Failed Insertion of Ureteral Access Sheath During Flexible Ureterorenoscopy
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ClinicalTrials.gov Identifier: NCT05911945 |
Recruitment Status :
Completed
First Posted : June 22, 2023
Last Update Posted : June 23, 2023
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Tracking Information | |||||
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First Submitted Date ICMJE | June 12, 2023 | ||||
First Posted Date ICMJE | June 22, 2023 | ||||
Last Update Posted Date | June 23, 2023 | ||||
Actual Study Start Date ICMJE | September 10, 2020 | ||||
Actual Primary Completion Date | September 10, 2021 (Final data collection date for primary outcome measure) | ||||
Current Primary Outcome Measures ICMJE |
Short Form-36 parameters [ Time Frame: Before surgery - 1 month after surgery ] In order to evaluate the quality of life of the patients, pre- and postoperative SF-36 form values will be compared.
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Original Primary Outcome Measures ICMJE | Same as current | ||||
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Current Secondary Outcome Measures ICMJE |
The success of the surgery [ Time Frame: Before surgery - 1 month after surgery ] Stone-free rates of the patients will be evaluated by computed tomography after surgery.
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Original Secondary Outcome Measures ICMJE | Same as current | ||||
Current Other Pre-specified Outcome Measures | Not Provided | ||||
Original Other Pre-specified Outcome Measures | Not Provided | ||||
Descriptive Information | |||||
Brief Title ICMJE | Failed Insertion of Ureteral Access Sheath During Flexible Ureterorenoscopy | ||||
Official Title ICMJE | Failed Insertion of Ureteral Access Sheath During Flexible Ureterorenoscopy: A Randomized Controlled Trial Comparing Second Session Flexible Ureterorenoscopy or Same Session Mini Percutaneous Nephrolithotomy | ||||
Brief Summary | Percutaneous nephrolithotomy (PNL) is the gold standard recommended treatment technique for kidney stones larger than 20 mm. For kidney stones between 10 - 20 mm, both shock wave lithotripsy (SWL) or flexible ureterorenoscopy (f-URS) are recommended as the first choice of treatment and PNL is recommended as the second. In patients who are planned to undergo f-URS, a ureteral access sheath (UAS) is placed in the ureter at the beginning of the operation in order to provide a better image, reduce intra-renal pressure, easier stone fragment retrieval and shorter operative time. In certain cases, such as ureteral stricture, kink or edema, the ureteral access sheath may not be able to successfully inserted into the ureter. At this stage, double-J (JJ) stent can be inserted into the ureter to create passive dilatation, and a second f-URS session can be scheduled a few weeks later. Another option is to perform PNL operation to the patient in the same session. In this randomized prospective study, we aimed to compare these two different surgical approaches in terms of patient comfort and surgical success in patients with kidney stones between 10 - 20 mm in which access sheath insertion was failed in the initial f-URS session. | ||||
Detailed Description | Patients with renal calculi between 1 - 2 cm in diameter who were admitted to a tertiary health institution were evaluated prospectively. Patients who were unsuitable for shock wave lithotripsy (SWL) treatment or who did not benefit from SWL sessions were included in the study. Randomization was performed using a random number table with a central computerized system. Before the procedure, the patients were asked to complete the Turkish language validated form of the Short Form - 36 (SF - 36) questionnaire. A total of 48 patients in whom ureteral access sheath insertion has failed during initial flexible ureterorenoscopy (f-URS) session were randomly divided into 2 groups. Group 1 underwent a JJ stent insertion and procedure terminated, while group 2 underwent mini percutaneous nephrolithotomy (mPNL) operation in the same session after prone positioning. Group 1 underwent f-URS 4-6 weeks later. One month after the operation, stone-free status was evaluated with computed tomography (CT) and detection of residual fragments of any size was defined as failure. The patients were asked to fill out the SF-36 questionnaire one month after the last surgery. Operative and postoperative data, SF-36 results, success, and complications were compared between the groups. The operation time included the time from initiation of cystoscopy to removal of amplatz for the mPNL group. For the F-URS group, it was calculated as the sum of the times between cystoscopy and fluoroscopy control of the JJ stent in both sessions. Surgical technique All surgeries were performed by the same team of experienced surgeons in with high expertise in endourology. A guidewire was placed in the ureter in the lithotomy position. Ureterorenoscopy was performed with an 8 Fr ureterorenoscope for active dilatation. An 11 - 13 Fr or 9.5 / 11.5 Fr UAS was attempted to be placed under fluoroscopy by the surgeon of the procedure. In cases where the UAS could not inserted, a 26 cm, 4.8 Fr JJ stent was placed under fluoroscopy in the f-URS group, and the procedure was terminated. In the mPNL group, same session mPNL procedure was performed. After initial JJ stent placement, patients in group 1 underwent a second f-URS session, 4 - 6 weeks later. After the JJ stent was removed, an 11 - 13 Fr UAS was placed in the ureter. Digital flexible ureterorenoscope was used as the flexible ureteroscope. Stone fragmentation was performed in dusting mode using a Ho:YAG laser with a 272 µ probe. After fragmentation, a 26 cm 4.8 Fr JJ stent was inserted into the ureter. The JJ stent was removed at 4 - 6 weeks postoperatively. For patients in group 2, after placing a 5 Fr ureteral open-ended catheter, patients were positioned in prone position and access was performed to the appropriate calyx with an 18-gauge percutaneous access needle using the triangulation technique accompanied by fluoroscopy, in the first session. After the guidewire was introduced into the pelvicalyceal system, sequential dilatation was applied with Amplatz dilatators, and a 21 Fr metallic sheath was placed. Stones were fragmented with a yttrium-aluminum-garnet (Ho:YAG) Laser lithotripter. At the end of the procedure, a 14 Fr nephrostomy catheter was placed in according to the residual stone, hemorrhage, and perforation status. In other cases, the procedure was concluded as totally tubeless. Postoperative routine intravenous analgesia was not applied to all patients. Study sample size analysis was computed using the G*Power program (effect size 0.5, alfa error 0.05, power 0.80). Statistical analysis was performed with 'Statistical Package for the Social Sciences' (SPSS) 25 program. The normality assessment of the distribution of the data was analyzed with the Shapiro-Wilk test and Q - Q plot. For continuous covariates, normality and homogeneity of each variable were evaluated and Student's or Welch's t-test was performed. Mann - Whitney U test was used for skewed data. Quantitative data were presented as mean ± standard deviation or median (IQR) values. Chi-square test or Fisher exact test (where the 20% of expected cell counts were less than 5) was used to compare qualitative data. The normality of the differences in SF - 36 data before and after the procedure was evaluated with the Skewness test and Q - Q plot. Paired-sample t - test was used to compare SF - 36 data before and after the procedure. The data were analyzed at 95% confidence level and the values with P < .05 were noted statistically significant. |
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Study Type ICMJE | Interventional | ||||
Study Phase ICMJE | Not Applicable | ||||
Study Design ICMJE | Allocation: Randomized Intervention Model: Parallel Assignment Masking: None (Open Label) Primary Purpose: Treatment |
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Condition ICMJE | Kidney Calculi | ||||
Intervention ICMJE |
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Study Arms ICMJE |
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Publications * |
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* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline. |
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Recruitment Information | |||||
Recruitment Status ICMJE | Completed | ||||
Actual Enrollment ICMJE |
48 | ||||
Original Actual Enrollment ICMJE | Same as current | ||||
Actual Study Completion Date ICMJE | December 1, 2021 | ||||
Actual Primary Completion Date | September 10, 2021 (Final data collection date for primary outcome measure) | ||||
Eligibility Criteria ICMJE | Inclusion Criteria:
Exclusion Criteria:
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Sex/Gender ICMJE |
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Ages ICMJE | 18 Years and older (Adult, Older Adult) | ||||
Accepts Healthy Volunteers ICMJE | No | ||||
Contacts ICMJE | Contact information is only displayed when the study is recruiting subjects | ||||
Listed Location Countries ICMJE | Turkey | ||||
Removed Location Countries | |||||
Administrative Information | |||||
NCT Number ICMJE | NCT05911945 | ||||
Other Study ID Numbers ICMJE | 256040791 | ||||
Has Data Monitoring Committee | Not Provided | ||||
U.S. FDA-regulated Product |
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IPD Sharing Statement ICMJE |
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Current Responsible Party | Ufuk Çağlar, Haseki Training and Research Hospital | ||||
Original Responsible Party | Same as current | ||||
Current Study Sponsor ICMJE | Haseki Training and Research Hospital | ||||
Original Study Sponsor ICMJE | Same as current | ||||
Collaborators ICMJE | Not Provided | ||||
Investigators ICMJE |
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PRS Account | Haseki Training and Research Hospital | ||||
Verification Date | June 2023 | ||||
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP |