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
|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|
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.
- 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.
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.
- The patient will be discharged be provided with routine postoperative care and seen in approximately 2 weeks per standard of are.
- 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.
|Study Type :||Observational [Patient Registry]|
|Estimated Enrollment :||100 participants|
|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|
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
- 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.
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
|Contact: Heather DiCarlo, MD||(410) firstname.lastname@example.org|
|Contact: Edward Wright, MDemail@example.com|
|Principal Investigator:||Heather DiCarlo, MD||The Johns Hopkins School of Medicine|