- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03861260
GAG Replacement vs URethral DIlAtatioN (GUARDIAN)
To Investigate and Compare The Efficacy of Urethral Dilatation Versus Glycosaminoglycan Layer Replacement in The Management Of Women With Recurrent Urinary Tract Infections
The aim of this randomised parallel trial is to compare the efficacy of Glycosaminoglycan layer replacement against cystoscopy and urethral dilatation in the treatment of recurrent urinary tract infection in pre-menopausal women.
The women will be randomised to 1 of 2 arms.Arm 1 patients will receive standard treatment from the Urologists. This will involve rigid cystoscopy and urethral dilatation, under general anaesthetic.
Arm 2 patients will receive standard treatment from the Gynaecologists.
Study Overview
Status
Conditions
Detailed Description
Recurrence of a Urinary Tract Infection (UTI) is defined as infection, following complete resolution of a previous UTI.Recurrent UTI (rUTI) is defined as 3 or more microbiologically confirmed UTI within 12 months. rUTI is an economic problem for healthcare services. rUTI is also detrimental to the quality of life (QoL) of women who suffer the disease. 61% of women who suffer rUTI report symptoms of depression and an associated decrease in their reported QoL scores. QoL was found to improve significantly with successful treatment.
E-coli is the most common bacteria causing UTI and 10% are thought to be antibiotic resistant. Consequently, new treatment strategies are required.
The Glycosaminoglycans (GAG) layer is thought to be instrumental as a defence mechanism against uro-pathogens.
GAG's are polysaccharides forming a gel like substance on the apical surface of the bladder wall and act as a barrier to uro-pathogens. There is now strong evidence that a reduction in the impermeability of the GAG layer is linked to rUTI. Urethral dilatation is an alternative treatment to GAG replacement in the management of rUTI. It is a treatment option more widely adopted by Urologists, although there is a paucity of data to support its use.
Currently there is no standardised strategy for the management of women with rUTI. Treatments vary between GAG layer replacement (intravessical therapy with hyaluronic acid and chondroitin sulphate) or a cystoscopy and urethral dilatation. Evidence for each regime varies greatly and is of poor quality. This is a randomised study comparing GAG layer replacement with cystoscopy and urethral dilatation.
Study Type
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Hampshire
-
Basingstoke, Hampshire, United Kingdom, RG24 9NA
- Hampshire Hospitals NHS Foundation Trust
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Female
Pre-menopausal 3 - 3 episodes of cystitis in the last 12 months as defined by:
- 3 symptoms from dysuria, frequency, urgency, suprapubic tenderness, haematuria, polyuria
- Or less than 2 symptoms from the above list, but with cloudy urine 4 - Normal flow studies with bladder residual <150ml 5 - Normal renal tract on USS
Exclusion Criteria:
- - Anatomical anomalies of urinary tract
- - Neurological condition
- - Diabetes mellitus
- - Pregnancy
- - Use of Immunosuppressants
- - Symptomatic of UTI at time of treatment
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 |
---|---|
Other: Rigid Cystoscopy and Urethral dilatation
Rigid cystoscopy, performed under General Anaesthetic, followed by intervention of urethral dilatation with Hagar dilators.
|
Patients will have a general anaesthetic and a rigid cytoscopic examination of the bladder dilated with sterile water.
The urethra will be dilated from FR20 in incremental diameter increases of 2 to French 32 if possible.
|
Other: Flexible cystoscopy and Glycosaminoglycan Layer replacement
Flexible cystoscopy, under Local Anaesthetic, followed by the intervention, which is 6 installations of Ialuril (a Glycosaminoglycan Layer replacement)
|
Patients will undergo flexible cystoscopy and intravesical installations of Hyaluronic acid (HA) + Chondroitin Sulphate (CS) (GAGs) weekly for 4 weeks and then at 8 weeks and 12 weeks.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The number of Urinary tract infections in the 12 months following treatment
Time Frame: 12 months
|
Number of symptomatic UTI episodes in 12 months following treatment
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The time to first urinary tract infection after completion of treatment.
