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

The study also found racial differences in the time to proceeding with surgical therapy. 

Use of surgical therapy for erectile dysfunction remains low, study shows

The unfortunate news of President Biden’s diagnosis has put a spotlight on prostate cancer, offering an opportunity to educate on the risks of the disease and the benefits of screening.

Biden’s prostate cancer diagnosis underscores importance of screening, awareness

The test utilizes chromosomal instability signatures to predict resistance to taxane-based chemotherapy in metastatic prostate cancer.

Genomic test can predict resistance to chemotherapy in prostate cancer

The results demonstrated a favorable ratio between radiation doses absorbed in the tumor vs the doses delivered to key healthy organs. 

177Lu-rhPSMA-10.1 injection shows positive radiation dosimetry results in mCRPC

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Clinical Focus

Glenn M. Chertow, MD, MPH; Anil K. Agarwal, MD, FACP, FASN, FNKF, FASDIN; Preethi Yerram, MD

Case-by-Case: Application of HIF-PHIs for the Treatment of Anemia in Patients With CKD

Jason Hafron, MD; Aaron D. Berger, MD; Arpeet Shah, MD

Medical Crossfire® in Adjunctive Testing: Charting a New Course in Prostate Cancer Risk Assessment

 discusses notable data on the UroLift System for the treatment of patients with benign prostatic hyperplasia (BPH), which were presented at the 2023 American Urological Association Annual Meeting in Chicago, Illinois. Gange is a urologist at Summit Urology Group in Salt Lake City, Utah as well as an Associate Medical Director for Teleflex. He discusses the following abstracts:

MP76-03: "Procedural Complications Associated with MIST and Invasive Surgery Compared to Disease Progression with Medical Therapy"

PD41-06: "Pooled analysis of 330+ subjects treated with the Prostatic Urethral Lift (PUL) reveals undertreatment impacts durability"

MP76-17: "Successful Outcomes in Acute Urinary Retention (AUR) Patients Treated with the Prostatic Urethral Lift (PUL) are Associated with Earlier Intervention"

The data were presented at the recent American Urological Association Annual Meeting. 

Dr. Gange discusses data on the UroLift System for BPH

® Assistant Editor Janelle Hart spoke with 

 He discusses the stigmas associated with enlargement of the prostate, or benign prostatic hyperplasia, and why more education is necessary to absolve these misconceptions. McVary is a professor of urology at the Stritch School of Medicine and director of the Center for Male Health at the Loyola University Medical Center in Maywood, Illinois.

“Even though there [are] many therapies that one can do, it's not a sign of anything ominous for most men,” says Kevin T. McVary, MD, FACS.

Destigmatizing Urology: Dr. McVary discusses enlarged prostates

paper, New Endoscopic In-office Surgical Therapies for Benign Prostatic Hyperplasia: A Systematic Review, for which he served as senior author. Lee is an Associate Professor of Urology and Healthcare Policy & Research at Weill Cornell Medicine Department of Urology in New York City.

The study encompassed the prostatic urethral lift (UroLift), water vapor thermal therapy (Rezum), and temporary implantable nitinol device (iTIND).

Study: New BPH treatments demonstrate efficacy

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

Further follow-up and additional treatments in the study are ongoing. 

Intraprostatic drug elution therapy shows promise for BPH-related LUTS

James C. Ulchaker, MD, shares his insights on the current range of BPH therapies.

Expert discusses the promise of emerging MISTs for BPH

Urologist Garrett D. Pohlman, MD, reflects on the benign prostatic hyperplasia offerings from the 2025 American Urological Association Annual Meeting.

We got a little MIST-y at this year’s AUA Annual Meeting

The investigators reported an overall incidence of AEs of 29.6%.

Safety, efficacy of vibegron sustained in men with OAB treated for BPH

In a recent interview, Kevin T. McVary, MD, FACS, discussed the expanded FDA label for the Rezūm System, which now includes prostate volumes up to 150 cm

, a significant increase from the previous 30cm

 range. He emphasizes that although the expanded indication is beneficial, it doesn't mean every patient with a larger prostate should automatically opt for Rezūm. Instead, shared decision-making is crucial, ensuring patients are aware of all available treatment options for large prostates, not just Rezūm, despite its improved indications.

