Prostate cancer (PCa) is a prevalent malignancy in men, and lipid metabolic reprogramming contributes to its progression and therapeutic resistance. However, the drivers of lipid metabolic dysregulation in PCa remain incompletely defined. Through transcriptomic sequencing of PCa patient tissues, we identified glutathione S-transferase mu 4 (GSTM4) as a novel regulator of lipid metabolism. GSTM4 was significantly downregulated in PCa tissues and negatively correlated with triglyceride content. Functionally, GSTM4 overexpression inhibited PCa cell proliferation and migration, thereby suppressing tumor development and bone metastasis. Mechanistically, GSTM4 acted independently of its classical detoxification activity by interacting with tripartite motif-containing 27 (TRIM27) and ATP citrate lyase (ACLY), a key enzyme in de novo lipid synthesis. GSTM4 promoted TRIM27-mediated ubiquitination and degradation of ACLY at lysine 554, reducing acetyl-CoA production and lipid accumulation. This inhibition of lipid synthesis suppressed PCa growth and metastasis in vitro and in subcutaneous, orthotopic, and bone metastasis models. Moreover, ETC-1002 (bempedoic acid), a clinically approved ACLY inhibitor, showed therapeutic potential against PCa. These findings reveal a non-canonical GSTM4-TRIM27-ACLY axis that regulates lipid metabolism and represents a promising therapeutic target for advanced PCa.

The role of ubiquitin in post-translational modifications is important for tumor progression, but how these mechanisms regulate bladder cancer (BLCA) is not completely known. The study demonstrated that FBXL6, a member of the F-box protein family, could drive oncogenesis in BLCA, as shown by integrative bioinformatic analysis and clinical sample validation. Experiments demonstrated that FBXL6 speeds up the in vitro growth and migration of BLCA cells and contributes to tumor development and metastasis in vivo. Mechanistically, transcriptomic and metabolic studies indicate that FBXL6 regulates the glycolytic pathway. Although FBXL6 knockdown has minimal impact on the mRNA levels of the key glycolytic enzyme ENO1, FBXL6 knockdown does alter ENO1 protein levels, suggesting post-translational regulation. Co-immunoprecipitation and GST pull-down assays validated the interaction between FBXL6 and ENO1, confirming that the LRR domain of FBXL6 and the C-terminal region of ENO1 are essential for their binding. Additionally, ubiquitination assays indicated that FBXL6 promotes K63-linked polyubiquitination of ENO1, which stabilizes it. Bringing back ENO1 expression partially offset the consequences of FBXL6 knockdown on proliferation and migration. In summary, our findings propose a new model where FBXL6 promotes BLCA progression by stabilizing ENO1 through K63 linkage, emphasizing its potential as a target for BLCA therapy.

This study aims to identify optimal parameters for using Thulium fiber lasers (TFL) in ureteral stone lithotripsy to ensure laser safety and maximize efficacy. Our goal is to improve the outcomes of single-use semi-rigid ureteroscopy for treating stones located in the proximal ureter. A clinically relevant thermal testing device was designed to investigate heating effects during TFL stone fragmentation. The device was utilized to identify safe power thresholds for TFL at various irrigation rates. Three other devices were used to assess varying pulse energy effects on stone fragmentation efficiency, dusting, retropulsion, and depth of tissue vaporization. Comparative experiments in fresh porcine renal units were performed to validate the efficacy and safety of optimal TFL parameters for semi-rigid ureteroscopy in proximal ureteral stone procedures. Our study found that the improved device generated a higher thermal effect. Furthermore, the safe power threshold for laser lithotripsy increased as the irrigation rate was raised. At an irrigation rate of 40 ml/min, it is safe to use an average power of less than 30 watts. Although increasing pulse energy has a progressively lower effect on fragmentation and dust removal efficiency, it did lead to a linear increase in stone displacement and tissue vaporization depth. Thermal testing showed 20 W (53.87 ± 2.67 °C) indicating potential urothelial damage. In our study of laser lithotripsy for proximal ureteral stones, the group treated with 0.3 J pulses had several advantages compared to the 0.8 J group: Fewer large fragments (> 4 mm): 0 vs. 1.67 fragments (1-2.25), p = 0.002, a lower number of collateral tissue injuries: 0.50 (0-1.25) vs. 2.67 (2–4), p = 0.011, and lower stone retropulsion grading: 0.83 (0.75-1) vs. 1.67 (1–2), p = 0.046. There was no significant difference in operating time between the groups (443.33 ± 78.30 s vs. 463.17 ± 75.15 s, p = 0.664). These findings suggest that TFL irradiation generates a greater thermal effect compared to non-irradiated stones. Furthermore, the thermal effect during laser lithotripsy is influenced by both power and irrigation flow rate. Our study suggests that using a power below 15 W with an irrigation flow rate of 20 ml/min is safe. Moreover, a pulse energy of 0.3 J appears to be optimal for achieving the best overall stone fragmentation effect.