Time Frame: 12 month study period
|
Time (in days) to first symptomatic UTI episode after completion of treatment.
|
12 month study period
|
The change in the Quality of life (QoL) between the time of treatment and at 3, 6 and 12 months following initiation of treatment.
Time Frame: 3, 6 and 12 months
|
Following treatment is there any recorded change in the QoL questionnaire (SF-12) score from pre-treatment baseline
|
3, 6 and 12 months
|
The number of adverse events recorded following treatment during the 12-month study period
Time Frame: 12 months
|
A record of the number, recorded in groups by their nature, of adverse events following treatment during the 12 month study.
|
12 months
|
The change in the Patient Satisfaction at 3, 6 and 12 months following initiation of treatment
Time Frame: 3, 6 and 12 months
|
Following treatment is there any recorded change in the Patient Satisfaction report from pre-treatment baseline
|
3, 6 and 12 months
|
The change in female sexual function index (FSFI) questionnaire at 3, 6 and 12 months
Time Frame: 3, 6 and 12 months
|
Following treatment is there any recorded change in the FSFI questionnaire score (out of 36) from pre-treatment baseline
|
3, 6 and 12 months
|
The change in Hospital anxiety and depression scale (HADS) questionnaire at 3, 6 and 12 months
Time Frame: 3, 6 and 12 months
|
Following treatment is there any recorded change in the HADS questionnaire score (out of 21 for anxiety and 21 for depression) from pre-treatment baseline
|
3, 6 and 12 months
|
Collaborators and Investigators
Investigators
- Principal Investigator: Christian Phillips, MBBS MD, Hampshire Hospitals NHS Foundation Trust
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 (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2018-FAM-99
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
Clinical Trials on Recurrent Urinary Tract Infection
-
Lawson Health Research InstituteUniversity of Western Ontario, CanadaCompletedUrinary Tract Infection | Recurrent Urinary Tract InfectionCanada
-
University of California, IrvineCompletedRecurrent Urinary Tract InfectionUnited States
-
Radboud University Medical CenterIBSA Institut Biochimique SA; Goodlife Pharma B.V.RecruitingRecurrent Urinary Tract InfectionNetherlands
-
University of SulaimaniCompletedRecurrent Urinary Tract InfectionIraq
-
IRCCS Policlinico S. MatteoCompleted
-
Beijing Institute of Disease Control and PreventionUnknownRecurrent Urinary Tract InfectionChina
-
University of California, San DiegoNYU Langone Health; American Urogynecologic SocietyCompletedRecurrent Urinary Tract InfectionUnited States
-
Hvidovre University HospitalRecruitingRecurrent Urinary Tract InfectionDenmark
-
Atlantic Health SystemNot yet recruitingRecurrent Urinary Tract Infection
-
Medical University of GrazCompletedRecurrent Urinary Tract InfectionAustria
Clinical Trials on Rigid cystoscopy with urethral dilatation
-
Medway NHS Foundation TrustWithdrawnOveractive Bladder | Urinary Incontinence | Voiding Dysfunction
-
Medway NHS Foundation TrustUnknownOveractive Bladder Syndrome | Voiding DysfunctionUnited Kingdom
-
University of Wisconsin, MadisonCompletedUrination Disorders | Hematuria | Recurrent Urinary Tract Infection | Voiding DysfunctionUnited States
-
Boston Scientific CorporationCompletedBenign Prostatic Hyperplasia | Lower Urinary Tract SymptomUnited States
-
Maulana Azad Medical CollegeCompletedLower Urinary Tract SymptomsIndia
-
University Hospital, GhentCompletedDiabetic Angiopathies | Intermittent ClaudicationBelgium
-
Todd Moyerbrailean DO FACOGTerminated
-
Centre Hospitalier Universitaire VaudoisTerminated
-
Varian, a Siemens Healthineers CompanyRecruitingProstate CancerUnited States
-
University of Southern CaliforniaUnknownEsophageal Stricture | Duodenal Stricture | Jejunal Stricture | Anastomotic Stricture of Small IntestineUnited States