Zachary Klaassen: Leslie, thanks for having me on UroToday.
Leslie Ballas: Oh my gosh, my pleasure. So tell me a little bit about your practice in placing spacers and how you're teaching the next generation of urologists to do this.
Zachary Klaassen: Yeah, super important. I'm a residency program director of 15 residents. So my job is to teach them how to take out kidneys and prostates, but also get them into spaces, no pun intended, where we have other opportunities to introduce them to other opportunities in their practice once they finish training. So my spacing journey started in 2018 and we were doing SpaceOAR and I did about 80 cases. Rad-onc, just like yourself came to me, "Hey, can you put these in?" I said, "Sure, no problem." And I realized that was a difficult procedure to teach just because of the hydrodissection 10-second placement. I had to trust that 10-second placement was going to go the right direction. So I'd let them put the needle in and then I'd usually push the injection.
So in 2022, when the FDA clearance came down for Barrigel, which is a non-animal stabilized hyaluronic acid, basically 98.5% water, the ability to do this in real time and pause and really check and see exactly where the gel is going sort of changed my entire treatment paradigm, but also my teaching paradigm. So since then, done about 250 myself, I've done probably eight and I've been teaching the residents with the other 242 cases. So I think it's really helped me sort of give the residents an opportunity to learn how to do this in residency training and probably half of them since graduation are doing it in their practice now.
Leslie Ballas: 250 is a lot. That's terrific.
Zachary Klaassen: Yeah.
Leslie Ballas: Wow. And what do you think about not only the teaching but the product itself? Is it a better product since you mentioned in your experience than SpaceOAR?
Zachary Klaassen: We don't have any head-to-head trials, so I think we have our experience and we have the clinical trial data. So we know that Barrigel decreased Grade 2+ toxicity in that acute timeframe when patients are getting radiation. And it's the only spacer on the market that has been able to successfully reduce Grade 2+ toxicity. So from a patient standpoint, that's really impactful. We're not treating for hemorrhoids and constipation, bleeding during radiotherapy. So from a urology perspective where we're used to seeing the GU toxicity, it sort of opened up, yeah, we got to think about the GI toxicity. So if we can decrease that GI toxicity risk, that's a no-brainer for the patient.
I think where it differentiates is if you look at the safety profile of Barrigel compared to some of the other competitors on the market, there's a lot less sort of post-FDA clearance issues that we're having. And so I think if you look at the MAUDE database, which sort of is a publicly funded FDA housed reporting, there's basically a couple of Barrigel procedures in that database, but not really related to the actual placement. And we know there's some other issues with the competitors on the market.
So when I look at this and I talk to the patient, I talk to the residents, this is why we're doing this, it's safe for the patient. We know that we're going to get a benefit of the Grade 2+ toxicity decrease and the fact that we can easily integrate it into our workflow and our teaching workflow has been super impactful.
Leslie Ballas: And have you had follow up with some of these residents? How many of them are making this part of their practice after residency?
Zachary Klaassen: Yeah, great question. I think since I started I've graduated eight residents during that timeframe and five are doing it in practice, so it's over 50%. I got to proctor one of my residents a few weeks ago and I didn't really have to, but he did a great job. So they're able to take that skillset and go back to their new practice and really contribute to helping the patients. They've seen it in my practice during their training. And so the challenge and the goal is to have as much exposure to different procedures in urology or radiation oncology residency to be able to make those decisions on their own. So I'm delighted that over half have said, "Hey, I see a benefit in this. It works into my workflow. The radiation oncologist wants me to put it in." And they're able to take that skillset and run with it from the get-go.
Leslie Ballas: Yes. And I can tell you that as we both know, practice patterns are different in different communities. Some places radiation oncologists place the spacer and I would say that certainly we are trying to expose our residents in radiation oncology to this as well.
Zachary Klaassen: Yeah, it's a great point. I think regardless of whether the radiation oncologist or the urologist is putting in, we know that patients need spacers. The reason Barrigel works in terms of training is because we can pause, we don't have that 10 second sort of blast off moment. We're able to see the gel going in real time on axial, sagittal, whichever way you want to do it. So because we have that capability to stop and double check, it really lends to teaching, whether it's a radiation oncology resident or a urology resident.
Leslie Ballas: Well, thank you so much for talking to me about this.
Zachary Klaassen: Of course.
Leslie Ballas: It was really a pleasure.
Zachary Klaassen: Nice joining on UroToday. Thank you.