Abstract Purpose To evaluate the efficacy of an enhanced recovery after surgery (ERAS) strategy for upper tract urothelial carcinoma (UTUC) patients undergoing laparoscopic radical nephroureterectomy (LRNU). Methods 90 patients who received LRNU at Zhongnan Hospital of Wuhan University between January 2018 and July 2022 were retrospectively analyzed, including 43 in the ERAS group and 47 in the pre-ERAS group. The clinical features, postoperative complications, length of hospital stay (LOS), and hospital expenditures of the two groups were compared via t-test, Mann-Whitney test, and Chi-square test. Results In comparison to the pre-ERAS group, the total and postoperative LOS were significantly shorter in the ERAS group [total LOS: 15.0 (13.0–20.0) vs. 21.0 (16.0–26.0), p < 0.001; postoperative LOS: 8.0 (7.0–9.0) vs. 11.0 (9.0–13.0), p < 0.001]. The ERAS group had lower hospitalization costs than that in the pre-ERAS group [56896.40 (48324.30-67498.01) vs. 64249.83 (55574.36-81581.82), p = 0.010]. Additionally, the ERAS group experienced a reduction in postoperative fever incidence (23.4% vs. 4.7%, p = 0.011). Conclusions In the realm of LRNU, ERAS protocols are safe and practical for minimizing the LOS while accelerating the rehabilitation of patients undergoing LRNU. This study offers insights for enhancing ERAS protocols for UTUC patients even further.

This study aims to explore the influence of different laser parameters on stone retropulsion and ablation rate during thulium fiber laser (TFL) lithotripsy, and to evaluate its dusting effect. An experimental setup was designed to simultaneously measure the displacement and mass loss of stones. Ex vivo lithotripsy experiments were performed using a self-designed TFL system with average power ranging from 10 to 30 W, frequency from 10 to 1000 Hz and pulse energy from 25 to 3000 mJ. Stone retropulsion and ablation rates were systematically evaluated across various parameter configurations. Additionally, the size distribution of particles generated during lithotripsy was comprehensively assessed. A higher average power resulted in a more intense stone retropulsion and a higher ablation rate. With a constant average power, both decreased as the frequency increased and the pulse energy decreased. The trend of mass loss was similar to that of the ablation rate. When the frequency was fixed, an increase in pulse energy significantly enhanced the retropulsion, whereas an increase in frequency at fixed pulse energy had a smaller impact on retropulsion. When the frequency reached 250 Hz and the pulse energy was reduced to 120 mJ, the stone retropulsion essentially disappeared. The maximum ablation rate (112.247 mg/min) was achieved at 10 Hz × 3000 mJ. For average powers fixed at 20 W and 10 W, the optimal parameters for the highest ablation rates were identified as 20 Hz × 1000 mJ and 20 Hz × 500 mJ, resulting in ablation rates of 65.451 mg/min and 40.742 mg/min, respectively. Under several representative configurations, all generated particles had diameters less than 600 μm. Compared with frequency, pulse energy has a greater impact on both retropulsion and ablation rate. For non-fixed stones, increasing the pulse energy enhances the ablation rate but also intensifies the retropulsion effect, which can partially offset the increase in ablation rate. The TFL exhibits an excellent dusting effect. A conservative setting of 10 W, frequency below 50 Hz and pulse energy above 200 mJ can be referenced for clinical application.

