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Benjamin P. Saylor is associate editor of Urology Times, an Advanstar Communications publication.

Oral sulopenem was approved by the FDA in October 2024 for the management of uUTIs. 

Phase 3 data of oral sulopenem for uUTIs published in NEJM Evidence

Detalimogene is currently under evaluation in the pivotal phase 1/2 LEGEND trial.

FDA grants RMAT designation to detalimogene voraplasmid for high-risk NMIBC

The approach was associated with a 30% decrease in PSMA uptake by the salivary glands without compromising the treatment’s efficacy.

Botulinum toxin reduces PSMA therapy-related salivary gland toxicity

 is compliance officer and medical director of coding and reimbursement, United Urology Group and Chesapeake Urology, in Towson, Maryland.

"We have received numerous complaints about the PA and predetermination process. We all wish we could answer this differently and definitively," write Jonathan Rubenstein, MD, and Mark Painter.

The C1769 prior authorization puzzle: A billing challenge

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Dr. Kaplan, a member of the Urology Times Editorial Council, is E. Darracott Vaughan Jr. Professor of Urology at Weill Cornell Medical College and and director of the Iris Cantor Men’s Health Center, New York Presbyterian Hospital, New York.

"LUTS is an important health care burden, and health care professionals should be screening for its presence in men at risk," writes Steven A. Kaplan, MD.

LUTS’ burden may extend to cardiac events

The management of BPH has had an interesting roller coaster ride over the past 25 years with new medicines, minimally invasive surgical therapies, and a host of novel surgical technologies, including lasers and bipolar electrosurgery.

New tech may bring exciting era in BPH

The FDA has accepted a new drug application (NDA) for zoliflodacin, an investigational first-in-class, single-dose, spiropyrimidinetrione oral antibiotic for the treatment of adult and pediatric patients 12 years and older with uncomplicated gonorrhea, Innoviva Specialty Therapeutics announced in a news release.

The Prescription Drug User Fee Act (PDUFA) target action date for the application is December 15, 2025.

Zoliflodacin is an oral antibiotic that inhibits type II topoisomerase, a bacterial enzyme that plays a key role in bacterial function and reproduction. According to the company, “If approved, zoliflodacin would be the first new antibiotic for treating gonorrhea in decades.”

The FDA has also granted a Qualified Infectious Disease Product designation to zoliflodacin, which enables the agent to benefit from priority review and market exclusivity.

“Today’s acceptance of the zoliflodacin NDA marks significant progress toward delivering health care providers with a potential new oral treatment option for uncomplicated gonorrhea, including infections caused by drug-resistant strains,” said David Altarac, MD, Chief Medical Officer of Innoviva Specialty Therapeutics, in the news release.

 “We look forward to working closely with the FDA during its review and, if approved, we are committed to expediting the availability of zoliflodacin to patients in the U.S.”

The NDA for zoliflodacin is supported by data from several clinical trials conducted through a collaboration with the Global Antibiotic Research & Development Partnership (GARDP). This portfolio of studies includes a pivotal phase 3 trial (NCT03959527) that evaluated zoliflodacin vs a standard of care (SOC) regimen (500 mg ceftriaxone intramuscular plus 1g oral azithromycin) in patients with uncomplicated gonorrhea.

Overall, the trial met its primary end point by demonstrating that zoliflodacin was non-inferior to the SOC regimen regarding microbiological response at the urogenital site at the test of cure visit (6 +/- 2 days following treatment). Specifically, the microbiological cure rate was 90.9% in the zoliflodacin arm vs 96.2% in the ceftriaxone/azithromycin arm, representing a difference of 5.3% (95% CI, 1.4% to 8.7%) across patients in the micro-intent-to-treat (ITT) population.

The 2 cohorts also demonstrated comparable results on the trial’s secondary end point of microbiological response at extragenital (rectal or pharyngeal) sites. Specifically, at pharyngeal sites, the cure rate was 79.2% in the zoliflodacin arm vs 78.6% in the ceftriaxone/azithromycin arm (difference, -0.67%; 95% CI, -20.8 to 16.3). At rectal sites, the cure rate was 87.3% and 88.6%, respectively (difference, 1.23%; 95% CI, -14.4 to 12.6).

Zoliflodacin was generally well-tolerated in the trial. Treatment-emergent adverse events (TEAEs) occurred in 46.2% of patients in the zoliflodacin arm vs 46.4% of patients in the ceftriaxone/azithromycin arm. The most common TEAEs in the zoliflodacin arm included headache (9.9%), neutropenia (6.8%), and leukopenia (3.9%).

