InterStim® Sacral Nerve Modulation Cycling Study

The study will assess the effects of different InterStim cycling settings on urinary urge incontinence.

Study Overview

• Status: Completed
• Conditions: Urinary Urge Incontinence
• Intervention / Treatment: Device: InterStim® (Device Programming)

Detailed Description

This feasibility study will assess the following outcomes:

• Voiding diaries
• Patient reported assessments of response or satisfaction
• Adverse events

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Florida
    • Saint Petersburg, Florida, United States, 33710
      • Pinellas Urology, Inc.
  • Iowa
    • Iowa City, Iowa, United States, 52242
      • University of Iowa Healthcare
  • Minnesota
    • Woodbury, Minnesota, United States, 55125
      • Metro Urology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

1. Implanted with either Neurostimulator Model 3023 (InterStim) or Neurostimulator Model 3058 (InterStim II) for at least 3 months
2. Implanted with tined lead models 3889 or 3093
3. Tined lead is located at S3 as determined by sensory or motor responses or x-ray or fluoroscopy
4. Currently showing some efficacy with an InterStim device but has the potential to be optimized per the opinion of the Investigator
5. Primary diagnosis before InterStim implant is urinary urge incontinence.
6. Must be willing to maintain her current regimen (dosage and frequency) of any overactive bladder (OAB) medication (anticholinergic, antimuscarinic or Myrbetriq (Mirabegron)) or tricyclic antidepression medication over the study duration, if applicable.
7. Female subject 18 years of age or older
8. Willing and able to accurately complete voiding diaries and questionnaires, attend visits (within the visit windows +7 days), and comply with the study protocol that includes maintenance of InterStim programming settings over the course of the study
9. Have had no more than one (InterStim) reprogramming at or within 28 days at or prior to randomization

10. Able to consent to participate by signing the Informed Consent Form

    Exclusion Criteria:

11. History of Multiple sclerosis
12. History of Reiter's syndrome
13. History of spinal cord injury or a cerebral vascular accident (CVA)
14. History of diabetes unless the diabetes is well-controlled through diet and/or medications
15. Active symptomatic urinary tract infection (UTI)
16. Stress incontinence as the primary diagnosis
17. Urgency frequency as a primary diagnosis
18. Pelvic pain of uncertain etiology that is not associated with a voiding dysfunction or where pelvic pain is the primary diagnosis
19. Interstitial cystitis as the primary diagnosis
20. Urinary retention as the primary diagnosis
21. Treatment of urinary symptoms with botulinum toxin in the past 12 months or any plan to have botulinum toxin treatment during the study
22. Bilateral lead placement
23. Have other implantable neurostimulator, pacemaker, or defibrillator
24. Have knowledge of planned diathermy, microwave exposure, high output ultrasonic exposure, RF energy exposure, or MRI scans not included within the scanning conditions provided within the MRI Guidelines for InterStim Therapy neurostimulation systems.
25. Have an anticipated system modification within the next 5 months
26. Women who are pregnant or planning to become pregnant (women of child-bearing potential must undergo a pregnancy test, with a clear negative result, no more than 7 days prior to randomization visit)
27. Subjects who frequently use the patient programmer to change device program settings ("frequently" is defined as at least once a day and does not include shutting off the device for safety purposes)
28. Characteristics indicating a poor understanding of the study or characteristics that indicate the subject may have poor compliance with the study protocol.
29. Study site personnel will contact the Medtronic Study Manager (or designee) to determine if a potential subject who plans to enroll in an investigational device or drug trial, or is currently enrolled in an investigational device or drug trial is eligible for this study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

