Autologous Versus Synthetic Versus Biological Sling for Trans-obturator Correction of Urinary Stress Incontinence - Full Text View

Purpose

The treatment of urinary stress incontinence with trans-obturator approach, know as transobturatory tape (TOT), is a largely used sling-adopting procedures. The efficacy and safety of this minimally invasive surgery have been demonstrated, also in comparison with similar procedures, i.e transvaginal tape (TVT).

To date the results of TOT in terms of efficacy and safety described in literature mainly refer to procedure in which synthetic materials are used, whereas few data regarding the use of biological materials are available. Moreover, despite the well known benefits of the available synthetic and eterologue kit, their use may be limited by the high cost of these materials. At this proposal it can be suggested as alternative option the possibility to perform the procedure using an autologous tissue, i.e. rectus fascia, and reusable introductory needles. Based on these considerations the aim of this trial will be to compare autologous, synthetic and biological mesh for TOT in women with urinary stress incontinence.

Condition	Intervention	Phase
Stress Urinary Incontinence	Procedure: Autologous transobturator tape procedure Procedure: Synthetic transobturator tape procedure Procedure: Biological transobturator tape procedure	Phase 4


Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	A Comparison in Terms of Efficacy and Safety Among Three Different Materials for Trans-obturator Correction of Urinary Stress Incontinence: Autologous, Synthetic and Biological Sling

Resource links provided by NLM:

MedlinePlus related topics: Pelvic Support Problems

U.S. FDA Resources

Further study details as provided by University Magna Graecia:

Primary Outcome Measures:

Cure rate [ Time Frame: 12 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Intra-operative complication rate [ Time Frame: one day ] [ Designated as safety issue: Yes ]
Postoperative complications rate [ Time Frame: 12 months ] [ Designated as safety issue: Yes ]
Failure rate [ Time Frame: 12 months ] [ Designated as safety issue: No ]
Recurrence rate [ Time Frame: 12 months ] [ Designated as safety issue: No ]
Quality of life [ Time Frame: 12 months ] [ Designated as safety issue: No ]
Sexual function [ Time Frame: 12 months ] [ Designated as safety issue: No ]


Estimated Enrollment:	8
Study Start Date:	August 2012
Estimated Primary Completion Date:	August 2014 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: 1 Autologous sling	Procedure: Autologous transobturator tape procedure A strip of rectus fascia is harvested. Small incision sites in the vagina and in the femoral/pelvic fold. Bilateral transobturator insertion of the autologous strip by means of reusable needles
Active Comparator: 2 Synthetic sling	Procedure: Synthetic transobturator tape procedure Small incision sites in the vagina and in the femoral/pelvic fold. Bilateral transobturator insertion of synthetic mesh by means of mono-use needles.
Active Comparator: 3 Biological sling	Procedure: Biological transobturator tape procedure Small incision sites in the vagina and in the femoral/pelvic fold. Bilateral transobturator insertion of biological mesh by means of mono-use needle

Detailed Description:

Women with genuine stress urinary incontinence will be enrolled and randomized in three groups (arm 1, arm 2, arm 3). All patients will be treated with a transobturatory approach, in patients of arm 1 will be used an autologous tissue and reusable introductory needles, in patients of arm 2 will be used a synthetic kit whereas in arm 3 will be a biological kit .

All eligible patients will undergo baseline assessment consisting of anthropometric, clinical, hormonal, urodynamic, and ultrasonographic evaluations. During the study, the surgical outcomes, the clinical subjective and objective efficacy data, and the adverse experiences will be evaluated in each patient.

Data will be analyzed using the intention-to-treat principle and a P value of 0.05 or less will be considered significant.

Eligibility


Ages Eligible for Study:	18 Years to 80 Years
Genders Eligible for Study:	Female
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Genuine stress urinary incontinence by self report, examination and test
Urethral hypermobility
Eligible for all three surgical procedures
Ambulatory

Exclusion Criteria:

Pregnancy
<12 months post-partum
Systemic disease and/or drugs known to affect bladder function
Current chemotherapy or radiation therapy
Urethral diverticulum, augmentation cytoplasty, or artificial sphincter
Recent pelvic surgery
Severe genuine stress incontinence (loss of urine with minimal physical activity) with associated prolapse equal to or more than second degree
Previous pelvic or anti-incontinence surgery
History of severe abdominopelvic infections
Known extensive abdominopelvic adhesions
Detrusor instability and/or intrinsic sphincter dysfunction
Other gynaecologic pathologies (eg, fibroids, ovarian cysts)
BMI >30

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00744198

Contacts


Contact: Stefano Palomba, MD		stefanopalomba@tin.it

Locations


Italy
"Pugliese" Hospital	Recruiting
Catanzaro, Italy, 88100
Contact: Ingrid Tomaino, MD 39-096-188-3234 angela.falbo@libero.it
Principal Investigator: Stefano Palomba, MD

Sponsors and Collaborators

University Magna Graecia

Investigators


Principal Investigator:	Stefano Palomba, MD	Chair of Obstetrics and Gynecology, University "Magna Graecia" of Catanzaro
Study Chair:	Fulvio Zullo, MD	Chair of Obstetrics and Gynecology, University "Magna Graecia" of Catanzaro

More Information

No publications provided


Responsible Party:	Stefano Palomba, Associate Professor, University Magna Graecia
ClinicalTrials.gov Identifier:	NCT00744198 History of Changes
Other Study ID Numbers:	02/2008
Study First Received:	August 26, 2008
Last Updated:	April 5, 2013
Health Authority:	Italy: Ethics Committee

Keywords provided by University Magna Graecia:


Autologous Biological Mesh Polypropylene Sling	Synthetic Stress incontinence Surgery TOT Treatment

Additional relevant MeSH terms:


Urinary Incontinence Urinary Incontinence, Stress Lower Urinary Tract Symptoms Signs and Symptoms	Urination Disorders Urologic Diseases Urological Manifestations

ClinicalTrials.gov processed this record on March 03, 2015