There were no deaths or serious adverse events reported in either arm.

In total, the phase 3 trial included 930 patients with uncomplicated gonorrhea, including patients living with HIV. The study enrolled participants across 16 clinical trial sites in the US, Belgium, the Netherlands, South Africa, and Thailand.

According to Innoviva, the phase 3 study was “the largest clinical trial ever conducted for a new treatment against gonorrhea infection.”

Those enrolled in the study were randomly assigned 2:1 to receive 3 g single-dose, oral zoliflodacin (n = 621) or to 500 mg ceftriaxone intramuscular plus 1g oral azithromycin (n = 309). The primary end point was microbiological cure by culture at urogenital sites in the micro-ITT populations, with a non-inferiority margin of 12%. The trial’s secondary end point was microbiological cure at extragenital sites.

“This important milestone demonstrates the crucial role that public-private partnerships can play in tackling the escalating global antimicrobial resistance crisis,” said Manica Balasegaram, Executive Director of GARDP, in the news release.

 “If zoliflodacin is approved, this collaboration paves the way for millions of people across the world to get access to a potentially powerful new drug to treat multidrug-resistant gonorrhea.”

1. Innoviva Specialty Therapeutics receives FDA New Drug Application acceptance for zoliflodacin, a first-in-class oral antibiotic for uncomplicated gonorrhea in adults. News release. Innoviva Specialty Therapeutics. Published online and accessed June 10, 2025. https://innovivaspecialtytherapeutics.com/innoviva-specialty-therapeutics-receives-fda-new-drug-application-acceptance-for-zoliflodacin-a-first-in-class-oral-antibiotic-for-uncomplicated-gonorrhea-in-adults/

2. FDA Grants Priority Review for Zoliflodacin New Drug Application for the Treatment of Uncomplicated Gonorrhea and Assigns Target PDUFA Date of December 15, 2025. News release. Innovia Specialty Therapeutics, Inc. Published online and accessed June 12, 2025. https://www.businesswire.com/news/home/20250612432209/en/FDA-Grants-Priority-Review-for-Zoliflodacin-New-Drug-Application-for-the-Treatment-of-Uncomplicated-Gonorrhea-and-Assigns-Target-PDUFA-Date-of-December-15-2025 

3. Luckey A, Broadhurst H, Daram P, et al. Oral zoliflodacin is non-inferior to a combination of ceftriaxone and azithromycin for treatment of uncomplicated urogenital gonorrhoea: results of a large global Phase 3 randomised controlled trial. Presented at: European Society of Clinical Microbiology and Infectious Disease Global Congress. April 27-30, 2024. Barcelona, Spain. https://gardp.org/wp-content/uploads/2024/04/Zoli001-Topline-ECCMID2024_final_V1.0_23Apr2024_.pdf

The FDA has accepted the NDA for zoliflodacin, a novel oral antibiotic for treating uncomplicated gonorrhea in patients aged 12 and older. Zoliflodacin, which inhibits type II topoisomerase, has been granted a Qualified Infectious Disease Product designation, allowing for priority review. Clinical trials, including a pivotal phase 3 study, demonstrated that zoliflodacin is non-inferior to the standard regimen of ceftriaxone and azithromycin. The trials showed comparable microbiological cure rates at urogenital and extragenital sites, with zoliflodacin being generally well-tolerated and no serious adverse events reported.

The NDA is supported by a pivotal phase 3 trial of zoliflodacin vs ceftriaxone plus azithromycin in patients with uncomplicated gonorrhea. 

News

FDA accepts new drug application for zoliflodacin for uncomplicated gonorrhea

Dr. De La Cerda provides an overview of a patient case involving a 68 year-old male presenting with severe back pain, with an analysis of the clinical presentation, workup, and medical history.

Bone Predominant mCRPC Patient Case

Video content above is prompted by the following:

What are your initial impressions of the case?

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The FDA has accepted a Biologics License Application (BLA) seeking approval of nivolumab (Opdivo) co-formulated with Halozyme’s proprietary recombinant human hyaluronidase (rHuPH20), or subcutaneous nivolumab, for the treatment of patients with all previously approved solid tumor indications for nivolumab as a monotherapy, monotherapy maintenance following completion of combination therapy with nivolumab plus ipilimumab (Yervoy), or in combination with chemotherapy or cabozantinib (Cabometyx).

