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Trial record 60 of 117 for:    "Penile Disease"

Efficacy of Amniotic Membranes in Complex Genitourinary Reconstruction

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ClinicalTrials.gov Identifier: NCT03685955
Recruitment Status : Not yet recruiting
First Posted : September 26, 2018
Last Update Posted : April 25, 2019
Sponsor:
Information provided by (Responsible Party):
Johns Hopkins University

Brief Summary:
Urinary fistulas are unfortunately one of the most common post operative complications in hypospadias repairs and bladder neck transections on pediatric and adult populations, an estimated 20%, resulting in multiple repeat operations with prolonged hospitalization. The negative sequelae of these fistulas have significant financial and psychosocial impact and the aim of this study is to evaluate if the fresh frozen preserved amniotic membrane tissue studied, which have live cells and intact naturally occurring growth hormones and peptides that augment healing that have been shown in early studies to be effective facilitating previous failed fistula repairs and leg ulcer healing, respectively, will help reduce the incidence of urinary fistulas in subject populations.

Condition or disease Intervention/treatment
Hypospadias Hypospadias and Epispadias and Other Penile Anomalies Fistula Fistula, Urinary Bladder Exstrophy and Epispadias Complex Bladder and Bladder Neck Disorders (Excluding Calculi) Biological: Amniotic membranes

Detailed Description:

Urinary fistulas in the pediatric and adult populations present significant surgical and economical challenges. These include urethrocutaneous and vesicocutaneous fistulas, which are unfortunately common in the investigators' patients with hypospadias and bladder exstrophy, respectively. Urethrocutaneous fistula is the most common complication following surgical repair of hypospadias with an incidence of 4-25%. This high complication rate is especially problematic as these fistulas once formed often recur requiring multiple surgical repairs resulting in potentially harmful physical and psychologic consequences on young patients. Vesicocutaneous fistulas develop in bladder exstrophy patients at a estimated rate of 20% following surgery aimed at making these patients continent by transecting the bladder neck and creating a catheterizable channel. Small, simple fistulas can be repaired primarily, however larger, multiple or recurrent fistulas must be closed in layers. Layered closures have been found to have higher success rates have been demonstrated with using additional tissue layers refistulization rate including local and distant tissue grafts, which add time and morbidity to surgical repairs.

Amniotic membranes have been shown to increase healing in chronic wounds such as a chronic venous stasis and diabetic ulcers and have been used in fistula repairs. Grafix and Stravix are frozen preserved placental membranes and Wharton's Jelly, respectively, that have high quantities of viable mesenchymal stem cells (MSCs), which add in tissue healing. The investigators believe these membranes can be used as a structural layer in fistula repairs, hypospadias repairs, and bladder neck closures to treat existing fistulas and prevent fistula formation in the primary repair setting.

  1. This is a prospective study examining patients with hypospadias will be considered for repair with the use of amniotic membranes. The repair of fistula with graft tissue is standard of care.
  2. Eligible patients will be identified in a clinic visit with one of the co-investigators.

    a. The patient will be consented and undergo a repair using amniotic membranes within the fistula site or primary repair at the discretion of the operating surgeon. Using different repair techniques is standard of care, however, the use of frozen preserved placental membranes is the study material. The size of the product will be determined by the surgical need at the time of repair.

  3. The patient will be discharged be provided with routine postoperative care and seen in approximately 2 weeks per standard of are.
  4. If the participant fails repair of participant's fistula, participant will not be offered a repeat repair with the amniotic membranes. Other forms of surgery may be offered, however.

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Study Type : Observational [Patient Registry]
Estimated Enrollment : 100 participants
Observational Model: Cohort
Time Perspective: Prospective
Target Follow-Up Duration: 2 Years
Official Title: The Effect of Amniotic Membranes on Complex Genitourinary Reconstruction Outcomes in Pediatric and Adult Populations
Estimated Study Start Date : June 2019
Estimated Primary Completion Date : December 1, 2020
Estimated Study Completion Date : December 1, 2020

Resource links provided by the National Library of Medicine


Group/Cohort Intervention/treatment
Genitourinary Reconstruction with Amniotic Membranes
Patients who undergo genitourinary reconstruction with amniotic membranes
Biological: Amniotic membranes
Amniotic membranes will be employed during participant's genitourinary reconstruction




Primary Outcome Measures :
  1. Failure rate of complex genitourinary reconstruction after incorporation of placental membranes into repair. [ Time Frame: 2 years ]
    We will evaluate patients with complex genitourinary wounds who have undergone surgical repair using preserved placental membranes, Grafix or Stravix. They will be evaluated in the standard post operative fashion to evaluate for failure of surgical repair of complex genitourinary reconstruction which will be defined by stricture recurrence, wound dehiscence, or recurrence of fistula.



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Ages Eligible for Study:   6 Months to 99 Years   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Pediatric and adult populations with complex genitourinary reconstructive needs including pediatric hypospadias repair, bladder exstrophy, neurogenic bladder, urinary fistulas, urethral stricture disease
Criteria

Inclusion Criteria:

  • 6mo - 99 years old
  • Undergoing surgical procedure with risk of or known urinary fistula

Exclusion Criteria:

  • Failed prior repair with amniotic membranes
  • Sensitivity to cryopreservation fluids or disinfecting solutions.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03685955


Contacts
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Contact: Heather DiCarlo, MD ‭(410) 955-2914‬ hdicarl1@jhmi.edu
Contact: Edward Wright, MD 410-550-7739 jwright1@jhmi.edu

Sponsors and Collaborators
Johns Hopkins University
Investigators
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Principal Investigator: Heather DiCarlo, MD The Johns Hopkins School of Medicine

Additional Information:

Publications of Results:
Other Publications:

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Responsible Party: Johns Hopkins University
ClinicalTrials.gov Identifier: NCT03685955     History of Changes
Other Study ID Numbers: IRB00168089
First Posted: September 26, 2018    Key Record Dates
Last Update Posted: April 25, 2019
Last Verified: April 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No

Additional relevant MeSH terms:
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Penile Diseases
Fistula
Calculi
Hypospadias
Bladder Exstrophy
Epispadias
Urinary Fistula
Pathological Conditions, Anatomical
Genital Diseases, Male
Urogenital Abnormalities
Congenital Abnormalities
Urinary Bladder Diseases
Urologic Diseases
Urethral Diseases