Dean Elterman, MD, MSc, FRCSC, discusses BREEZE and ZEST data for Zenflow

In this video, Dean Elterman, MD, MSc, FRCSC, the Lang Family Chair in Urologic Innovation and an associate professor of urology at the University of Toronto, discusses the clinical implications of the BREEZE and ZEST studies evaluating the Zenflow Spring System for benign prostatic hyperplasia (BPH), focusing on patient selection, durability, efficacy, and procedural workflow.

Elterman attributes the 99% catheter-free discharge rate in the BREEZE study largely to appropriate patient selection. The trial enrolled men with prostate volumes between 30 mL and 80 mL who were not in urinary retention and did not have high post-void residuals. These criteria mirror the “average” BPH population commonly seen in practice and align with prior minimally invasive surgical therapy (MIST) studies. As a result, he believes the outcomes are highly generalizable to both academic and community settings when similar selection principles are applied.

Regarding durability, Elterman highlights the value of the 3-year ZEST data, conducted outside the US, which demonstrated sustained improvements in International Prostate Symptom Score and flow rates without sexual dysfunction. He emphasizes that because the Zenflow device is non-ablative and does not involve cutting, heating, or tissue destruction near ejaculatory structures, sexual function is preserved. The stability of symptoms over 3 years alleviates concerns about early recurrence or progression, suggesting that mechanical decompression alone can provide lasting benefit in properly selected patients.

Addressing the 60% 1-year responder rate, Elterman notes that no BPH therapy—medical, minimally invasive, or surgical—achieves universal response due to anatomical variability and comorbid conditions such as overactive bladder. He underscores reversibility as a key differentiator: unlike permanent implants or surgery, the Zenflow device can be removed if patients fail to meet treatment goals, allowing progression to alternative therapies.

Finally, Elterman describes a streamlined procedural workflow, with a shift toward local anesthesia, flexible cystoscopy, outpatient treatment, and rapid discharge without catheterization. He said he sees Zenflow as enabling true in-office adoption and supporting a broader paradigm shift toward earlier, less invasive interventional therapy that preserves bladder health and improves patient experience.