Nivolumab is currently approved under several indications, including in combination with ipilimumab for the first-line treatment of patients with intermediate- or poor-risk advanced renal cell carcinoma (RCC), in combination with cabozantinib for the first-line treatment of patients with advanced RCC, for the treatment of patients with advanced RCC who have received prior anti-angiogenic therapy, and in combination with cisplatin and gemcitabine for the first-line treatment of patients with unresectable or metastatic urothelial carcinoma.

The FDA is set to have a decision regarding the subcutaneous nivolumab formulation on or by December 29, 2024.

 According to a news release from Bristol Myers Squibb,

 approval of the formulation would make it the first and only subcutaneously administered PD-1 inhibitor.

“We believe subcutaneous nivolumab has the potential to make a significant difference in the lives of patients, which is reinforced by the FDA’s acceptance of our application,” said Gina Fusaro, PhD, vice president, global program lead, Bristol Myers Squibb, in the news release.

 “Opdivo is a foundational PD-1 inhibitor approved for many different types of cancer, and our continued investment in research that puts patients first remains a priority. If approved by the FDA, the subcutaneous administration of nivolumab would provide patients and their physicians with a new option that delivers the same well-known benefits as IV Opdivo but with the improved convenience of an injection administered in 3 to 5 minutes rather than a 30-to-60-minute infusion.”

The BLA submission is supported by findings from the phase 3 CheckMate-67T trial (NCT04810078), in which subcutaneous nivolumab met the study’s co-primary end points by demonstrating noninferiority to intravenous (IV) nivolumab regarding time average nivolumab serum concentration over 28 days (C

; geometric mean ratio [GMR}, 2.098; 90% CI, 2.001-2.200) and minimum serum concentration at a steady state (C

Data from the study, which were presented at the 2024 American Society of Clinical Oncology Genitourinary Cancers Symposium in San Francisco, California,

 also showed that subcutaneous nivolumab demonstrated noninferiority to IV nivolumab in the key powered secondary end point of objective response rate (ORR). Specifically, the subcutaneous arm demonstrated an ORR of 24.2% (95% CI, 19.0-30.0) per blinded independent central review (BICR), compared with 18.2% (95% CI, 13.6-23.6) in the IV arm.

The safety profile for subcutaneous nivolumab was consistent with that of the IV formulation. Among patients who received the subcutaneous formulation, 8.1% experienced injection-site reactions, with all being low-grade and transient. Deaths due to study drug toxicity occurred in 3 patients in the subcutaneous arm and 1 patient in the IV arm. Most deaths that occurred during the study were due to disease progression.

In total, the phase 3, open-label CheckMate-67T trial enrolled 495 patients with advanced or metastatic ccRCC who had received prior systemic therapy. Patients were randomly assigned 1:1 to receive 1200 mg subcutaneous nivolumab plus rHuPH20 every 4 weeks (n = 248) or to 3 mg/kg IV nivolumab every 2 weeks (n = 247) for up to 2 years of treatment or until disease progression, unacceptable toxicity, withdrawal, or death.

The co-primary pharmacokinetic end points for noninferiority testing were C

 of subcutaneous nivolumab vs IV nivolumab. The key secondary end point was ORR per BICR.

Final completion of the CheckMate-67T study is expected in January 2026.

1. U.S. Food and Drug Administration accepts Bristol Myers Squibb’s application for subcutaneous nivolumab (nivolumab and hyaluronidase). News release. Bristol Myers Squibb. May 6, 2024. Accessed May 7, 2024. https://news.bms.com/news/corporate-financial/2024/U.S.-Food-and-Drug-Administration-Accepts-Bristol-Myers-Squibbs-Application-for-Subcutaneous-Nivolumab-nivolumab-and-hyaluronidase/default.aspx

2. Bristol Myers Squibb announces updated action date by the U.S. Food and Drug Administration for subcutaneous nivolumab (nivolumab and hyaluronidase). News release. Published online and accessed May 21, 2024. https://investors.bms.com/iframes/press-releases/press-release-details/2024/Bristol-Myers-Squibb-Announces-Updated-Action-Date-by-the-U.S.-Food-and-Drug-Administration-for-Subcutaneous-Nivolumab-nivolumab-and-hyaluronidase/default.aspx

3. George S, Bourlon TB, Chacon MR, et al. Subcutaneous nivolumab (NIVO SC) vs intravenous nivolumab (NIVO IV) in patients with previously treated advanced or metastatic clear cell renal cell carcinoma (ccRCC): Pharmacokinetics (PK), efficacy, and safety results from CheckMate 67T. 

