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Optimizing Endourologic Stone Removal: A Comparison of CVAC and FANS Techniques
Rachael Elizabeth Muggleton, BS1, Rajbabu Krishnamoorthy, MD2.
1Lake Erie College of Osteopathic Medicine, ELMIRA, NY, USA, 2The Guthrie Clinic, Sayre, PA, USA.
Background: Nephrolithiasis is an unrelenting pathology in urology with a rising incidence and a measurable healthcare burden. The current surgical intervention is retrograde intrarenal surgery utilizing flexible ureteroscopy and laser lithotripsy. This method has shown successful management of renal stones regardless of size and patient profiles. However, even with advancements made, it remains a challenge to achieve single-session stone clearance. This is evident with larger stones, unfavorable anatomy, and multiple calculi.
A limitation of f-URS is the inefficient evacuation of fragments following lithotripsy. Residual fragments can prolong operation times and decrease rates of “stone-free” procedures. Irrigation used for visualization may increase intrarenal pressures, increasing the risk of postoperative infectious complications. To address these limitations, two suction-based technologies have emerged: flexible and navigable suction ureteral access sheaths (FANS) and steerable ureteroscopic renal evacuation using the CVAC system
. Methods: A retrospective cohort study of 100 patients treated at The Guthrie Clinic, January 1, 2025, to April 30, 2026. Patients were grouped by intervention: CVAC or FANS. Data was extracted from Epic. The primary outcome was the rate of stone-free status; secondary outcomes included operative times and stone burdens.
Results: 100 patients were included (50 in each group). Stone-free rates differed between groups; FANS showed a stone-free rate of 76% compared with CVAC's 90%. Secondary outcomes showed that stone burden differed significantly. CVAC's stone burden averaged 15.03 mm, with FANS averaging 12.94 of stone burden, p = 0.040. Operative time didn't differ significantly; CVAC procedures averaged 81.1 min and FANS 90.8 min, p=0.352.
Conclusion: CVAC was associated with higher stone-free rates compared with the FANS system despite larger stone burdens and no increase in operative time. These findings suggest that CVAC demonstrated comparable operative time, laser utilization, and postoperative outcomes despite increased stone burden, with better stone-free rates. Prospective studies are warranted.
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