- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04594161
Effectiveness of Drainage by PCN vs. JJ in Patients With Symptoms of Obstructive Kidney Disease Caused by Urolithiasis (STONE)
Effectiveness of Drainage of the Kidney by Percutaneous Nephrostomy Catheter Placement Vs. Retrograde Double J Catheter Placement in Patients With Symptoms of Obstructive Kidney Disease Caused by Urolithiasis
Study Overview
Status
Conditions
- Kidney Diseases
- Urologic Diseases
- Kidney Calculi
- Urinary Calculi
- Urolithiasis
- Stone Ureter
- Stone, Kidney
- Urinary Stone
- Pyelonephritis
- Hydronephrosis
- Obstruction
- Kidney Failure, Acute
- Ureter Obstruction
- Urinary Obstruction
- Kidney Dysfunction
- Kidney Insufficiency
- Pyelonephritis Acute
- Stone, Urinary
- Ureter Calculi
- Ureteric Obstruction
- Calculus Ureteral
- Stone;Renal
- Obstruction Ureter
- Pyelonephritis Obstructive
- Pyelonephritis; Calculus
- Pyelonephritis; Obstruction
- Pyelonephrosis
- Hydronephrosis; Infection
- Hydronephrosis, Infected
- Hydronephrosis; Obstruction, Ureter
- Hydronephrosis; Obstruction, Renal Calculus
- Hydronephrosis, Secondary
- Renal Pelvis; Obstruction
Intervention / Treatment
Detailed Description
SUMMARY Rationale If a stone obstructs the ureter and impairs urine-efflux from the kidney this may cause infection, pain resulting from a renal colic and/or renal impairment. Drainage of the kidney may be necessary and can be established by placement of either a percutaneous nephrostomy (PCN) or a retrograde double J catheter (JJ). Considering method of drainage, setting, room in which drainage procedures takes place and anesthesia method, there are in fact 16 different approaches for drainage available, each with its own consequences for the patient and on expenses. Although evidence is poor, both methods of drainage are to be considered as equal.[1] This is reflected by the differences in preference between different countries.[2] In 2016 the Dutch association for urology (Nederlandse Vereniging voor Urologie (NVU)) marked this subject as one of the primary knowledge gaps in urology in The Netherlands and gave it priority on the national knowledge agenda for urology.[3] From patients' as well as from societal perspective it is of importance that the decision for placement of either PCN or JJ will be made based on evidence based arguments and in a uniform way.
Hypothesis: Percutaneous nephrostomy is non inferior to retrograde double J catheter regarding time to clinical recovery. Secondly, patient reported outcome measures (PROMS) comparing treatment room and OR settings of drainage procedures will most likely not be significantly different.
Finally, because percutaneous nephrostomy catheters are more often placed in a (outpatient) urological or radiological treatment room, this is expected to be less expensive than placement of a double J catheter (more often placed in the OR). Objective: To investigate the effectiveness of percutaneous nephrostomy catheter placement versus retrograde double J catheter placement in patients with symptoms of obstructive kidney disease (with either infection and/or pain and/or kidney function deterioration) caused by urolithiasis.
Study design: Multicenter prospective randomized controlled non-inferiority trial.
Study population: Male and female adult patients with signs of obstructive kidney disease with kidney or ureteral lithiasis as an underlying cause and with an indication for drainage based on symptoms of or laboratory tests indicating infection and/or pain and/or kidney function.
Intervention: One group receives drainage by percutaneous nephrostomy catheter placement as opposed to the other group which will receive drainage by retrograde double J catheter placement.
Main study parameters/endpoints:
The primary objective is to assess whether a PCN is non-inferior to double J catheter regarding time to clinical recovery in patients with obstructive kidney disease resulting from urolithiasis.
The primary outcome parameter is time to clinical recovery. Clinical recovery is defined as reaching one or more of the following criteria. The mandatory amount of criteria to achieve clinical recovery is dependent on the indication for placement of a PCN or a JJ.