4. A study of subcutaneous nivolumab versus intravenous nivolumab in participants with previously treated clear cell renal cell carcinoma that is advanced or has spread (CheckMate-67T). ClinicalTrials.gov. Last updated March 1, 2024. Accessed May 7, 2024. https://clinicaltrials.gov/study/NCT04810078

The FDA is set to have a decision regarding the subcutaneous nivolumab formulation on or by December 29, 2024. 

FDA accepts BLA for subcutaneous nivolumab in solid tumors

The FDA has granted 510(k) clearance to a label expansion for the Rezūm System, raising the maximum prostate volume that can be treated with the device from 80 cm

 for patients with benign prostatic hyperplasia (BPH).

The device was previously approved in March 2019

 for patients with BPH with prostate volumes ranging from 30 cm

The approval is supported by several studies highlighting the efficacy of Rezūm Water Vapor Thermal Therapy in patients with larger prostates. The first, published in 

 was a systemic review and meta-analysis suggesting that treatment with Rezūm provided a statistically significant and clinically meaningful improvement in short-term relief of lower urinary tract symptoms (LUTS) while demonstrating a low rate of adverse events (AEs) in men with prostate volumes of at least 80 cm

In total, the analysis included 15 studies (11 of which were retrospective studies) that included 471 patients with prostate volumes of at least 80 cm

. The median follow-up was 6 months (range, 3 to 17).

Overall, treatment with Rezūm led to statistically significant improvements in International Prostate Symptom Score (IPSS; mean change, -11.0; 95% CI, -12.2 to -9.7; 

 < .001), IPSS-QOL (mean change, -2.9; 95% CI, -3.5 to -2.4; 

 < .001), Qmax (mean change, 6.5 mL/s; 95% CI, 4.8 to 8.2 mL/s; 

 < .001), and post-void residual (mean change, -101 mL; 95% CI, -145 to -57; 

 < .001). There was no significant change in International Index of Erectile Function-Erectile Function (IIEF-EF; mean change: 0.3; 95% CI: -1.1, 1.6; 

Serious AEs were reported in less than 0.1% of patients (95% CI, 0.0% to 0.4%). Further, 1.2% of patients (95% CI, 0.0% to 3.5%) required surgical retreatment.

The FDA also reviewed data from a manufacturer-sponsored prospective, nonrandomized, single-arm study

 and compared these data to results from the pivotal trial of the Rezūm System.

“The clinical evidence showed overall comparable results between patients with prostate volumes [greater than] 80cm

 “Use of the proposed device in the expanded patient population does not result in any new concerns of safety or effectiveness.”

In total, the manufacturer-sponsored study included 47 patients with prostate volumes ranging from 80.8 cm

. Overall, 83% of patients demonstrated a response to treatment at 6-month follow-up. The average improvement in IPSS was 11.9 [plus or minus] 7.5 points at 6 months.

The study also met its primary safety end point, with no instances of device-related composite safety events.

According to the authors, these findings were consistent with those seen from the pivotal trial of Rezūm in prostate glands of up to 80 cm

. In total, the pivotal study included 197 patients who were randomly assigned to receive Rezūm (n = 136) or to the control arm (n = 61). Of the 61 patients in the control arm, 53 crossed over to receive Rezūm at the 3-month time point.

Five-year data from the pivotal trial showed that treatment with Rezūm reduced IPSS by 48% and BPH Impact Index by 48%. Further, patients who received Rezūm showed a 45% increase in quality of life and a 44% increase in maximum flow rate.

The retreatment rate at 5 years was 4.4%. No patients experienced device- or procedure-related sexual dysfunction or sustained de novo erectile dysfunction.

Results were similar among those in the crossover group.

1. Section 510(k) premarket notification for Rezum System. FDA. June 11, 2025. Accessed June 20, 2025. https://bostonscientific.showpad.com/share/fhLW6RP6GHlhhVecgQsXX

2. 510(k) premarket notification database. FDA. Accessed June 20, 2025. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm?ID=K250584

3. Section 510(k) premarket notification for Rezūm System. FDA. March 25, 2019. https://www.accessdata.fda.gov/cdrh_docs/pdf19/K190093.pdf

4. McVary KT, Miller LE, Bhattacharyya S, et al. Water vapor thermal therapy in men with prostate volume ≥80 cm3: a systematic review and meta-analysis. 

. 2024:184:244-250. doi:10.1016/j.urology.2023.10.036

5. Woo H, Levin R, Cantrill C, et al. Prospective trial of water vapor thermal therapy for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia in subjects with a large prostate: 6- and 12-month outcomes. 