In a recent interview, Kevin T. McVary, MD, FACS, discussed the expanded FDA label for the Rezūm System

Kevin T. McVary, MD, FACS, discusses the expanded label for Rezum in BPH

McVary addressed a meta-analysis published in 

 that showed statistically significant improvements in International Prostate Symptom Score (IPSS), IPSS-Quality of Life, Qmax, and post-void residual in men with prostate volumes of at least 80 cm

 after Rezūm treatment. Clinically, he finds it reassuring that extending Rezūm treatment to larger prostates does not compromise outcomes. Improvements in IPSS, quality of life, post-void residual, and sexual function in larger glands are comparable to those seen in the previously approved range.

Furthermore, recent findings indicate that larger prostates may experience equal, if not better, and faster improvements with no adverse impact on sexual function compared to smaller prostates. McVary noted this was an unexpected but consistent finding, suggesting that treating larger prostates with Rezūm does not sacrifice care, outcomes, or safety.

1. McVary KT, Miller LE, Bhattacharyya S, et al. Water vapor thermal therapy in men with prostate volume ≥80 cm

: A systematic review and meta-analysis. 

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

Videos

The system is now cleared for use in prostates up to 150 cm3.

2025 American Urological Association Annual Meeting

, presented a talk titled, “Innovation in endourology & building successful clinical programs.” In an interview with 

®, Krambeck detailed key considerations for building these programs, such as defining success measures and determining the optimal timing for adding on a new partner.

On the former, Krambeck noted that it’s important to take into account number of cases, amount of publications, and clinical outcomes in order to measure success.

Krambeck is the chief of endourology and stone disease in the department of urology as well as the Edmund Andrews professor of urology at Northwestern Medicine in Chicago, Illinois.

Amy E. Krambeck, MD, discusses how to define success and how to determine the optimal timing for adding on a new partner. 

Amy Krambeck, MD, on considerations for building clinical programs in endourology 

According to Krambeck, there are drawbacks to adding a partner too soon as well as adding one too late. When looking to add someone, you need find the “sweet spot,” which, according to Krambeck, “I think it's where you're full and you're starting to get a little bit tired and patients are starting to wait just a little bit. That's the perfect time to add a partner that you really trust, and you're ready to start handing over cases and handing over referrals to.”

Krambeck also noted that before adding a partner, you should make a plan of what you will handle with the extra time.

“Are you going to look at outcomes? Are you going to do more administration? Maybe [do] more research or education? But have a plan before it happens, so that you're prepared and ready for the transition.”

Recent data show that the use of minimally invasive surgical therapies (MISTs) for the management of benign prostatic hyperplasia (BPH) is increasing among men aged 50 to 65.

Overall, MIST utilization increased from 7% in 2015 to 51% in 2022 among men aged 50 to 54, supplanting TURP as the leading surgical modality for BPH. In the 55 to 59 and 60 to 65 age groups, MISTs made up 43% and 35% of procedures in 2022, respectively.

, walks through these findings, which were initially presented at the 

 in Las Vegas, Nevada. Forbes is a urologist and assistant professor at the University of British Columbia in Vancouver, Canada.

Connor M. Forbes, MD, discusses recent data on trends in the surgical management of BPH. 

Connor Forbes, MD, on trends in surgical procedures for BPH

Data also showed that although the increase in MISTs was initially led by Prostatic Urethral Lift (PUL), Water Vapor Thermal Therapy (WVTT) appears to be gaining more traction. In patients aged 50 to 54, WVTT accounted for 15% of all MISTs in 2022, while PUL accounted for 36%.

Based on these data, Forbes concluded, “Overall, what we were seeing is a recent uptick in MIST utilization, particularly prostatic urethral lift and water vapor thermal therapy in younger men with BPH between the ages of 50 and 65.”

1. Forbes CM, Aworunse O, Ezekekwu E, et al. Trends in surgical management of benign prostatic hyperplasia (BPH) across age groups: analysis using real-world data 2007-2022. 

. 2025;213(5S):e200. doi:10.1097/01.JU.0001109776.58983.66.30

MIST utilization increased from 7% in 2015 to 51% in 2022 among men aged 50 to 54. 