Metastasis is a leading cause of death in patients with prostate cancer (PCa). Transient receptor potential channel 7 (TRPM7) functions as a Mg2+/Ca2+-permeable channel as well as a protein kinase that regulate various cellular processes including cell adhesion, migration and survival. However, the function of TRPM7 in metastasis of PCa remains largely unknown. Microarray analysis suggested that calcium signaling pathway was significantly altered in metastatic PCa tissues, compared with benign prostatic hyperplasia tissues. Bioinformatics analysis using microarray data and database for annotation, visualization and integrated discovery database revealed altered genes involved in calcium signaling pathway were significantly upregulated in TRPM7 deficiency PCa cells, which was also confirmed by experimental verification. Therefore, we aim to investigate the role of TRPM7 in human PCa cell migration and invasion as well as the underlying mechanisms. We observed that TRPM7 was upregulated in PCa cells and tissues compared with prostate hyperplasia cells and tissues. Further investigations suggested that TRPM7 deficiency suppressed migration and invasion of distinct PCa cell lines while overexpression of TRPM7 increased migration of PCa cells. In addition, knockdown of TRPM7 in PCa cells reversed the epithelial–mesenchymal transition (EMT) status, accompanied by downregulation of MMPs and upregulation of E-cadherin. Taken together, our study indicated that downregulation of TRPM7 could inhibit migration and invasion via reversing EMT status in PCa cells.

Purpose: This study aimed to validate the efficacy and safety of the HTH-1 handheld robotic needle holder versus conventional instrument in laparoscopic ureterolithotomy. Methods: This is a noninferiority clinical trial conducted in three hospitals. Patients were enrolled and randomly allocated into the experimental or control group on whom laparoscopic ureterolithotomy was performed with the ureteral incision sutured using the HTH-1 and conventional needle holder, respectively. The average suture time per stitch (STPS) of ureter was calculated as the primary efficacy indicator. Postoperative drainage volumes were recorded, and the instruments' operating performance was subjectively evaluated and compared between groups. Adverse events occurred during the trial and interference of the instruments to the monitor were assessed as the safety indicators. Results: From April to September 2018, 50 patients were enrolled with 25 ones in each group. For the efficacy indicators, the noninferiority of the STPS was determined when the noninferiority margin was 40 seconds. The postoperative drainage volumes were not significantly different between groups. The instruments' operating performance was rated as smooth in all cases of both groups. For the safety indicators, no adverse events or interference of the instruments to the monitor occurred during surgery in any case. Clavien 1 complications occurred in 7 (4 in the experimental group versus 3 in the control group, P = 1.000) patients after surgery. Conclusions: The HTH-1 is effective and safe and noninferior to conventional needle holder in laparoscopic ureterolithotomy. Adequate training and skills assessment are needed before application on patients. Clinical trial registration: The clinical trial registration was completed in Jiangsu Provincial Drug Administration (record number: Suxielinbei 20180018).

Bladder cancer (BLCA) remains a highly lethal genitourinary malignancy with complex tumor biology and limited therapeutic strategies. This study investigates the oncogenic role of YKT6, a SNARE protein, in BLCA progression and molecular mechanisms. It is demonstrated that YKT6 is significantly upregulated in BLCA tissues and cell lines, correlating with advanced tumor grade, aggressive histology, and poor patient prognosis from public datasets and tissue microarray. Transcriptomic and functional analyses reveal that YKT6 promotes BLCA cell proliferation, migration, and metastasis both in vitro and in vivo. Mechanistically, YKT6 activates the Wnt/β‐catenin signaling pathway through a novel mechanism involving USP7‐mediated deubiquitination of β‐catenin. By recruiting USP7, YKT6 inhibits β‐catenin's proteasomal degradation, thereby stabilizing the protein and driving nuclear accumulation. This stabilization leads to increased expression of oncogenic target genes and induces epithelial‐mesenchymal transition (EMT). Pharmacological interventions demonstrate that Wnt signaling inhibition reverses YKT6‐driven malignant effects, while pathway activation restores tumor progression in YKT6‐silenced cells. USP7 knockdown abrogates YKT6‐mediated β‐catenin stabilization, confirming their functional interdependence. Clinically, the YKT6/USP7/β‐catenin axis strongly correlates with poor prognosis, providing a proof‐of‐concept for the druggability of this axis. The findings unveil YKT6 as a novel regulator of Wnt signaling through USP7‐dependent deubiquitination, offering insights for precision BLCA therapy.