- If indication for drainage is infection: improvement of infection, indicated by a decrease of WBC in two executive laboratory results and below 15.000 mm3 and a body temperature of 36-38.5 C. and/or
- If indication for drainage is untreatable pain: Numeric rating score (NRS) considering pain resulting from a renal colic is improved and < 3 points and/or
- If indication for drainage is deterioration of kidney function: improvement of creatinine/ Glomerular Filtration Rate (GFR) in two executive laboratory results It may occur that the indication for drainage is a combination of the above named indications. Clinical recovery will then be reached in case all parameters related to the different indications are within the set range. Secondary outcomes are further clinical data, PROMS (measured by the EQ-5D-5L, NRS, a satisfaction scale and a catheter questionnaire) and societal costs (measured by a diseasespecified iMCQ questionnaire).
Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The placement of either PCN or double J catheter is standard care. Currently the choice for PCN or a double J catheter is based on expert opinion and may be driven by arguments considering logistics or assumptions about the quality of life for a patient after placement.
Considering the difference in rate of placement of both PCN and double J catheter between various hospitals and different countries, it is believed experts have no uniform work method to handle the dilemma of choosing between these two techniques.[2] Furthermore the current EAU-guideline 2018 states that both methods of drainage are to be considered as equal.[1] Therefore there is no reason to believe, patients will be affected negatively by being placed randomly in either the double J group or the PCN group. Questionnaires will be filled in daily during hospitalization and twice or less afterwards. This is not considered to be a risk for the patient. The longest questionnaires (EQ-5D-5L and iMCQ) will take approximately 10-20 minutes to fill in, additional to the shorter scales (NRS, satisfaction scale) which will take approximately 1 minute to fill in. Generally It will take 90 minutes, spread over the course of three months, to fill in all questionnaires. For frequency and timing of the questionnaires. Finally, no additional visits to a hospital, withdrawal of blood samples or exposure to radiation is to be expected when taking part in this study.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Barbara Schout, dr.
- Phone Number: +31 715828282
- Email: bmaschout@alrijne.nl
Study Contact Backup
- Name: Nora Hendriks, Drs.
- Phone Number: +31636571112
- Email: nhendriks@alrijne.nl
Study Locations
-
-
Noord Holland
-
Amsterdam, Noord Holland, Netherlands, 1105 AZ
- Amsterdam UMC, location AMC
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- In order to be considered eligible to participate in this study, a subject must meet all of the following criteria:
- Male/female >18 year
- Symptoms and/or laboratory results indicating obstructive kidney disease with or without infection.
- A kidney or ureteral stone is present on ultrasound or CT (max 3 months old prior to presentation)
- Both drainage techniques are feasible and safe in opinion of the treating physician (from logistics point of view and in the best interest of the patient).
- Willing and able to comply with filling in questionnaires and follow-up regiment
Exclusion Criteria:
A potential subject who meets any of the following criteria will be excluded from participation in this study:
- Analphabetic or not mastering the Dutch language
- Pregnancy
- Usage of anticoagulation agents other than acetylsalicylic acid.
- Contraindication for either technique looking at history and anatomy (e.g. kidney transplant, pouch, Bricker deviation, urethral or ureteral stenosis)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Percutaneous Nephrostomy
drainage of the kidney by means of a percutaneous Nephrostomy
|
A Percutaneous Nephrostomy will be placed in patients with obstructive urolithiasis
Other Names:
|
Active Comparator: Double J catheter
drainage of the kidney by means of a double J catheter
|
A Double J catheter will be placed in patients with obstructive urolithiasis
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
time (hours) to clinical recovery regarding infection
Time Frame: 3 months
|
Unit is hours (0-∞), higher scores mean a worse outcome. Clinical recovery is defined as reaching one or more of the following criteria (all criteria are added seperately) - If indication for drainage is infection clinical recovery is defined as: improvement of infection, indicated by a decrease of WBC (unit: mm3) in two executive laboratory results and at least below 15.000 mm3. |
3 months
|
time (hours) to clinical recovery regarding infection
Time Frame: 3 months
|
Unit is hours (0-∞), higher scores mean a worse outcome. Clinical recovery is defined as reaching one or more of the following criteria (all criteria are added seperately) - If indication for drainage is infection clinical recovery is defined as: improvement of infection, indicated by a body temperatur between 36.0-38.5 °Celsius. and/or
|
3 months
|
time (hours) to clinical recovery regarding pain
Time Frame: 3 months
|
Unit is hours (0-∞), higher scores mean a worse outcome.
Clinical recovery is defined as reaching one or more of the following criteria (all criteria are added seperately) If indication for drainage is untreatable pain clinical recover is defined as: Numeric Rating Score (NRS) considering pain resulting from a renal colic is improved and < 3 points (higher scores mean greater level of pain).
|
3 months
|
time (in hours) to clinical recovery regarding kidney function
Time Frame: 3 months
|
Unit is hours (0-∞), higher scores mean a worse outcome.
Clinical recovery is defined as reaching one or more of the following criteria (all criteria are added seperately) If indication for drainage is deterioration of kidney function: improvement of creatinine (μmol/L) and/or Glomerular Filtration Rate (ml/min/1.73
m2) in two executive laboratory results.
|
3 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
patient reported outcome measures (PROMS) quality of life
Time Frame: 3 months
|
EQ-5D-5L questionnaire (range 0-1; greater scores reflect a higher quality of life).
|
3 months
|
patient reported outcome measures (PROMS) pain score
Time Frame: 3 months
|
Numeric Rating Score (NRS) considering pain questionnaire (range 0-10; greater scores reflect higher pain levels)
|
3 months
|
patient reported outcome measures (PROMS) satisfaction
Time Frame: 3 months
|
satisfaction scale (range 0-10; greater scores reflect higher levels of satisfaction)
|
3 months
|
patient reported outcome measures (PROMS) catheter related problems
Time Frame: 3 months
|
catheter questionnaire.
All answers will be analysed using frequencies.
No score is applicable.
|
3 months
|
patient reported outcome measures (PROMS) cost and productivity
Time Frame: 3 months
|
disease-specified iMCQ (Medical Consumption Questionnaire)/iPCQ (Productivity Cost Questionnaire).
All answers will be analyzed using frequencies and will be used in economical models to calculate productivity burden and societal and individual costs.
|
3 months
|
patient reported outcome measures (PROMS) on costs iMCQ (Medical consumption questionnaire)
Time Frame: 3 months
|
disease-specified iMCQ (Medical Consumption Questionnaire).
All answers will be analyzed using frequencies and will be used in economical models to calculate productivity burden and societal and individual costs.
|
3 months
|
patient reported outcome measures (PROMS) productivity
Time Frame: 3 months
|
iPCQ (Productivity Cost Questionnaire).
All answers will be analyzed using frequencies and will be used in economical models to calculate productivity burden and societal and individual costs.
|
3 months
|
Collaborators and Investigators
Collaborators
Investigators
- Study Chair: Ad Hendrikx, dr., no affiliation
Publications and helpful links
Helpful Links
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
Keywords
Additional Relevant MeSH Terms
- Pathological Conditions, Anatomical
- Nephritis
- Ureteral Diseases
- Nephritis, Interstitial
- Pyelitis
- Nephrolithiasis
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Urogenital Diseases
- Male Urogenital Diseases
- Kidney Diseases
- Renal Insufficiency
- Acute Kidney Injury
- Urinary Calculi
- Urolithiasis
- Calculi
- Kidney Calculi
- Pyelonephritis
- Urologic Diseases
- Ureteral Obstruction
- Hydronephrosis
- Pyonephrosis
Other Study ID Numbers
- METC 2020_057
- NL70822.058.19 (Other Identifier: ABR)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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.
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