TOPLINE:

In patients treated for large renal stones, vacuum-assisted flexible ureteroscopy was associated with higher stone-free rates and shorter hospital stays.

METHODOLOGY:

• In a retrospective study, researchers reviewed records of 156 adults treated for 2-3 cm kidney stones at a Chinese hospital between 2022 and 2024.
• Patients underwent one of three procedures: vacuum-assisted flexible ureteroscopy that suctioned out stone fragments, standard-sheath flexible ureteroscopy using baskets, or mini-percutaneous nephrolithotomy that removed stones through a small skin tract.
• Researchers compared measures including operative time, changes in hemoglobin levels after surgery, pain scores, length of stay, hospitalization costs, and adverse events.
• Stone-free status — defined as either no residual stones or residual fragments less than 4 mm in diameter — was assessed on day 3 and at 1 month after surgery using kidney-ureter-bladder radiography.

TAKEAWAY:

• Vacuum-assisted flexible ureteroscopy lasted a mean of 77.56 minutes, standard‐sheath flexible ureteroscopy lasted a mean of 85.04 minutes, and mini‐percutaneous nephrolithotomy lasted a mean of 67.60 minutes (P < .05).
• The mean decrease in hemoglobin levels after surgery was smaller in patients who underwent vacuum-assisted (3.50 g/L) or standard-sheath (4.01 g/L) ureteroscopy than those who underwent nephrolithotomy (13.86 g/L; P < .001).
• Stone-free rates at day 3 after surgery were higher in patients who underwent vacuum-assisted vs standard-sheath ureteroscopy (94.0% vs 75.9%; P < .05); this advantage persisted at 1 month and was similar to that observed with nephrolithotomy.
• Vacuum‑assisted flexible ureteroscopy was linked to the shortest hospital stay, and mini‑percutaneous nephrolithotomy was linked to the lowest hospital costs. 

IN PRACTICE:

“[The] findings suggest that FV-UAS-assisted fURL [flexible vacuum-assisted ureteral access sheath flexible ureteroscopic lithotripsy] may offer a useful balance between surgical invasiveness and stone clearance efficiency in selected patients with 2-3 cm renal stones,” the researchers wrote.

SOURCE:

The study was led by Hao Gu of Xi’an People’s Hospital in China. It was published online on June 5 in Therapeutic Advances in Urology.

LIMITATIONS:

The study was conducted at a single center, and patients were not randomly assigned to the treatments. Kidney-ureter-bladder radiography may have missed small residual fragments.

DISCLOSURES:

The study received support from the Youth Cultivation Project of Xi’an Health Committee and the Research Incubation Fund of Xi’an People’s Hospital. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.