Purpose: To determine the feasibility and safety of a new domestic single-port surgical robot in urologic partial nephrectomy and radical prostatectomy, as measured by the primary metric outcome (surgical success rate). In addition, this study measured important perioperative surgical outcomes, such as operative time, blood loss, postoperative length of stay, docking time, and thermal ischemia time, and reported pathologic data using the surgical robot. Materials and Methods: This prospective, single-center, single-group clinical study was conducted between August 2023 and October 2023. One surgeon used a new domestic single-port surgical robot (EDGE SP1000) to perform six urologic procedures, including three partial nephrectomies and three extraperitoneal radical prostatectomies. Perioperative data were prospectively recorded, early oncologic outcomes were assessed based on the surgical margin status, and equipment ergonomic comfort was assessed using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Results: All six procedures were effectively completed without conversion to open surgery, laparoscopy, or use of multiport robots. The average total operation time was 207.92 ± 32.42 minutes, estimated blood loss was 100 mL (10-900 mL), and postoperative hospital stay was 8.67 ± 1.33 days. The average docking time was 16.25 ± 5.68 minutes, and warm ischemia time was 17.00 ± 2.65 minutes. None of the patients required perioperative blood transfusion. All pathologic examination margins were negative. No serious perioperative complications occurred (Clavien-Dindo grade 3). The surgeon reported that the device was comfortable to use, with a NASA-TLX score of 35.67 ± 4.23. Conclusions: It is safe and feasible to perform urologic procedure using the EDGE single-port endoscopic surgical robot (EDGE SP1000) control system.

Reticulophagy, a selective macroautophagy/autophagy process targeting endoplasmic reticulum fragments via receptors, plays a critical role in cellular homeostasis. This study reveals that CCPG1, a reticulophagy receptor, drives bladder cancer (BLCA) tumorigenesis and confers cisplatin resistance. We observed elevated reticulophagy activity in BLCA cells compared to normal counterparts, particularly under conditions of nutrient stress. CCPG1 expression was significantly upregulated in BLCA patient samples and correlated with poor prognosis. Functional studies demonstrated that CCPG1 knockdown suppressed reticulophagy, leading to decreased cell proliferation and increased apoptosis. Conversely, overexpression of the wild-type CCPG1, but not a MAP1LC3/LC3-binding-deficient variant, rescued reticulophagy and promoted tumor growth. Notably, we found that cisplatin treatment inhibited reticulophagy by downregulating CCPG1 expression through the ATM-CHEK2/Chk2 signaling pathway. CCPG1 knockdown synergistically enhanced cisplatin cytotoxicity to BLCA cells, while CCPG1 overexpression conferred resistance. These findings highlight CCPG1-mediated reticulophagy as a driver of BLCA progression and as a potential prognostic biomarker and therapeutic target.

BACKGROUND: Gemcitabine (GEM) is a standard treatment for bladder cancer (BLCA), but resistance to this chemotherapy often reduces its efficacy. Thus, to uncover the molecular mechanisms of this resistance is essential to reverse GEM resistance. METHODS: To explore the role of the USP43/E2F1/NSDHL pathway in GEM resistance in BLCA, we employed integrated analytical approaches including gene expression profiling, biochemical assays, xenograft models, among others. RESULTS: We discovered that the oncogene E2F1, which is highly expressed in GEM-resistant BLCA cells, plays a significant role in promoting resistance to the drug. We found that E2F1 enhances GEM resistance by activating NSDHL, an enzyme crucial for cholesterol biosynthesis, leading to increased cholesterol levels. We also identified USP43 as the deubiquitinase that stabilizes E2F1, contributing to its increased expression in response to GEM. CONCLUSION: Our study indicates the USP43/E2F1/NSDHL pathway as a key mechanism in cholesterol-mediated GEM resistance in BLCA, providing novel insights for therapeutic intervention to counteract chemoresistance.

This study aims to evaluate the effectiveness of upper pole calyx fornix subapical puncture in percutaneous nephrolithotomy (PCNL) compared to traditional middle calyx puncture. The subapical puncture technique offers the advantages of upper pole access while minimizing the risk of pleural injury. We conducted a retrospective analysis of 194 patients who underwent PCNL at our hospital from May 2022 to November 2023. Patients were divided into two groups based on puncture technique: the Upper-PCNL group (n = 122) with upper pole calyx fornix subapical puncture and the Mid-PCNL group (n = 72) with middle calyx fornix apex puncture. Data collected included tract establishment time, operative time, stone-free rates, complications, and auxiliary procedures. The Upper-PCNL group demonstrated significantly higher primary stone-free rates (83.6

