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  "documentTitle": "PROCEPT BioRobotics Corporation (PRCT)",
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  "authorName": "Spruce Point Capital Management",
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  "presentationDate": "2025-01-16 00:00:00",
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  "notes": "The slide uses a combination of a data table and narrative callouts to debunk a specific bear case regarding MIST durability.",
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      "kind": "callout",
      "text": "In its IPO prospectus, Procept featured a lengthy discussion of its superior durability relative to MISTs despite a lack of long-term data. However, much of that language has been removed in its 2023 10-K. More recent data suggests that MIST durability is not materially worse than that of resective procedures. Importantly, it is possible, if not common practice, for patients to simply undergo a subsequent MIST once the effectiveness of the procedure has waned.",
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      "kind": "callout",
      "text": "According to the CDC, US men have a 74.8-year life expectancy. Thus, 3 to 5-year retreatment horizons obviate durability concerns for the average 71-year-old patient.",
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      "kind": "metric",
      "text": "Risk of Postoperative Sexual Dysfunction",
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      "text": "While Aquablation offers lower risk of sexual dysfunction side-effects relative to other resective procedures, MISTs are generally superior. While MISTs were once derided for their higher retreatment rates (roughly 30% over a 3-5 year horizon), more recent research has shown their durability to be only marginally lower than that of resective procedures.",
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      "text": "43,147 men diagnosed with BPH underwent 22,629 TURP, 11,392 PVP, 7,529 PUL, and 1,597 WVTT. At 1-year post-index: PUL was associated with the lowest rate of complication (PUL 15%, TURP 17%; PVP 19%, ; WVTT 26%); retreatment rates were not different (TURP 5.3%, PVP 5.3%, PUL 5.9%, WVTT 6.2%). At 5 years post-index: retreatment was lowest for TURP (7.0%) and was not significantly different between PVP and PUL (8.9% and 11.6%, respectively).",
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      "kind": "quote",
      "text": "\"Retreatment rates and postprocedural complications...\" — Kaplan, et al",
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      "kind": "source-note",
      "text": "Source: Leong, et al, Kaplan, et al, CDC, Procept IPO prospectus, Procept 2023 10-K",
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      "kind": "table",
      "text": "Table comparing sexual dysfunction risks (REj, PE, DV, ED) across TURP, HoLEP, PVP, TUNA, TUMT, Aquablation, UroLift, Rezum, and PAE.",
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      "kind": "title",
      "text": "MISTs Offer Fewer Side-Effects, And Durability Concerns May Be Overdone",
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