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Trial details imported from ClinicalTrials.gov

For full trial details, please see the original record at https://clinicaltrials.gov/show/NCT02786290




Registration number
NCT02786290
Ethics application status
Date submitted
9/05/2016
Date registered
30/05/2016
Date last updated
6/02/2019

Titles & IDs
Public title
The Zenflow Spring System Feasibility and Safety Study
Scientific title
The Zenflow Spring System Feasibility and Safety Study (ZEST)
Secondary ID [1] 0 0
CLIN-0002
Universal Trial Number (UTN)
Trial acronym
ZEST
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Benign Prostatic Hyperplasia 0 0
Condition category
Condition code
Renal and Urogenital 0 0 0 0
Other renal and urogenital disorders

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Treatment: Devices - Zenflow Spring System

Experimental: Treatment Group - Receives intervention with the Zenflow Spring System.


Treatment: Devices: Zenflow Spring System
The Zenflow Spring is a nitinol urethral implant for the treatment of Lower Urinary Tract Symptoms (LUTS) that arise due to bladder outlet obstruction (BOO), secondary to the presence of Benign Prostatic Hypertrophy (BPH). The device is intended to be a permanent implant however it may be removed if necessary.

Intervention code [1] 0 0
Treatment: Devices
Comparator / control treatment
Control group

Outcomes
Primary outcome [1] 0 0
Device Success defined as both 1) deliverability of the implant and 2) freedom from unanticipated adverse events (UAEs) not listed in the protocol or AEs that meet the protocol definition of Serious AEs. - Frequency of Device Success is assessed by subject, for both successful device placement in the target anatomy and absence of serious or unanticipated adverse events through discharge.
Timepoint [1] 0 0
Intraoperative
Primary outcome [2] 0 0
Occurrence of device and/or procedure related Adverse Events as determined by investigator and independent medical reviewer - Frequency and severity of any device or procedure related adverse events, by subject.
Timepoint [2] 0 0
Intraoperative
Primary outcome [3] 0 0
Occurrence of Adverse Event specific to indwelling catheterization, descriptive analysis - Frequency of indwelling catheterization = or > 7 days following placement of the investigational device.
Timepoint [3] 0 0
Seven days following implantation of the investigational device
Primary outcome [4] 0 0
Effectiveness of implant measured through symptom improvement (International Prostate Symptom Score - IPSS) - Subjects should demonstrate improvement of > or = to 3 point reduction from baseline measurement.
Timepoint [4] 0 0
3 months following device placement
Secondary outcome [1] 0 0
Assessment of Sexual Health using the Sexual Health in Men (SHIM) questionnaire - Observational assessment of subject scores on SHIM at the 6 months and 12 months visit, compared to baseline.
Timepoint [1] 0 0
6 months, 12-,24-,36-, months post implantation
Secondary outcome [2] 0 0
Assessment of Incontinence, using the Incontinence Severity Index (ISI) questionnaire - Observational assessment of subject scores on ISI at 2 weeks, 1 month and 3 months compared to baseline.
Timepoint [2] 0 0
2 weeks, 1 month, 3 months
Secondary outcome [3] 0 0
Observation of pain using a validated Visual Analogue Scale (VAS) questionnaire - Observational assessment of subject reports of pain on the VAS questionnaire, at discharge and follow up visits up to 3 months, compared to baseline.
Timepoint [3] 0 0
through 3 month follow-up
Secondary outcome [4] 0 0
Improvement in Uroflowmetry compared to baseline - Uroflowmetry is measured at 3 months post implantation and compared to baseline
Timepoint [4] 0 0
3-, 6-, 12-, 24-, 36-months post implantation
Secondary outcome [5] 0 0
Effectiveness of implant measured through symptom improvement (International Prostate Symptom Score - IPSS) - Observation of IPSS scores compared to baseline at 12 months follow up.
Timepoint [5] 0 0
12 months 24 months and 36 months
Secondary outcome [6] 0 0
Effectiveness of the treatment by assessing need for further treatment to alleviate symptoms of BPH. - Observation of incidence of repeat invasive treatment for LUTS through 12 months post-procedure
Timepoint [6] 0 0
12 months 24 months and 36 months

Eligibility
Key inclusion criteria
1. 50 to 80 years of age

2. Baseline IPSS score > 13, and a baseline Quality of Life (Qol) question score > 3

3. Prostate volume 25 - 80 cc by Trans Rectal Ultrasound (TRUS), measured within past 90
days

4. Anterior prostatic urethral length 2.5 - 4.0 cm by cystoscopy, as measured from
bladder neck to verumontanum. TRUS will be accepted as a primary screening measure.