Both SARS-CoV-2 mRNA and mucosal vaccines induce protective immunity against COVID-19 but showed different immune profiles. We conducted a longitudinal head-to-head analysis of the safety and immunogenicity of the aerosolized adenovirus-vectored and mRNA COVID-19 vaccines. 450 participants were enrolled and randomly assigned into three groups to be vaccinated with an aerosolized Ad5-vectored bivalent vaccine (wild-type and BA.5, Ad5-CoV5T), an intramuscular bivalent mRNA vaccine (mbO5), and an aerosolized wild-type Ad5-vectored vaccine (Ad5-nCoV). The primary outcomes were adverse reactions within 28 days and anti-XBB.1.5-specific neutralizing antibody titers at day 28 after vaccination. The secondary outcome assessed safety within 30 min, serious adverse event within 6 months, and the persistence of anti-XBB.1.5/BA.5-specific neutralizing antibodies during the 6 months. Both the vaccines were well tolerated, but participants vaccinated with mbO5 reported more adverse reactions (73.3% mbO5 vaccinees vs. 28.7% aerosol vaccinees). No serious adverse events were recorded. The Ad5-CoV5T vaccine induced a superior anti-XBB.1.5-specific neutralizing titer than Ad5-nCoV at day 28 (geometric mean titer ratio of 1.48, 95% CI 1.12-1.97), while the mbO5 vaccine induced the highest antibody titer. The neutralizing antibodies were declined at month 6 and were similar across the three groups. In the pre-specified exploratory analysis, the mbO5 and the aerosolized vaccines induced comparable antigen-specific memory B cells but the latter stimulated higher frequency of IgA isotype and higher expression of CXCR3. This trial met the main hypothesis; the findings may provide insights for the development of the next-generation COVID-19 vaccines. Clinical Trials.gov identifier: NCT05886790.

Climate change has markedly increased adverse effects on human health and economic growth1-3. However, few studies have differentiated the impacts of extreme temperatures at the city level and analysed the future implications for human health under various climate change scenarios4-6. Here we leverage data on historical relationships among six kinds of climate-sensitive diseases (CSDs) and associated hospitalizations and temperatures across 301 cities (more than 90% of all cities) and more than 7,000 hospitals in China, and use a nonlinear distributed lag model. This study projects hospitalization risks associated with extreme temperatures through to the year 2100 and develops the hospitalization burden economic index to assess the burden under three carbon emission scenarios across cities. Five dimensions, including spatial distribution, disease categories, population age groups, future time horizons and carbon emission development pathways, have been evaluated. Historical data indicate a higher incidence of temperature-related risks among the CSDs in northwestern and southwestern China. Notably, gestation-related disease risks are associated with increased vulnerability to extreme heat in specific regions. The projections show that under current thermal conditions without adaptations, the excess hospitalizations from extreme heat will reach 0.6, 3.8 and 5.1 million by 2100 under the low-, middle- and high-emission scenarios, respectively. These findings highlight the need for targeted mitigation strategies to reduce uneven climate-related hospitalization risks and economic burdens while accounting for differences in city geography, extreme temperatures, population groups and carbon emission development pathways.

To evaluate temperature changes and thermal injury during thulium fiber laser (TFL) lithotripsy in the urinary tract and identify the safe irrigation rate, providing a reference for optimal parameter settings in clinical practice. An in vitro thermal injury experiment was conducted using a home-made TFL operating at 40 W. The experiment utilized a glass tube simulating the urinary tract. A peristaltic pump circulated 25 °C saline at irrigation rates ranging from 10 to 40 mL/min. Real-time temperature measurements were recorded using thermocouples, and thermal injury was assessed by calculating the thermal dose threshold. Additionally, a validated numerical simulation model was developed to analyze temperature distributions and predict safe irrigation rates at 20 and 30 W. In the in vitro experiment, at 40 W, severe thermal injury occurred in the urinary tract when the irrigation rate was below 30 mL/min, particularly in the ureter and renal calyx. The numerical simulation model demonstrated a high degree of consistency with the experimental results. According to the simulation, at 30 W, thermal injury occurred in the renal calyx when the irrigation rate was below 20 mL/min. At 20 W, thermal injury was observed in the renal calyx when the irrigation rate was below 10 mL/min. The increase in temperature and the extent of thermal injury were strongly dependent on laser power and irrigation rate, with a lesser dependence on anatomical location. The accuracy of the numerical simulation was validated through experiments, demonstrating its capability to reliably predict temperature variations and thermal injury under different laser power settings and irrigation rates.

