- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02591381
Transcorporal Versus Standard Artificial Urinary Sphincter Placement (TC vs ST AUS)
A Randomized Study of Transcorporal Versus Standard Artificial Urinary Sphincter Placement
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Procedure/ Methods:
Patients will be identified in the urology clinic upon their standard of care visit for AUS placement. The procedures that determine whether a patient is a surgical candidate are as follows:
- Incontinence Impact Questionnaire Short Form (IIQ-7) and Urinary Incontinence Symptoms index (ISI) standardized questionnaires
- Physical examination
- Review of medical history that would preclude surgery
- Cystoscopy to evaluate and rule out stricture
- Uroflow/Post void residual to ensure adequate bladder capacity
Pre surgery work up includes:
- Urine analysis and if indicated urine culture and treatment of urinary tract infection
- Flow, post-void residual if possible
- Cystoscopy to rule out bladder neck contracture or urethral stricture
- History and physical examination
- Treatment of men with 2 days of chlorhexidine wash to the perineum
- Incontinence sexual function questionaires
- Aminogllycoside and other abx prior to surgery
- 24 hour pad weight
Post-surgery follow up:
- Routine removal of catheter within 5 days post-op
- Treatment of antibiotics post-operatively to be limited to 1 week
- Activation of AUS at 4-8 weeks post-op
- Incontinence sexual function questionnaires
- 24 hour pad weight
Routine follow ups will be conducted at 2 weeks, 6 weeks, 3 months, 6 months post-operatively, and yearly thereafter (SOC). Patient characteristics that will be collected include:
- etiology of the incontinence.
- pre-operative pad usage
- prior anti-incontinence procedures
- adjuvant therapy for prostate cancer such as radiotherapy, or other history of pelvic radiation
- post-operative urodynamic studies
- cystoscopy findings
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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California
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San Francisco, California, United States, 94143
- University of California San Francisco
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- All patients undergoing an AUS procedure would potentially be candidates for the study
Exclusion Criteria: There are several situations in which either a TC or ST procedure would be specifically indicated, and it would be unethical to randomize these patients to the other procedure.
- No men without erectile dysfunction
- No use of injectable agents into the corporal body
- No prior urethral surgery (Prior surgery defined as; urethroplasty, urethral sling, prior AUS placement or explantation, recto-urethral fistula closure)
- No current penile prosthesis
- No concomitant placement of penile prosthesis at the time of AUS placement
- Males under the age of 18, as well as females, are also excluded
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: STANDARD AUS Placement
Standard placement of an artificial urinary sphincter involves a small incision made in the patient's perineum or scrotum and a fluid-filled cuff is placed around the bulbar urethra (the portion of the urethra between the bladder neck and penis).
Connected to the cuff with tubing, is a balloon filled with fluid that is placed behind the pubic bone or in the space between the peritoneum and abdominal muscles.
A control pump is placed in the scrotum and allows the device to cycle, thus either exerting pressure to close off the urethra or releasing pressure to allow the urethra to open and the patient to void.
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The AUS is the gold standard for treatment of severe stress urinary incontinence, particularly in patients following surgical resection of the prostate for prostate cancer.
AUSs are small devices that prevent urinary flow via compression of the urethra, thus mimicking the native urinary sphincter.
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Experimental: TRANSCORPORAL AUS Placement
Transcorporal placement has been introduced as a way to reduce risk of erosion and involves tunneling the cuff through the erectile bodies.
The same incision is made as for the standard approach, and then an incision is made in each corpus cavernosum (cylinders of tissue that allow for erection).
This allows the cuff to be placed around both the urethra and through the lining of the corporal bodies, increasing the bulk of tissue behind the urethra to protect it from erosion.
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The AUS is the gold standard for treatment of severe stress urinary incontinence, particularly in patients following surgical resection of the prostate for prostate cancer.
AUSs are small devices that prevent urinary flow via compression of the urethra, thus mimicking the native urinary sphincter.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Revision or removal surgery for AUS cuff problems other than mechanical failure: these include cuff erosion, impending erosion (discretion of surgeon), persistent retention due to small cuff, urethral atrophy
Time Frame: Through study completion, an average of up to 1 year
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Through study completion, an average of up to 1 year
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of post-operative urinary retention
Time Frame: Up to 2-4 weeks
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Urinary retention defined as urinary catheter placement for more than 5 days post-op.
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Up to 2-4 weeks
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Change in 24 hour pad test at 3 months post-op compared to pre-op
Time Frame: 3 months post op
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3 months post op
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Erectile function as measured pre and post AUS placement via the Sexual Health Inventory for Men (SHIM)
Time Frame: 3 month post op, 12 month post op
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Sexual health is an important part of an individual's overall physical and emotional well being.
This questionnaire is designed to help identify if the patient may be experiencing erectile dysfunction.
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3 month post op, 12 month post op
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Incontinence impact as measured by the Incontinence Symptom Index (ISI)
Time Frame: 3 month post op, 12 month post op
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This brief questionnaire is designed to assess the severity of the patient's urinary incontinence
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3 month post op, 12 month post op
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Quality of Life impact as measured by the Incontinence Impact Questionnaire--Short Form (IIQ)
Time Frame: 3 month post op, 12 month post op
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Some people find that accidental urine loss may affect their activities, relationships, and feelings.
The questions in this assessment refer to areas in the subjects life that may have been influenced or changed by incontinent symptoms.
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3 month post op, 12 month post op
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: benjamin n breyer, MD, MAS, FAC, University of California, San Francisco
Publications and helpful links
General Publications
- Haab F, Trockman BA, Zimmern PE, Leach GE. Quality of life and continence assessment of the artificial urinary sphincter in men with minimum 3.5 years of followup. J Urol. 1997 Aug;158(2):435-9.
- Dalkin BL, Wessells H, Cui H. A national survey of urinary and health related quality of life outcomes in men with an artificial urinary sphincter for post-radical prostatectomy incontinence. J Urol. 2003 Jan;169(1):237-9. doi: 10.1097/01.ju.0000040621.68116.4e.
- Guralnick ML, Miller E, Toh KL, Webster GD. Transcorporal artificial urinary sphincter cuff placement in cases requiring revision for erosion and urethral atrophy. J Urol. 2002 May;167(5):2075-8; discussion 2079.
- Aaronson DS, Elliott SP, McAninch JW. Transcorporal artificial urinary sphincter placement for incontinence in high-risk patients after treatment of prostate cancer. Urology. 2008 Oct;72(4):825-7. doi: 10.1016/j.urology.2008.06.065. Epub 2008 Aug 26.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- K12DK083021-AUS
- K12DK083021 (U.S. NIH Grant/Contract)
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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