- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02009540
Botulinum Toxin in the Treatment of Idiopathic Detrusor Overactivity
Efficacy of Peri-trigonal Onabotulinumtoxin Injections in the Treatment of Refractory Idiopathic Detrusor Overactivity (IDO): A Single-blind, Randomised Controlled Trial Comparing Peri-trigonal Injections vs Injection of the Bladder Body.
Overactive Bladder (OAB) is a chronic condition caused by instability of the detrusor or bladder muscle, which gives rise to symptoms of urinary urgency and often urinary incontinence. Idiopathic Detrusor Overactivity (IDO) is a subset of OAB where the cause for the bladder muscle instability is unknown.
OAB is usually treated by conservative measures or with oral medications eg. anticholinergics. Injection of onabotulinum toxin A (onaBoNT-A) into the bladder wall is licenced in the treatment of refractory IDO where oral medications fail. The injected toxin paralyses the bladder by blocking the ability of certain (motor) nerves to communicate with the bladder muscle. As these nerves are mainly concentrated in what is known as the "body" of the bladder this is traditionally where the injections are given.
In addition to its action on motor nerves, onaBoNT-A also affects sensory nerve pathways. Recent studies show that IDO is caused by both motor and sensory nerve dysfunction, therefore injecting the "trigone", a part of the bladder where sensory nerves are particularly dense, may be of clinical benefit. Three studies comparing trigone versus trigone-sparing injection of botulinum toxin in the treatment of IDO have been carried out. One of these indicated a significant benefit in targeting the trigone and the other two did not show any difference.
Our study aims to examine if injection of onaBoNT-A into the trigone alone will provide symptom and functional improvement in patients with IDO by comparing peritrigonal injection of onaBoNT-A with the traditional method of injection which spares the trigone.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: H D Flood, FRCSI
- Email: e_red1@yahoo.co.uk
Study Locations
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Limerick, Ireland
- University Hospital of Limerick
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Contact:
- H D Flood
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Fulfil ICS criteria for OAB
- Urodynamically proven detrusor instability
- Symptoms lasting >6/12
- Patients must discontinue anticholinergic medication >14 days prior to randomisation and withhold the use of anticholinergics for the duration of the study.
- Patients with mixed incontinence are eligible if their urge symptoms are predominant. These will be instruced to record only episodes of urge urinary incontinence.
- Providing informed consent to participate in the study
- At least 18 years of age
Exclusion Criteria:
- Previous BoNT-A injection within 9 months of randomisation
- History of any neurological condition e.g. MS, Parkinsons, CVA
- Contraindication to BoNT e.g. Myaesthenia gravis
- Urinary tract infection in previous 6/12
- Antimicrobial therapy in previous 6/12
- Previous or current diagnosis of prostate or bladder cancer
- History of treatment with cyclophosphamide
- Radiation cystitis
- Urethral dilatation, cystometrogram, bladder cystoscopy under anaesthetic or a bladder biopsy in previous 3/12
- Augmentation cystoplasty, cystectomy or neurectomy
- Urethral stricture of <12ch
- Pregnancy
- Sexually active women of childbearing potential who are unwilling to use contraceptive measures for the duration of the trial.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Placebo Comparator: Botulinum toxin injected to bladder body
arm will receive 100u of onaBoNT-A in 20x1ml aliquots (5u/ml).
20 injections will be given into the bladder wall, sparing the trigone.
Injections will be given through all layers of the bladder eg suburothelially and intradetrusor.
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arm will receive 100u of onaBoNT-A in 20x1ml aliquots (5u/ml).
20 injections will be given into the bladder wall, sparing the trigone.
Injections will be given through all layers of the bladder eg suburothelially and intradetrusor.
The intervention will be performed under local anaesthetic using a flexible cystoscope.
Other Names:
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Active Comparator: Botulinum toxin injected into trigone
Arm B will receive 100u onaBoNT-A injected into 10x1ml suburothelial peri-trigonal sites (aliquot dose 10u/ml).
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Arm B will receive 100u onaBoNT-A injected into 10x1ml suburothelial peri-trigonal sites (aliquot dose 10u/ml).
The procedure will be performed under local anaesthetic by flexible cystoscopy.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Global Response Assessment
Time Frame: measured at 3 months following intervention
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measured at 3 months following intervention
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Functional outcomes - 3 day sensation related bladder diary
Time Frame: measured at 3 months following intervention
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Three day sensation related bladder diary
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measured at 3 months following intervention
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IIQ-7 quality of life questionnaire
Time Frame: measured at 3 months following intervention
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measured at 3 months following intervention
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Treatment tolerability - numerical rating scale (0-10)
Time Frame: measured at 2 weeks following intervention
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measured at 2 weeks following intervention
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UDI-6 quality of life questionnaire
Time Frame: measured at 3 months following intervention
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measured at 3 months following intervention
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: H D Flood, FRCSI, University Hospital of Limerick
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Urologic Diseases
- Urinary Bladder Diseases
- Lower Urinary Tract Symptoms
- Urological Manifestations
- Urinary Bladder, Overactive
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Peripheral Nervous System Agents
- Cholinergic Agents
- Membrane Transport Modulators
- Acetylcholine Release Inhibitors
- Neuromuscular Agents
- Botulinum Toxins
- Botulinum Toxins, Type A
- abobotulinumtoxinA
Other Study ID Numbers
- UHL02/2013
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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