The treatment landscape in benign prostatic hyperplasia (BPH) is shifting toward more personalized approaches to care, according to 

®, Elterman emphasized the growing need to align treatment decisions with patient-defined outcomes—particularly in terms of symptom relief and quality of life. He also highlighted a rising interest in first-line interventional therapies (FITs), a category of minimally invasive treatments designed to offer symptom control while preserving sexual function.

Elterman recently presented new data on one of these options—the Zenflow Spring System—at the 

Dean Elterman, MD, discusses the shift toward personalized care in benign prostatic hyperplasia.

Dean Elterman, MD, on the shift toward personalized care in BPH

Elterman noted that the interest in FITs is only going to continue to grow. 

“We have definitely seen a shift in the idea of being able to really tailor treatments to both the individual and terms of what is important to them with values and preferences, as well as their individual prostate,” Elterman explained. “As we understand a little bit more about prostate anatomy, shape, and size, and also understand that patients want to have an improvement in their symptoms, [and] also preservation of sexual function in a lot of men, the idea of being able to introduce these minimally invasive treatments, or first-line interventional therapies, FITs, like the Zenflow Spring System, is really important. These types of technologies are going to become more and more popular and needed, especially as we have this aging population.”

1. Elterman D, Gilling P, Chin P, et al. 36-month outcomes from the ZEST pilot studies of the Zenflow Spring System for the treatment of benign prostatic hyperplasia (BPH). 

. 2025;213(5S):e277. doi:10.1097/01.JU.0001109800.53897.68.12

“We have definitely seen a shift in the idea of being able to really tailor treatments to both the individual and terms of what is important to them with values and preferences, as well as their individual prostate,” says Dean Elterman, MD, MSc.

Three-year data from the ZEST pilot studies continued to show significant and durable benefit of the investigational Zenflow Spring System in patients with benign-prostatic hyperplasia (BPH).

2025 American Urological Association (AUA) Annual Meeting

 in Las Vegas, Nevada. In an interview with 

, a urologist at the University of Toronto in Canada, discussed the background and key findings from the study.

“We're now entering an era of new types of technologies to treat BPH in a minimally invasive fashion,” explained Elterman. “One of the concepts is this idea of first-line interventional therapies, which are essentially stent-like devices that are designed to be minimally invasive with respect to being inserted with a flexible scope. They can be done under local anesthesia. They provide benefit with respect to symptom improvement, but also preservation of sexual function, and they can be easily removed and reversed to allow patients to move on to other types of therapy. The Zenflow Spring System is essentially one of these FITs, or first-line intervention therapies.”

Dean Elterman, MD, shares 3-year data on the Zenflow Spring System for patients with BPH

Dean Elterman, MD, shares 3-year data on Zenflow Spring System for BPH

Elterman noted, “The main takeaways were, essentially, over 3 years, we saw a good, sustained improvement in symptom score measured by the IPSS; it improved up to 46%. We saw an improvement in quality of life by at least 50%. We saw an improvement in urinary peak flows by over 30%. We saw a great responder rate of around 74% of patients.”

Data also showed no deterioration in erectile or ejaculatory function over 36 months.

The Zenflow Spring System is currently being assessed in the prospective, randomized BREEZE trial (NCT04987138), which enrolled participants through clinical trial sites in the US and Canada.

1. Elterman D, Gilling P, Chin P, et al. 36-month outcomes from the ZEST pilot studies of the Zenflow Spring System for the treatment of benign prostatic hyperplasia (BPH). J Urol. 2025;213(5S):e277. doi:10.1097/01.JU.0001109800.53897.68.12

2. Safety and effectiveness study of the Zenflow Spring System (BREEZE). ClinicalTrials.gov. Last updated April 11, 2024. Accessed May 27, 2025. https://clinicaltrials.gov/study/NCT04987138

“We're now entering an era of new types of technologies to treat BPH in a minimally invasive fashion,” says Dean Elterman, MD.

Panelist discusses how urologists can benefit from adopting newer treatment modalities like aqua ablation for BPH, emphasizing its growing popularity, ease of learning, and efficiency in improving patient throughput, while still allowing urologists to leverage their existing skills.

