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The Ideal Time Interval Between Repeated Shock Wave Lithotripsy Sessions For Renal Stones: A Randomized Controlled Trial

Primary Purpose

Ideal Time Interval

Status
Unknown status
Phase
Not Applicable
Locations
Egypt
Study Type
Interventional
Intervention
Shock Wave Lithotripsy for renal stone.
Sponsored by
Mansoura University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Ideal Time Interval

Eligibility Criteria

16 Years - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion criteria Adult patient with ≤ 2 cm single calyceal renal stone in a normal functioning kidney.

Exclusion criteria:

  1. Contraindications to ESWL:

    • Uncontrolled Hypertension
    • Renal insufficiency
    • Diabetic patient
    • Coagulopathy
    • Morbid obesity
    • Upper urinary tract obstruction
    • Active urinary tract infection
  2. Previous surgical or SWL treatment of renal stones.
  3. Congenital renal anomalies and solitary kidney
  4. Pediatric patients (age <18 years).

Sites / Locations

  • Urology and Nephrology Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Active Comparator

Active Comparator

Arm Label

Group 1

Group 2

Group 3

Arm Description

Group 1 will undergo SWL with 3 days between each session.

Group 2 will undergo SWL with 7 days between each session

Group 3 will undergo SWL with 14 days between each session.

Outcomes

Primary Outcome Measures

to identify the ideal time interval between SWL sessions used for treatment of renal stones and subsequent renal damage.
Renal damage: Tubular damage: Tubular damage will be assessed through estimation of changes in urinary execration of the renal tubular enzyme, Kidney injury molecule -1 (KIM-1). Glomerular damage: Glomerular damage will be assessed by the presence of proteinuria and changes of GFR calculated by renal isotope scan. Renal morphological and hemodynamic changes: Changes will be assessed by estimation of ERPF by renal isotope scan. The presence of peri-renal or subcapsular hematomas on non-contrast spiral CT. Assessment of renal tissue oxygenation using functional MRI.

Secondary Outcome Measures

3 months stone free rate
Treatment success is defined as clinically insignificant residual fragments of < 4 mm

Full Information

First Posted
September 25, 2020
Last Updated
October 2, 2020
Sponsor
Mansoura University
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1. Study Identification

Unique Protocol Identification Number
NCT04575480
Brief Title
The Ideal Time Interval Between Repeated Shock Wave Lithotripsy Sessions For Renal Stones: A Randomized Controlled Trial
Official Title
The Ideal Time Interval Between Repeated Shock Wave Lithotripsy Sessions For Renal Stones: A Randomized Controlled Trial
Study Type
Interventional

2. Study Status

Record Verification Date
October 2020
Overall Recruitment Status
Unknown status
Study Start Date
July 15, 2020 (Actual)
Primary Completion Date
July 15, 2022 (Anticipated)
Study Completion Date
January 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Mansoura University

4. Oversight

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

5. Study Description

Brief Summary
There is no consensus about the required time intervals between repeated SWL sessions applied for renal stones with some centers waiting for 3 days, others for one week and others up to one month to repeat lithotripsy. In the 2019 EUA guidelines stated that "There are no conclusive data on the intervals required between repeated SWL sessions. However, clinical experience indicates that repeat sessions are feasible (within 1 day for ureteral stones). The intense use of ESWL currently, the lack of knowledge about acute lesions caused by re-treatment within a short time interval and the empirical way by which treatment is conducted, stimulated us to search for a precise answers to the question What the ideal time interval between SWL sessions in the treatment of renal stone patients should be. This randomized controlled trial will be conducted at Urology and Nephrology Center in Mansoura, Egypt. Patients more than 18 years old with single primary renal stone fulfilling inclusion criteria will be randomly allocated to 3 groups (50 patients each).Group 1 will undergo SWL with 3 days between each session. Group 2 will undergo SWL with 7 days between each session and Group 3 will undergo SWL with 14 days between each session. Study parameters will be renal damage including the following items: Tubular damage will be assessed through estimation of changes in urinary excretion of renal tubular enzyme kidney injury molecule 1(KIM-1). Glomerular damage will be assessed by estimation of proteinuria and changes in GFR calculated by renal isotope scan. Renal morphological and haemodynamic changes. Treatment success is defined as clinically insignificant residual fragments less than 4 mm size.
Detailed Description
STUDY DESIGN: Randomized Trial STUDY SETTING/LOCATION: The study will be conducted in a single tertiary center, Urology and Nephrology Centre in Mansoura, Egypt. STUDY POPULATION: Adults (>18years) with primary single renal stone amenable for SWL according to EUA guidelines (C. TÜRK, 2019) . Inclusion criteria Adult patient with ≤ 2 cm single calyceal renal stone in a normal functioning kidney. Exclusion criteria: Contraindications to ESWL: Uncontrolled Hypertension Renal insufficiency Diabetic patient Coagulopathy Morbid obesity Upper urinary tract obstruction Active urinary tract infection Previous surgical or SWL treatment of renal stones. Congenital renal anomalies and solitary kidney Pediatric patients (age <18 years). STUDY GROUPS Patient fulfilling the study criteria will be randomly allocated to one of three groups (50 Patient in each): Group 1 will undergo SWL with 3 days between each session. Group 2 will undergo SWL with 7 days between each session and Group 3 will undergo SWL with 14 days between each session. Each patient will serve as internal control through comparing both pre-ESWL and post-ESWL values of our study parameters. / Candidates Potential participants will be invited to participate in this study after signing an informed consent. Potential participants will be given enough information, in a way they will understand, about the potential risks and benefits of being involved in this clinical study. Baseline evaluation (Before ESWL) (S0): Complete history and physical examination. Laboratory Investigations Blood Samples: Blood sample will be withdrawn Pre-ESWL (B.S0) for: CBC Serum creatinine Prothrombin concentration Urine Samples: Samples of urine will be obtained before ESWL session(U.S0) for Urine analysis &estimation of KIM-1 Urine culture will be obtained in cases of pyuria Radiological investigation: NCCT will be performed. Stone criteria will be identified as regard to volumes, site, location, stone density and associated hydronephrosis. I.V.P (intravenous pyelography) will be performed if needed to exclude the presence of narrow neck calyx or stones in closed calyces. Dynamic renal scintigraphic scanning using technetium-99m Diethylene Triamine Pentaacetic Acid (TC-99m DTPA). The renal uptake, percentage of uptake from the injected dose, split function, ERPF, corrected glomerular filtration rate (GFR), time to peak clearance (T max), and half-time clearance will be calculated, because these parameters are helpful indicators in the evaluation of renal function. Functional MRI assessment to evaluate the renal tissue oxygenation using Blood-Oxygen Level Dependent (BOLD) and possible anatomical changes Randomization Randomization will be performed using computer generated, sequentially numbered method. Procedure technique: The following protocol will be applied for all patients in study groups. SWL will be performed using the Dornier Gemini lithotripter (Dornier MedTech, Wessling, Germany) . A total of 3 000 shocks will be delivered at 80 shocks/min. The patient will receive 1 mg/kg pethidine i.v. for analgesia. Treatment will begin at machine power step 1, which will deliver 49 MPa focal pressure and 0.35 mJ/mm2. Power will be gradually increased by one step for each 200 shocks up to step 4, which deliver 70 MPa and 0.7 mJ/mm2. The maximum session number will be 3 session. Patient treated with <2 sessions will be excluded from the analysis. After 1st ESWL session: Urine sample will be obtained 2to 4 hours after the end of the first session (U.S1) for estimation of urinary proteinuria and estimation of KIM-1 Visual analogue scale will be compared between the study groups Non contrast spiral CT (low dose) will be performed before 2nd session to detect residual fragments, presence of obstruction and the need for re-treatment. Functional MRI assessment to evaluate the renal tissue oxygenation. After 2nd ESWL session: Urine sample will be obtained after 2 to 4 hours after the second session (U.S2) for proteinuria and estimation of KIM-1. Visual analogue scale. Non contrast spiral CT (low dose will be performed before 3rd session to detect residual fragments, presence of obstruction and the need for re-treatment. Functional MRI assessment to evaluate the renal tissue oxygenation. After 3 months of the treatment : Samples of urine will be obtained after 3 month from the start of treatment U.S3 for Urine analysis & estimation of urinary proteinuria and estimation of KIM-1 Blood sample will be withdrawn (B.S3) for: CBC Serum creatinine and calculation of eGFR values NCCT will be done after 3 months of the last session of ESWL for detection of the stone free rate. Dynamic renal scintigraphic scanning using TC-99m DTPA as described before. Functional MRI assessment to evaluate the renal tissue oxygenation Statistical analysis Analysis of data will be performed with Statistical Package for Social Science (SPSS) software. Continuous data will be presented as mean ± SD when normally distributed and as medium and range when non-normally distributed. Categorical data will be presented as frequency and percentage. Comparison between mean ± SD between the three groups will be carried out by ANOVA test. Comparison between the median and range between the 3 groups will be performed by Kruskal -Wallis test. Comparison between categorical variables between groups will be performed using Chi-square or Fisher Exact test as appropriate. Regression analysis to estimate the best model which can predict the related kidney injury. In all comparison, a P.value < 0.05 will be considered significant.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ideal Time Interval