. 2023 Nov 8:58:64-72. doi:10.1016/j.euros.2023.10.006

6. McVary KT, Gittelman MC, Goldberg KA, et al. Final 5-year outcomes of the multicenter randomized sham-controlled trial of a water vapor thermal therapy for treatment of moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia. 

. 2021;206(3):715-724. doi:10.1097/JU.0000000000001778.

The FDA has expanded the label for the Rezūm System, allowing treatment of benign prostatic hyperplasia (BPH) in prostates up to 150 cm3, up from the previous 80 cm3 limit. This decision is based on studies demonstrating the system's efficacy and safety in larger prostates, with significant improvements in urinary symptoms and low adverse event rates. A manufacturer-sponsored study confirmed these findings, showing comparable results to the pivotal trial for smaller prostates. The Rezūm System continues to show promise in improving quality of life and urinary function without affecting sexual function.

The approval is supported by several studies highlighting the efficacy of Rezūm Water Vapor Therapy in patients with larger prostates.

FDA approves label expansion for Rezūm Water Vapor Thermal Therapy for BPH

 discusses his talk, “Barriers in Recruiting and Running Effective Clinical Trials in Independent Practices,” which was presented at the 

2025 American Urological Association (AUA) Annual Meeting

“If you look at national data within the United States, 80% of trials do not meet trial recruitment goals, 50% of trial sites enroll 0 to 1 patient, and 30% of patients drop out of trial. So, it's definitely a significant need that we have to address, and that's what we're hopefully going to address today,” Hafron explained.

Hafron is the chief medical officer and director of clinical research at Michigan Institute of Urology.

Jason M. Hafron, MD, CMO, discusses his talk, “Barriers in Recruiting and Running Effective Clinical Trials in Independent Practices."

Jason Hafron, MD, outlines AUA 2025 session on clinical trial recruitment

Hafron also outlined several advantages to clinical trial enrollment in the independent practice setting. These include decreased travel times to care, close collaborations with institutional IRBs, and more. 

He added, "I think the key to success of enrolling a trial is a committed PI, or principal investigator, or a research champion that's dedicated to research but also has dedicated time within his or her schedule so that research isn't a burden but a priority."

Pearls & Perspectives: Sexual Health in MSM, with Joshua R. Gonzalez, MD

—a board-certified urologist and sexual medicine specialist based in Los Angeles, California—for a candid, inclusive conversation on sexual health in men who have sex with men (MSM) and how urologists can better meet the needs of this often-overlooked patient population.

Gonzalez shares how his fellowship under Irwin Goldstein, MD, helped him develop a broad, inclusive approach to sexual medicine, one that reflects the diversity of human experience across gender, orientation, and identity. Together, Pearlman and Gonzalez discuss how standard definitions of sexual dysfunction often rely on heteronormative models—especially around conditions like erectile dysfunction, premature ejaculation, and delayed ejaculation—and why a more nuanced clinical lens is necessary.

They dive into Gonzalez’s work as co-founder of 

, a sexual wellness company launched during the pandemic to meet real patient needs—starting with a supplement aimed at increasing ejaculatory volume. Gonzalez explains how this came directly from patient feedback, particularly from gay men, who described how volume contributed to pleasure, identity, and confidence. They also explore how this interest intersects with broader themes in men’s health—like sexual aging, performance expectations, and the underappreciated role of ejaculation in orgasmic satisfaction.

The conversation covers practical, case-based strategies for counseling MSM patients: how to ask about types of sex in a culturally sensitive way, how anal sex or topping can influence erection requirements, and how tools like intracavernosal injections and at-home phenylephrine can be incorporated into individualized treatment plans. They also discuss delayed ejaculation, sounding, edging, pelvic floor dysfunction, and the use of physical therapy and Botox to address pain with bottoming.

Later, they turn to procedural care—specifically penile girth enhancement using hyaluronic acid fillers—and how sexual practices may affect timing and technique. Gonzalez shares safety pearls on sounding, anal toys, and erection rings, emphasizing harm reduction over judgment, and urging clinicians to meet patients where they are.

In his closing message, Gonzalez challenges urologists to move beyond assumptions and create space for patients of all identities to talk openly about their sex lives. “Meet people where they’re at,” he says, “and give them the tools to have better sex—safely and confidently.”

The conversation covers practical, case-based strategies for counseling MSM patients.

Steven A. Kaplan, MD

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