Dr. Laurence Klotz, Urologic Oncology
About Dr. Klotz
Laurence Klotz, CM, MD is a urologist at Sunnybrook Health Sciences Centre in Toronto. He has been involved in the management of patients with urologic cancer, and research in prostate cancer, for 3 decades. He is the chairman of the Canadian Urology Research Consortium and past president of the Canadian Urological Association and the World Urologic Oncology Federation. He currently serves as Professor of Surgery at the University of Toronto and holds the Sunnybrook Chair in Prostate Cancer Research. He received the Order of Canada, as well as numerous other national and international awards, for his work in prostate cancer, including Lifetime Achievement Awards from both the Canadian Urological Association and the University of Toronto. He is an honorary member of the American Urological Association and the Editor Emeritus of the CUA Journal. He has more than 500 peer review publications and has written 6 books.
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What is the TULSA Procedure?
The word ‘TULSA’ stands for Transurethral Ultrasound Ablation. It is a minimally invasive procedure that uses directional ultrasound to produce very high temperatures to ablate (destroy) targeted prostate tissue. It can be used to ablate the entire prostate, or for focal therapy.
The procedure is performed in a Magnetic Resonance Imaging (MRI) suite and uses the TULSA-PRO® system to ablate prostate tissue. The physician can see the prostate at all times throughout the procedure. The procedure combines real-time MRI with robotically-driven directional thermal ultrasound to deliver predictable, physician-prescribed ablation of whole-gland or partial prostate tissue.
The TULSA Procedure is radiation-free, incision-free and FDA cleared. The physician can customize the procedure depending on patients’ needs, conditions and desired functional outcomes.
TULSA was invented at Sunnybrook, and Dr. Klotz has been involved in the development and evaluation of the technology over the last 20 years. The TULSA team he leads is one of the most experienced in the world.
TULSA: Frequently Asked Questions (FAQs)
1. How does the TULSA Procedure differ from other prostate therapies?
The TULSA Procedure ablates (destroys) prostate tissue from the ‘inside-out’. A device enters the urethra which delivers thermal ultrasound energy (high heat), outwards from the urethra towards the edge of the prostate. This approach avoids the need for surgical incisions to reach the prostate, and it avoids direct thermal contact with the neurovascular bundles surrounding the prostate and with the rectum, which minimizes the risk of side effects like erectile dysfunction and incontinence. A urethral cooling mechanism protects the urethra from thermal damage.
The thermal ultrasound energy is also delivered in a directional pattern allowing it to reach more prostate tissue. This directional beam also moves in a sweeping motion, allowing for efficient ablation of large prostate volumes.
Finally, the TULSA Procedure features real-time temperature maps, enabling the physician to see the temperature of the prostate tissue and surrounding structures every 5 seconds during ablation. This visibility allows the physician to actively monitor tissue heating and make changes to the treatment delivery if necessary, making the TULSA Procedure controlled and predictable.
2. Can the TULSA Procedure perform partial and whole gland ablation?
Yes. The physician can customize the procedure to ablate a specific area of the prostate, or the entire prostate, depending on the patients needs and their urinary and sexual preservation goals.
3. What are the side effects?
As with all procedures, there are side effects with the TULSA Procedure. These side effects are minimized since the physician has the ability to avoid important nerve bundles and structures around the prostate. The most common side effects include: pain/discomfort in the ablation area, blood in urine, urinary tract infection, urinary incontinence, and erectile dysfunction. According to the TACT trial*, a whole-gland TULSA Procedure study, 23% of participants had erectile dysfunction, 2.6% had urinary incontinence, 2.6% had urethral stricture, no participants had gastrointestinal toxicity.
*Klotz, et al. “Magnetic Resonance Imaging-Guided Transurethral Ultrasound Ablation of Prostate Cancer.” The Journal of Urology (2020)
4. How much does the TULSA Procedure cost? Can I get reimbursed?
At this point in time, TULSA is not covered by Provincial Insurance Plans (ie, OHIP). The cost is $30,000. CAD (in toto). There are no additional taxes. The fee is tax deductible in most provinces. Some private insurance companies reimburse for the TULSA procedure and will provide this information upon request.
5. Who qualifies for the TULSA Procedure?
Patients interested in the TULSA Procedure must be screened by Dr. Klotz. This includes an assessment of your general health, and the characteristics of your cancer, including the pathology report, MRI, and any other relevant tests. This information must be provided to Dr. Klotz prior to the assessment. Dr. Klotz reviews the MRI with Dr. C. Patel, Chief of MR radiology at Sunnybrook prior to a final decision. You may also require a CT scan of your pelvis and a cystoscopy (examination of your urethra) prior to a final decision. Dr. Klotz will make these arrangements on your behalf if indicated.
What is the TULSA Procedure?
The word ‘TULSA’ stands for Transurethral Ultrasound Ablation. It is a minimally invasive procedure that uses directional ultrasound to produce very high temperatures to ablate (destroy) targeted prostate tissue. The procedure is performed in a Magnetic Resonance Imaging (MRI) suite and uses the TULSA-PRO® system to ablate prostate tissue. The physician can see the prostate at all times throughout the procedure. The procedure combines real-time MRI with robotically-driven directional thermal ultrasound to deliver predictable, physician-prescribed ablation of whole-gland or partial prostate tissue.
TULSA Procedure Advantages
The TULSA-PRO system automatically adjusts the ultrasound power to compensate for varying tissue properties and blood flow which are unique to each patient. The TULSA Procedure is not a “one-side-fits-all” treatment - it’s a customizable procedure that is personalized based on your unique anatomy and issue.
The TULSA Procedure is precise. Without making any incisions or using radiation, your physician has the ability to avoid important nerve bundles and structures around your prostate, decreasing the risk of side effects.
If you are in need of future prostate care, you may either have a repeat TULSA Procedure, or undergo any other type of prostate therapy to address your prostate needs. TULSA does not prevent further treatment, including surgery or radiation, if neccesary.
Dr. Klotz performs REZUM Water Vapor Therapy for BPH
Urinary problems from BPH occur because the enlarged prostate compresses or blocks the urethra (the tube that carries urine from the bladder). When treatment effectively relieves this obstruction, the urethra opens and urine can flow freely again.
REZUM therapy is powered by convective water vapor energy which delivers targeted, controlled doses of stored thermal energy to ablate excess prostate tissue. Each 9-second treatment uses 0.42ml of heated sterile water vapor which uniformly disperses through the tissue. Condensation releases stored thermal energy which causes immediate cell death without damaging surrounding areas while preserving erectile, ejaculatory, and urinary functions.
Over 3 months, your body’s natural healing response reabsorbs the ablated tissue, reducing the prostate volume and opening the urethra to relieve obstruction. Most people need only one water vapor treatment for full results. The procedure is performed in an outpatient setting, with light sedation provided by your anesthetist, and completed in under ten minutes.
REZUM is not covered by OHIP