7. Study Design

Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Randomized trial, conducted in Urology and Nephrology Centre in Mansoura, Egypt. Including adults >18 years with primary single renal stone amenable for SWL according to EUA guidelines (≤ 2 cm single calyceal renal stone in a normal functioning kidney) . Exclusion criteria include contraindications to ESWL (uncontrolled Hypertension , coagulopathy etc), previous intervention for renal stones , congenital renal anomalies and solitary kidney. Patients will be randomized to one of three groups (50 Patient in each): Group 1 will undergo SWL with 3 days between each session , Group 2 will undergo SWL with 7 days between each session and Group 3 will undergo SWL with 14 days between each session. pre-ESWL and post-ESWL values will be compared.Participants will be invited after signing an informed consent including the potential risks and benefits of each intervention in this clinical study.
Masking
Participant
Allocation
Randomized
Enrollment
150 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Group 1
Arm Type
Active Comparator
Arm Description
Group 1 will undergo SWL with 3 days between each session.
Arm Title
Group 2
Arm Type
Active Comparator
Arm Description
Group 2 will undergo SWL with 7 days between each session
Arm Title
Group 3
Arm Type
Active Comparator
Arm Description
Group 3 will undergo SWL with 14 days between each session.
Intervention Type
Procedure
Intervention Name(s)
Shock Wave Lithotripsy for renal stone.
Intervention Description
The following protocol will be applied for all patients in study groups. SWL will be performed using the Dornier Gemini lithotripter (Dornier MedTech, Wessling, Germany) . A total of 3 000 shocks will be delivered at 80 shocks/min. The patient will receive 1 mg/kg pethidine i.v. for analgesia. Treatment will begin at machine power step 1, which will deliver 49 MPa focal pressure and 0.35 mJ/mm2. Power will be gradually increased by one step for each 200 shocks up to step 4, which deliver 70 MPa and 0.7 mJ/mm2. The maximum session number will be 3 session. Patient treated with <2 sessions will be excluded from the analysis
Primary Outcome Measure Information:
Title
to identify the ideal time interval between SWL sessions used for treatment of renal stones and subsequent renal damage.
Description
Renal damage: Tubular damage: Tubular damage will be assessed through estimation of changes in urinary execration of the renal tubular enzyme, Kidney injury molecule -1 (KIM-1). Glomerular damage: Glomerular damage will be assessed by the presence of proteinuria and changes of GFR calculated by renal isotope scan. Renal morphological and hemodynamic changes: Changes will be assessed by estimation of ERPF by renal isotope scan. The presence of peri-renal or subcapsular hematomas on non-contrast spiral CT. Assessment of renal tissue oxygenation using functional MRI.
Time Frame
3 months
Secondary Outcome Measure Information:
Title
3 months stone free rate
Description
Treatment success is defined as clinically insignificant residual fragments of < 4 mm
Time Frame
3 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
16 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria Adult patient with ≤ 2 cm single calyceal renal stone in a normal functioning kidney. Exclusion criteria: Contraindications to ESWL: Uncontrolled Hypertension Renal insufficiency Diabetic patient Coagulopathy Morbid obesity Upper urinary tract obstruction Active urinary tract infection Previous surgical or SWL treatment of renal stones. Congenital renal anomalies and solitary kidney Pediatric patients (age <18 years).
Facility Information:
Facility Name
Urology and Nephrology Center
City
Mansoura
State/Province
Dakahlia
ZIP/Postal Code
35514
Country
Egypt

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
in partial fulfillment of MD Degree in urology
IPD Sharing Time Frame
2 years

Learn more about this trial

The Ideal Time Interval Between Repeated Shock Wave Lithotripsy Sessions For Renal Stones: A Randomized Controlled Trial

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