5. Failed or intolerant to medication regimen for the treatment of LUTS.
Minimum age
50 Years
Maximum age
80 Years
Gender
Males
Can healthy volunteers participate?
No
Key exclusion criteria
New Zealand only: A maximum of 5 participants in acute or chronic urinary retention may be
included in the study provided they meet other entry criteria. Exclusion exemptions for
these patients are described in 4a, 5a and they are exempt from #6.

Participants will be excluded from participating in this trial if they meet any of the
following criteria:

1. Obstructive median prostatic lobe or high bladder neck

2. Urethral stricture, meatal stenosis, or bladder neck obstruction - either current, or
recurrent requiring 2 or more dilatations

3. Elevated Prostate Specific Antigen (PSA) (age 50-70 PSA =4; age 70+ PSA =6.5) unless
negative biopsy within last 3 months, or a positive biopsy

4. Post-void residual volume (PVR) > 250 ml, if not in acute retention 4a. No maximum
post void residual volume required if patient in acute or chronic urinary retention.
(New Zealand Only, up to 5 patients)

5. Peak urinary flow rate > 12 ml/second, with = 125 ml voided volume at baseline. 5a. No
maximum urinary flow or minimum voided volume required if participant in acute or
chronic urinary retention. (New Zealand Only, up to 5 patients)

6. History of chronic urinary retention. (New Zealand Only, up to 5 patients)

7. History of neurogenic bladder

8. Compromised renal function (e.g., serum creatinine > 1.8 mg/dl)

9. Concomitant Urinary Tract Infection (UTI)

10. Concomitant bladder stones

11. Confirmed or suspected prostate/bladder cancer

12. Previous pelvic irradiation or radical pelvic surgery

13. Previous prostate surgery, stent implantations, laser prostatectomy, hyperthermia or
another invasive treatment to the prostate

14. Chronic prostatitis, or recurring prostatitis within the past 12 months

15. Serious concurrent medical conditions such as uncontrolled diabetes

16. Known allergy to nickel

17. Life expectancy less than 12 months

18. Use of concomitant medications (e.g., anticholinergics, antispasmodics or
antidepressants) affecting bladder function

19. Anti-coagulant, anti-platelet, or thrombolytic medication other than Acetylsalicylic
Acid (ASA) or Clopidogrel. ASA and Clopidogrel must be ceased 7 days prior to the
procedure.

20. 5--reductase inhibitors within 6 months of pre-treatment evaluation unless evidence of
same drug dose for at least 6 months with a stable voiding pattern (the drug dose
should not be altered or discontinued for entrance into or throughout the study).

21. -blockers within 2 weeks of pre-treatment evaluation unless evidence of same drug dose
for at least 6 months with a stable voiding pattern (the drug dose should not be
altered or discontinued for entrance into or throughout the study).

22. Future fertility concerns

23. Any severe illness that might prevent study completion or would confound study results

Study design
Purpose of the study
Treatment
Allocation to intervention
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?



Intervention assignment
Single group
Other design features
Phase
Not Applicable
Type of endpoint(s)
Statistical methods / analysis

Recruitment
Recruitment status
Active, not recruiting
Data analysis
Reason for early stopping/withdrawal
Other reasons
Date of first participant enrolment
Anticipated
Actual
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
Sample size
Target
Accrual to date
Final
Recruitment in Australia
Recruitment state(s)
Recruitment outside Australia
Country [1] 0 0
Bulgaria
State/province [1] 0 0
Sofia
Country [2] 0 0
New Zealand
State/province [2] 0 0
Nelson
Country [3] 0 0
New Zealand
State/province [3] 0 0
Tauranga

Funding & Sponsors
Primary sponsor type
Commercial sector/Industry
Name
Zenflow, Inc.
Address
Country