Rationale: Bladder cancer (BLCA), one of the most lethal urological tumors, exhibits high rates of recurrence and chemoresistance, particularly to gemcitabine (GEM). Understanding the mechanisms of GEM resistance is crucial for improving therapeutic outcomes. Our study investigates the role of DLGAP5 in promoting GEM resistance through modulation of glycolysis and MYC protein stability in BLCA cells. Methods: We utilized various BLCA cell lines and clinical tissue samples to analyze the impact of DLGAP5 on GEM resistance. Through biochemical assays, protein interaction studies, and gene expression analyses, we examined how DLGAP5 interacts with USP11 and MYC, assessed the effects on MYC deubiquitination and stability. The influence of these interactions on glycolytic activity and GEM resistance was also evaluated via mouse subcutaneous xenograft model and spontaneous BLCA model. Results: Our findings indicate that DLGAP5 enhances GEM resistance by stabilizing MYC protein via deubiquitination, a process mediated by USP11. DLGAP5 was found to facilitate the interaction between USP11 and MYC, promoting MYC-driven transcription of DLGAP5 itself, thereby creating a positive feedback loop. This loop leads to sustained MYC accumulation and increased glycolytic activity, contributing to GEM resistance in BLCA cells. Conclusion: The study highlights the critical role of DLGAP5 in regulating MYC protein stability and suggests that disrupting the DLGAP5-USP11-MYC axis may provide a novel therapeutic approach to overcome GEM resistance in BLCA. DLGAP5 represents a potential target for therapeutic intervention aimed at mitigating chemoresistance in bladder cancer BLCA.

Rationale: Renal cell carcinoma (RCC) is a highly malignant and common urological tumor. In our previous study, we reported the upregulation of PRR11 in RCC, emphasizing its important role in cell cycle regulation and apoptosis. In this follow-up study, we aim to further investigate the carcinogenic mechanism of PRR11. Methods: Immunoprecipitation-mass spectrometry (IP-MS), ubiquitination assays, and in vitro phosphorylation assays were used to investigate the phosphorylation and ubiquitination-mediated degradation of PRR11 by FBXW7 and GSK3β. RNA-seq analysis of PRR11 knockdown RCC cells and cellular functional assays, including flow cytometry and comet assays, were performed to explore downstream signaling pathways and regulatory functions. Mouse subcutaneous tumor, tail vein lung metastasis, and popliteal lymph node metastasis models were established to validate PRR11's role in vivo. Results: Our results reveal that GSK3β recognizes and phosphorylates the CDC4 phosphodegron (CPD) consensus motif of PRR11, enabling FBXW7 to bind to PRR11 and catalyze its K48-linked ubiquitination and degradation. Moreover, PRR11 activates AKT signaling, which inhibits GSK3β activity. This inhibition prevents the phosphorylation of CPD motifs on PRR11, thereby obstructing FBXW7-mediated ubiquitination and degradation. The interaction between PRR11 and AKT creates a positive feedback loop that increases the level of both proteins, which ultimately accelerates RCC progression by inhibiting oxidative DNA damage. Conclusion: The FBXW7/GSK3β-PRR11-AKT axis plays a pivotal role in the development of RCC by regulating oxidative DNA damage. Targeting PRR11 may be a potential therapeutic strategy for RCC.

PURPOSE:To evaluate the effectiveness and safety of an upgraded integrated vacuum suction catheter in semi-rigid ureteroscopic laser lithotripsy (VC-URSL) compared to traditional methods for treating impacted upper ureteral stones. PATIENTS AND METHODS:This prospective, randomized controlled trial was conducted from September 2022 to March 2024 at a single center, enrolling 95 patients aged 18-70 years with a single radiopaque impacted upper ureteral stone. Participants were randomized into two groups: the VC-URSL group used an integrated vacuum suction catheter featuring a stainless steel stabilizing tube and a narrowed distal end to prevent obstruction, while the T-URSL group underwent standard ureteroscopic lithotripsy without vacuum assistance. Both groups utilized a holmium-YAG laser under general anesthesia. Primary outcomes included operative time, stone-free rates on the first postoperative day and after one month, and complication rates, specifically fever and stone retropulsion. RESULTS:The VC-URSL group achieved significantly shorter operative times (37.60 ± 3.87 min vs. 46.21 ± 7.54 min, P < 0.001) and higher initial stone-free rates (91.7% vs. 74.5%, P = 0.025) compared to T-URSL. Additionally, the VC-URSL group had fewer complications, with lower rates of fever (2.1% vs. 17.0%, P = 0.015) and stone retropulsion (6.3% vs. 21.3%, P = 0.033). CONCLUSIONS:VC-URSL offers a more effective, safer, and efficient alternative to T-URSL, enhancing outcomes while reducing complications. Further multicenter trials with larger populations are recommended for broader validation.