Zenflow explained: A non-ablative, reversible approach to BPH

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 evolving role of shape-memory prostate stents—specifically Zenflow—as a first-line interventional therapy for men with lower urinary tract symptoms due to benign prostatic obstruction.

He emphasizes that a key differentiator of this new class of devices lies in material science and mechanism of action. Unlike older urethral stents made of rigid, tightly woven stainless steel that were prone to irritation, encrustation, and tissue reaction, Zenflow is constructed from nitinol, a highly elastic, shape-memory alloy. Nitinol responds to body temperature by adjusting its rigidity, allowing it to gently conform to the urethral anatomy without causing tissue damage.

Mechanistically, Zenflow functions by softly opening and reshaping the prostatic urethra rather than retracting tissue mechanically or destroying it through thermoablative techniques. There is no cutting, burning, or ablation involved. Instead, the spring-like system restores a more natural, open urethral configuration, facilitating improved urinary flow when the bladder contracts. This physiologic approach aims to reduce irritation while preserving future treatment options.

Elterman frames patient selection around the concept of “first-line interventional therapy.” Ideal candidates are men who are unwilling, unable, or intolerant of medical therapy but who may not yet be ready for definitive surgical intervention. An important advantage of Zenflow is its reversibility; the stent can be removed if symptoms progress or if the patient later opts for another procedure. This optionality is particularly appealing to patients seeking symptom relief without permanently altering anatomy.

From a procedural standpoint, Elterman notes that the learning curve is favorable. Most urologists are already comfortable with flexible cystoscopy, which is central to Zenflow deployment. Compared with rigid scopes, flexible cystoscopy improves patient comfort and allows procedures to be performed under local anesthesia with minimal or no sedation. Key technical considerations include proper scope angulation and orientation to ensure accurate deployment within the prostatic urethra.