Ethics approval
Ethics application status

Summary
Brief summary
This is a First in Human study to assess the feasibility, safety and effectiveness of the
Zenflow Spring System in relieving the symptoms of obstructive Benign Prostatic Hyperplasia
(BPH).
Trial website
https://clinicaltrials.gov/show/NCT02786290
Trial related presentations / publications
Charles J, Valenti L, Britt H. BPH - management in general practice. Aust Fam Physician. 2011 Oct;40(10):757.
Woo HH, Gillman MP, Gardiner R, Marshall V, Lynch WJ. A practical approach to the management of lower urinary tract symptoms among men. Med J Aust. 2011 Jul 4;195(1):34-9.
Milani S, Djavan B. Lower urinary tract symptoms suggestive of benign prostatic hyperplasia: latest update on alpha-adrenoceptor antagonists. BJU Int. 2005 Jun;95 Suppl 4:29-36. Review.
Schelin S, Geertsen U, Walter S, Spångberg A, Duelund-Jacobsen J, Krøyer K, Hjertberg H, Vatne V, Richthoff J, Nordling J. Feedback microwave thermotherapy versus TURP/prostate enucleation surgery in patients with benign prostatic hyperplasia and persistent urinary retention: a prospective, randomized, controlled, multicenter study. Urology. 2006 Oct;68(4):795-9.
Bruskewitz RC, Larsen EH, Madsen PO, Dørflinger T. 3-year followup of urinary symptoms after transurethral resection of the prostate. J Urol. 1986 Sep;136(3):613-5.
Thomas JA, Tubaro A, Barber N, d'Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyère F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitán C, Knispel H, Bachmann A. A Multicenter Randomized Noninferiority Trial Comparing GreenLight-XPS Laser Vaporization of the Prostate and Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Obstruction: Two-yr Outcomes of the GOLIATH Study. Eur Urol. 2016 Jan;69(1):94-102. doi: 10.1016/j.eururo.2015.07.054. Epub 2015 Aug 15.
Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, Lack N, Stief CG; Urology Section of the Bavarian Working Group for Quality Assurance. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008 Jul;180(1):246-9. doi: 10.1016/j.juro.2008.03.058. Epub 2008 May 21.
Mandeville J, Gnessin E, Lingeman JE. New advances in benign prostatic hyperplasia: laser therapy. Curr Urol Rep. 2011 Feb;12(1):56-61. doi: 10.1007/s11934-010-0153-1. Review.
Ahyai SA, Lehrich K, Kuntz RM. Holmium laser enucleation versus transurethral resection of the prostate: 3-year follow-up results of a randomized clinical trial. Eur Urol. 2007 Nov;52(5):1456-63. Epub 2007 Apr 25.
Bachmann A, Tubaro A, Barber N, d'Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyère F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitán C, Knispel H, Thomas JA. 180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial--the GOLIATH study. Eur Urol. 2014 May;65(5):931-42. doi: 10.1016/j.eururo.2013.10.040. Epub 2013 Nov 11.
Gao YA, Huang Y, Zhang R, Yang YD, Zhang Q, Hou M, Wang Y. Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate--a prospective, randomized, and controlled clinical trial. Radiology. 2014 Mar;270(3):920-8. doi: 10.1148/radiol.13122803. Epub 2013 Nov 13.
Bouza C, López T, Magro A, Navalpotro L, Amate JM. Systematic review and meta-analysis of Transurethral Needle Ablation in symptomatic Benign Prostatic Hyperplasia. BMC Urol. 2006 Jun 21;6:14. Review.
Roehrborn CG, Rukstalis DB, Barkin J, Gange SN, Shore ND, Giddens JL, Bolton DM, Cowan BE, Cantwell AL, McVary KT, Te AE, Gholami SS, Moseley WG, Chin PT, Dowling WT, Freedman SJ, Incze PF, Coffield KS, Borges FD, Rashid P. Three year results of the prostatic urethral L.I.F.T. study. Can J Urol. 2015 Jun;22(3):7772-82.
Peyton CC, Badlani GH. The management of prostatic obstruction with urethral stents. Can J Urol. 2015 Oct;22 Suppl 1:75-81. Review.
Oesterling JE. A permanent, epithelializing stent for the treatment of benign prostatic hyperplasia. Preliminary results. J Androl. 1991 Nov-Dec;12(6):423-8.
Perry MJ, Roodhouse AJ, Gidlow AB, Spicer TG, Ellis BW. Thermo-expandable intraprostatic stents in bladder outlet obstruction: an 8-year study. BJU Int. 2002 Aug;90(3):216-23.
Shore ND, Dineen MK, Saslawsky MJ, Lumerman JH, Corica AP. A temporary intraurethral prostatic stent relieves prostatic obstruction following transurethral microwave thermotherapy. J Urol. 2007 Mar;177(3):1040-6.
Yildiz G, Bahouth Z, Halachmi S, Meyer G, Nativ O, Moskovitz B. Alliumâ„¢ TPS--A New Prostatic Stent for the Treatment of Patients with Benign Prostatic Obstruction: The First Report. J Endourol. 2016 Mar;30(3):319-22. doi: 10.1089/end.2015.0593. Epub 2015 Nov 17.
Song HY, Kim CS, Jeong IG, Yoo D, Kim JH, Nam DH, Bae JI, Park JH. Placement of retrievable self-expandable metallic stents with barbs into patients with obstructive prostate cancer. Eur Radiol. 2013 Mar;23(3):780-5. doi: 10.1007/s00330-012-2650-8. Epub 2012 Sep 16.
Armitage JN, Cathcart PJ, Rashidian A, De Nigris E, Emberton M, van der Meulen JH. Epithelializing stent for benign prostatic hyperplasia: a systematic review of the literature. J Urol. 2007 May;177(5):1619-24. Review.
Public notes

Contacts
Principal investigator
Name 0 0
Peter Gilling, MD
Address 0 0
Tauranga Urology Research Ltd.
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for public queries
Name 0 0
Address 0 0
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for scientific queries

Summary results
Other publications