Adoption of New Treatment Modalities to Treat BPH

Video content above is prompted by the following:

Advice for Urologists Considering Aqua Ablation for BPH Treatment

: Aqua ablation is rapidly gaining momentum and is expected to continue growing in popularity as a treatment option for benign prostatic hyperplasia (BPH). While it doesn’t yet hold the largest share of the market, its adoption rate is outpacing other procedures.

: Even experienced urologists with a strong background in transurethral resection of the prostate procedures will find aqua ablation relatively easy to learn. The learning curve is manageable, with around 20 procedures recommended to become proficient. It’s suggested to perform at least 9 procedures in the first 90 days to build confidence.

: Excellent training and support are available through Procept, the company behind aqua ablation. Knowledgeable trainers are eager to help urologists succeed, and all cases are recorded for review. This support extends to both early-career residents and more experienced practitioners.

: Start with smaller prostates (30 to 100 g) and gradually progress to larger ones as confidence and skills grow. Even under 30-g prostates can be treated effectively once the practitioner feels comfortable.

: One common concern about aqua ablation is bleeding, due to the water jet used in the procedure. However, the training teaches effective techniques for minimizing bleeding, especially in the bladder neck region. Spot resection can be done posttreatment to manage any remaining minor bleeding.

: Aqua ablation procedures involve both sitting and standing, which can be better for the urologist’s ergonomics than sitting for long periods during other procedures. This mobility during the operation can be more comfortable and less taxing on the body.

: Urologists who have experience with other procedures like holmium or GreenLight laser can easily adapt to aqua ablation, as the technique and principles are transferable.

: After performing a modest number of procedures, many urologists find aqua ablation to be an effective and sustainable option. With consistent practice and review of cases, it becomes an integral part of the practice, offering good outcomes for patients and efficiency for surgeons.

Aqua ablation is an accessible and promising treatment modality for BPH, with great potential for enhancing productivity, improving outcomes, and reducing strain on the surgeon.

Video Series

Panelist discusses how hospitals benefit from adopting aqua ablation therapy by improving surgical efficiency, reducing turnover times, enabling outpatient procedures, and providing a highly effective treatment option that can enhance patient outcomes while preserving sexual function.

BPH: Strategies for Guiding Patients From Medication to Intervention

Strategies for Guiding Patients From Medication to Intervention

Aqua ablation therapy, especially with the new-generation device Hydros, is being increasingly adopted by hospitals for its efficiency and patient benefits. Here are some key points:

: Aqua ablation allows for faster turnover times, often as little as 30 minutes. Surgeons can perform 7 to 9 procedures in a day with minimal downtime, making it ideal for hospitals aiming to increase patient throughput.

: Unlike other procedures, aqua ablation’s duration is less dependent on prostate size. Both small and large prostates take approximately 45 minutes to 1 hour, compared with other methods that may take up to 3 hours for larger prostates. This consistency allows for more efficient scheduling and higher procedure volume.

: Aqua ablation can often be done as an outpatient procedure, meaning patients don’t need to stay overnight. This reduces hospital costs and allows for quicker turnover, benefiting both the institution and the patients.

: Aqua ablation is known for preserving sexual function, which is a significant advantage for patients. Word-of-mouth recommendations and positive patient experiences have led to increased demand, enhancing the hospital’s reputation (the “halo effect”).

: Aqua ablation presents an effective option for patients who are weary of long-term medical therapy. Many patients on benign prostatic hyperplasia (BPH) medications are unaware of interventional alternatives like aqua ablation, which can offer better and more durable relief. It also reduces dependency on medications that patients must take for life, which may not always be effective in the long term.

: Continuing BPH medications without addressing underlying issues can lead to bladder complications, such as poor compliance, bladder instability, and the formation of diverticula. Aqua ablation, as a definitive treatment, reduces the risks of these complications and helps avoid long-term damage from unaddressed obstruction.

By adopting aqua ablation therapy, hospitals not only improve patient outcomes but also benefit from higher patient turnover, increased satisfaction, and enhanced reputation due to the procedure’s effectiveness and low adverse effect profile.

Panelist discusses how the ability to administer treatments robotically, regardless of prostate size, affects resource expenditures in a clinic, highlighting the need for extended recovery periods and increased use of apps to streamline patient management and reduce resource burdens.

Benign Prostatic Hyperplasia

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