5

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Continuous; The device parameter will be continuous.	Device: InterStim® (Device Programming)
Other: Cycling Parameter #1; The device parameter will be cyclic program #1.	Device: InterStim® (Device Programming)
Other: Cycling Parameter #2; The device parameter will be cyclic program #2.	Device: InterStim® (Device Programming)
Other: Cycling Parameter #3; The device parameter will be cyclic program #3.	Device: InterStim® (Device Programming)
Other: No Stimulation; Following the randomized portion of the study, an assessment was conducted to estimate the effect of a month of no stimulation on incontinence.	Device: InterStim® (Device Programming)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Urinary Urge Incontinent (UUI) Episodes Per Day - Randomized Portion	Urinary urge incontinent episodes were collected through a diary on daily basis for approximately 4 weeks when subjects were under each cycling setting. Only the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.	4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Degree of Urgency - Randomized Portion	Each UUI episode was rated on following scales: 0=None, 1=Mild, 2=Moderate, 3=Severe, which were collected through a diary on daily basis for approximately 4 weeks when subjects were under each cycling setting. The average degree of urgency per UUI episode was calculated from the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.	4 week
Number of Pads Used Per Day - Randomized Portion	Number of pad use were collected through a diary on daily basis for approximately 4 weeks when subjects were under each cycling setting. Only the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.	4 weeks
Global Response Assessment (GRA) - Randomized Portion	Summary statistics of GRA at different cycling settings are provided. The GRA assessed incontinence symptoms as compared to symptoms prior to subject's entry into the study. Subjects were asked how much their incontinence changed since starting the study: markedly worse, moderately worse, mildly worse, same, slightly improved, moderately improved, or markedly improved. The responses to the symptom change were categorized into three levels for the analysis: worse (markedly worse, moderately worse, mildly worse), same (same), better (slightly improved, moderately improved, or markedly improved). Percentages of subjects reported worse, same or better under each cycling setting since starting the study are presented.	4 weeks
Number of UUI Episodes Per Day - no Stimulation	UUI episodes were collected through a diary on daily basis for approximately 4 weeks when subjects were under no stimulation. Only the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.	4 Weeks
Degree of Urgency - no Stimulation	Each UUI episode was rated on following scales: 0=None, 1=Mild, 2=Moderate, 3=Severe, which were collected through a diary on daily basis for approximately 4 weeks when subjects were under no stimulation. The average degree of urgency per UUI episode was calculated from the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.	4 weeks
Number of Pads Used Per Day - no Stimulation	Number of pad use were collected through a diary on daily basis for approximately 4 weeks when subjects were under no stimulation. Only the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.	4 Weeks
Global Response Assessment - no Stimulation	Summary of GRA under no stimulation setting is provided. The GRA assessed incontinence symptoms as compared to symptoms prior to subject's entry into the study. Subjects were asked how much their incontinence changed since starting the study: markedly worse, moderately worse, mildly worse, same, slightly improved, moderately improved, or markedly improved. The responses to the symptom change were categorized into three levels for the analysis: worse (markedly worse, moderately worse, mildly worse), same (same), better (slightly improved, moderately improved, or markedly improved).	4 Weeks
Adverse Events - no Stimulation	Summary of adverse device effects when subjects were under no stimulation is provided. Percentage of subjects experiencing any type of Adverse Device Effect under no stimulation is presented.	4 Weeks

Collaborators and Investigators

• Sponsor: MedtronicNeuro
• Investigators: Principal Investigator: Steven W Siegel, MD, Metro Urology; Principal Investigator: Shaw Zhou, MD, Pinellas Urology, Inc.; Principal Investigator: Karl Kreder, Jr., MD, MBA, University of Iowa Healthcare

Publications and helpful links

General Publications

• Siegel S, Kreder K, Takacs E, McNamara R, Kan F. Prospective Randomized Feasibility Study Assessing the Effect of Cyclic Sacral Neuromodulation on Urinary Urge Incontinence in Women. Female Pelvic Med Reconstr Surg. 2018 Jul/Aug;24(4):267-271. doi: 10.1097/SPV.0000000000000457.

Study record dates

Study Major Dates

• Study Start: September 1, 2013
• Primary Completion (Actual): November 1, 2015
• Study Completion (Actual): November 1, 2015

Study Registration Dates

• First Submitted: June 25, 2013
• First Submitted That Met QC Criteria: October 7, 2013
• First Posted (Estimate): October 8, 2013

Study Record Updates

• Last Update Posted (Actual): December 12, 2017
• Last Update Submitted That Met QC Criteria: November 14, 2017
• Last Verified: November 1, 2017

More Information

Terms related to this study

• Keywords: Incontinence; Urinary; Urge
• Additional Relevant MeSH Terms: Urologic Diseases; Lower Urinary Tract Symptoms; Urological Manifestations; Urination Disorders; Urinary Incontinence; Urinary Incontinence, Urge
• Other Study ID Numbers: 1670