Cystoscopy Plus Urethral Dilatation Versus Cystoscopy Alone in Women With Overactive Bladder Syndrome and Impaired Voiding

Study Description

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Brief Summary:

Urethral dilatation is a commonly undertaken intervention for a variety of urinary complaints including overactive bladder symptoms. There is however very little evidence for its efficacy, and no randomized trial evidence. The aim of this study is to ascertain the effect of urethral dilatation on overactive bladder symptoms and on voiding parameters. The null hypothesis is that there will be no difference in symptoms or voiding parameters between the urethral dilatation and sham groups.

Eligible women will be assessed initially with a history and examination, a King's Health Questionnaire and Bristol Female Urinary Tract Symptoms (BFLUTS) questionnaire and pressure flow studies. They will be randomized to undergo either cystoscopy alone or cystoscopy and urethral dilatation. Patients will be blinded to the procedure undertaken and randomized using a series of opaque envelopes. Follow up will be at 6 weeks with repeat questionnaires and pressure flow studies. Subjective and objective outcomes will be compared between the two groups.

Condition or disease	Intervention/treatment	Phase
Overactive Bladder Syndrome; Voiding Dysfunction	Procedure: Cystoscopy; Procedure: Cystoscopy and urethral dilatation	Not Applicable

Detailed Description:

This study is a randomised controlled trial. Objective outcomes will be evaluated at 6 weeks' post-operatively. Subjective outcomes will be evaluated at 6 weeks' and 6 months' post-operatively.

Study Population Entry to the study will be offered to all women with OAB symptoms with impaired voiding on cystometry (flow rate less than 15mls/sec with volume of 200mls voided and a normal or high detrusor pressure at maximum flow), who have failed to improve with 2 different anticholinergic medications. Subjects will be recruited from the Urogynaecology clinic at Medway Maritime Hospital. A power calculation was carried out which showed a minimum sample size of 30 (i.e. 15 in each arm) to be necessary to ensure an 80% power with a significance level of 0.05.

Pre-operative Assessment All patients will undergo an initial assessment consisting of a full urogynaecogical history and examination, BFLUTS questionnaire and Urgency Perception Scale, and pressure flow studies. As mentioned before, each patient will have been treated with anticholinergic medications prior to being offered this intervention.

Surgical Technique All procedures will be carried out under general anaesthesia. A dose of intravenous gentamicin will be given to each patient at induction. After emptying the bladder, saline cystoscopy will be carried out with a 30 degree cystoscope. The bladder mucosa will be systematically inspected for any abnormalities and the bladder filled either until the sphincter mechanism is overcome or to 1000mls. The bladder is emptied again and a second fill undertaken. The bladder mucosa is inspected for petechial haemorrhages, erythema and other signs of chronic cystitis on the second fill.

In subjects randomised to undergo urethral dilatation, this will be undertaken using Hagar dilators. There is no evidence in the literature regarding normal urethral calibre in women. Therefore, the urethra will be dilated to a maximum of 10 Hagar as per our unit's protocol. Women will be discharged on the same day, if they pass urine adequately.

Post-operative Assessment Subjects will be seen in the Urogynaecology clinic at 6 weeks' post-operatively and assessed with a BFLUTS questionnaire, UPS and repeat pressure flow studies. Each patient will be assessed subjectively at 6 months' post-operatively using the symptom questionnaires.

Significance testing will be used to compare symptom scores and pressure flow parameters between each group pre- and post-operatively.

Study Design

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Study Type :	Interventional (Clinical Trial)
Estimated Enrollment :	30 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	Single (Participant)
Primary Purpose:	Treatment
Official Title:	A Randomized Study of Cystoscopy and Urethral Dilatation Versus Cystoscopy Alone in Women With Overactive Bladder Syndrome and Impaired Voiding.
Study Start Date :	January 2009
Estimated Primary Completion Date :	October 2009
Estimated Study Completion Date :	October 2009

Arms and Interventions

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Arm	Intervention/treatment
Sham Comparator: Cystoscopy alone; Women in this arm will undergo saline cystoscopy under general anaesthesia only.	Procedure: Cystoscopy; Saline cystoscopy under general anaesthesia
Active Comparator: Cystoscopy and urethral dilatation; Women in this group will undergo cystoscopy and urethral dilatation under general anaesthesia	Procedure: Cystoscopy and urethral dilatation; Saline cystoscopy and urethral dilatation (using Hegar dilators) under general anaesthesia

Outcome Measures

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Primary Outcome Measures :

1. Change in pressure flow parameters (voided volume, maximum flow rate, acceleration of flow rate and detrusor pressure at maximum flow) at 6 weeks' post-operatively. [ Time Frame: 6 weeks ]
2. Change in symptoms as measured by the BFLUTS questionnaire and Urgency Perception Scale at 6 weeks' and 6 months' post-operatively. [ Time Frame: 6 weeks and 6 months ]

Secondary Outcome Measures :

1. Change in quality of life status as determined by change in King's Health Questionnaire scoring at 6 weeks and 6 months' post-operatively. [ Time Frame: 6 weeks and 6 months ]

Eligibility Criteria

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Ages Eligible for Study:	Child, Adult, Senior
Sexes Eligible for Study:	Female
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

1. OAB symptoms (based on relevant domains of BFLUTS questionnaire and Urgency Perception Scale) which have not improved with 2 anticholinergic treatments.
2. Maximum flow rate of less than 15 ml/s on a volume voided of 200mls or more, with a normal or high detrusor pressure at maximum flow on pressure flow studies
3. Patients must be able to give informed consent for the study

Exclusion Criteria:

1. Presence of concurrent urodynamic stress incontinence
2. Patient unfit or unwilling to undergo a general anaesthetic
3. Patients with bladder pathology or haematuria of unknown origin
4. Patients with neurological disorders (as these may affect voiding)

Contacts and Locations

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Contacts

Contact: Jonathan Duckett, FRCOG	+1634 830000 ext 5154	jonathan.duckett@medway.nhs.uk

Locations

United Kingdom
Medway Maritime Hospital	Recruiting
Gillingham, Kent, United Kingdom, ME7 5NY
Principal Investigator: Jonathan Duckett, FRCOG
Sub-Investigator: Maya Basu, MBBS, BSc(Hons)

Sponsors and Collaborators

Medway NHS Foundation Trust

Investigators

Principal Investigator:	Jonathan Duckett, FRCOG	Medway NHS Trust

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Basu M, Khullar V, Duckett J. Urethral dilatation: Is there any benefit over cystoscopy and distension? A randomized trial in women with overactive bladder symptoms. Neurourol Urodyn. 2014 Mar;33(3):283-8. doi: 10.1002/nau.22411. Epub 2013 May 1.

Responsible Party:	Mr Jonathan Duckett, Medway NHS Trust
ClinicalTrials.gov Identifier:	NCT00839969 History of Changes
Other Study ID Numbers:	08/H1101/97
First Posted:	February 10, 2009
Last Update Posted:	February 10, 2009
Last Verified:	February 2009

Keywords provided by Medway NHS Foundation Trust:

overactive bladder syndrome; voiding; pressure flow studies; urethral dilatation

Additional relevant MeSH terms:

Syndrome; Urinary Bladder, Overactive; Aneurysm; Dilatation, Pathologic; Disease; Pathologic Processes; Urinary Bladder Diseases; Urologic Diseases; Lower Urinary Tract Symptoms	Urological Manifestations; Signs and Symptoms; Vascular Diseases; Cardiovascular Diseases; Pathological Conditions, Anatomical; Anesthetics; Central Nervous System Depressants; Physiological Effects of Drugs