm group, despite the much higher stone clearance in larger stones over 2 cm. I would say that this buck in the trend could really be explained by a number of factors. For one, post-op imaging of any kind was performed in only 70% of our patients, with a CT being the best measure of stone-free rate performed in just 20% of them. So there really is a large percentage of percentage of patients that were not accounted for here. Second, it's worth noting that many truly stone-free patients were likely purged from these data, as many surgeons elected not to obtain post-op imaging when they felt they had achieved a complete intraoperative stone clearance. Said differently, post-op imaging, notably CT scans, were generally reserved for those patients expected to have residual stone for the purposes of second stage treatment planning, for example, so that really biases the data toward some of the lower reported stone-free rates. That's a key distinction when we're interpreting these findings of a real-world practice compared to those of say, a more controlled study with standardized post-op imaging protocols,” Winoker said.

REFERENCE

1. Klyde DM, Aro T, Okeke Z, Hoenig DM, Rai A, Winoker JS. Real-world experience with CVAC 2.0 for steerable ureteroscopic renal evacuation in a large, multi-site academic institution. J Urol. 2025;213(5S2). e36. doi:10.1097/01.JU.0001109712.09934.41.06