Clinical Evaluation of Ajust™ in Stress Urinary Incontinence (CEASe)
Primary Purpose
Female Stress Urinary Incontinence
Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Ajust Adjustable Single-Incision Sling
Sponsored by
About this trial
This is an interventional treatment trial for Female Stress Urinary Incontinence
Eligibility Criteria
Inclusion Criteria:
- Female, age at least 18 years
- Have signed an Informed Consent Form
- Has been diagnosed with stress urinary incontinence as documented by: a minimum 30-degree urethral deflection, considered to be a candidate for transobturator repair by consulting surgeon (investigator), has a positive CST
- Desires surgical correction of SUI using the Ajust™ Adjustable Single-Incision Sling
Exclusion Criteria:
- Patient is actively participating in any other genitourinary clinical trial of an experimental drug or device
- Patient is known to be pregnant or desiring future childbearing
- Patient has a known urinary tract infection, or known infection in the operative field at the time of device implantation
- Patient is unable to have their anticoagulation therapy suspended for the completion of the surgical procedure
- Patient requires concurrent correction of pelvic organ prolapse
- Patient has a history of previous sling procedure
- Patient has known history of detrusor overactivity demonstrated by urodynamics
- Patient has known urinary retention
- Patient has a current genitourinary fistula or urinary diverticulum
- Patient has a prior history of pelvic radiation
- Patient has a MESA urge symptom score (% of total possible urge score) that is greater than their MESA stress symptom score (% of total possible stress score)
- Any condition in the opinion of the Investigator that would preclude the use of the Ajust™ Adjustable Single-Incision Sling, or preclude the subject from completing the follow-up requirements
Sites / Locations
- Clark Center for Urogynecology
- Female Pelvic & Urogynecology Institute of Michigan, Grand Rapids Womens Health
- Princeton Urogynecology
- Institute for Female Pelvic Medicine and Reconstructive Surgery
- Manjon Gynecology
- Southern Uroynecology
Arms of the Study
Arm 1
Arm Type
Other
Arm Label
Ajust Adjustable Single-Incision Sling
Arm Description
Urinary incontinence sling
Outcomes
Primary Outcome Measures
Percentage of Patients Free of Stress Urinary Incontinence
Percentage of patients who are free of stress urinary incontinence, as assessed by a negative (-) Cough Stress Test (CST) and no surgical retreatment, at the 12 month study visit.
Percentage of Subjects Who Showed Improvement in Self-reported SUI Symptoms at 12 Months
Improvement was defined as a 25-point decrease (improvement) in Urinary Distress Inventory (UDI-6) score (Range: 0 - 100).
Secondary Outcome Measures
Operative, Perioperative and Long-Term Complications During Operative Procedure
Percentage of Patients with Procedure and/or Device Related Adverse Events During the Operative Procedure
Operative, Perioperative and Long-Term Complications Perioperatively
Percentage of Patients with Procedure and/or Device Related Adverse Events Perioperatively
Operative, Perioperative and Long-term Complications Through 36 Months
Percentage of Patients with Procedure and/or Device Related Adverse Events through 36 months
Change in Post-operative Pain
Mean change in Overall McCarthy Surgical Pain Scale from Day 0 to Day 7. McCarthy Pain Scale is a 50 millimeter line with "No Pain Sensation" noted at the 0 mm mark and "Most Intense Pain Imaginable" noted at the 50 mm mark. Each day, subjects are asked to mark their level of pain somewhere along the line. Change in pain level is reported in millimeters.
Percentage of Subjects Who Showed Improvement in Self-reported SUI Symptoms at 36 Months
Improvement was defined as a 25-point decrease (improvement) in Urinary Distress Inventory (UDI-6) score (Range: 0 - 100).
Change in Incontinent Impact Questionnaire at 12 Months
Mean change in overall IIQ-7 summary score (range 0 - 100). Scores on the IIQ-7 range from 0 (best outcome) to 100 (worst outcome). For this outcome measure, IIQ-7 at baseline was compared to that administered at 12-months post-surgery.
Change in Incontinent Impact Questionnaire at 36 Months
Mean change in overall IIQ-7 summary score (range 0 - 100). Scores on the IIQ-7 range from 0 (best outcome) to 100 (worst outcome). For this outcome measure, IIQ-7 at baseline was compared to that administered at 36-months post-surgery.
Percentage of Patients With Impression of Improvement With Procedure at 12 Months
Patient satisfaction was assessed using the Patient Global Impression of Improvement (PGII) questionnaire. Patients were considered to be "satisfied" if they felt that their urinary tract condition was "very much better" or "much better" than how it felt before the surgery.
Percentage of Patients With Impression of Improvement With Procedure at 36 Months
Patient satisfaction was assessed using the Patient Global Impression of Improvement (PGII) questionnaire. Patients were considered to be "satisfied" if they felt that their urinary tract conditio0n was "very much better" or "much better" than how it felt before the surgery.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT01290796
Brief Title
Clinical Evaluation of Ajust™ in Stress Urinary Incontinence
Acronym
CEASe
Official Title
Clinical Evaluation of Ajust™ in Stress Urinary Incontinence (CEASe)
Study Type
Interventional
2. Study Status
Record Verification Date
February 2017
Overall Recruitment Status
Completed
Study Start Date
January 2011 (undefined)
Primary Completion Date
June 2013 (Actual)
Study Completion Date
October 2015 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
C. R. Bard
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
The purpose of this study is to assess the overall effectiveness of the Ajust Adjustable Single-Incision Sling in the surgical treatment of female stress urinary incontinence.
Detailed Description
Urinary incontinence (UI), or the complaint of any involuntary loss of urine, ranges in severity from the occasional leaking urine during actions resulting in increased abdominal pressure (coughing, sneezing, laughing, exercise, etc.) to sudden, unpredictable strong urges to void. Female stress urinary incontinence (SUI) is attributed to a weakening of the pelvic floor muscles.
A recent review of literature describing the prevalence of UI calculated the median prevalence of female UI to be 27.6% (4.8-58.4%), with the prevalence of significant incontinence increasing with age. The prevalent cause of UI was further categorized into stress (50%), mixed (32%) and urge (14%).
Nonsurgical treatment of female SUI has traditionally been limited to alpha-adrenergic agonists and estrogens, pelvic floor exercises, biofeedback, electrical stimulation and behavior modification1. Options for surgical treatment consists of periurethral injections of bulking agents, transvaginal suspensions, retropubic suspensions, slings and sphincter prostheses.
The Ajust™ Adjustable Single-Incision Sling is a fully adjustable single-incision sling that anchors in the transobturator membranes, anatomically sufficient spaces for support of the urethra.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Female Stress Urinary Incontinence
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
153 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Ajust Adjustable Single-Incision Sling
Arm Type
Other
Arm Description
Urinary incontinence sling
Intervention Type
Device
Intervention Name(s)
Ajust Adjustable Single-Incision Sling
Intervention Description
The Ajust™ Adjustable Single-Incision Sling is a minimally invasive suburethral sling indicated for the treatment of female SUI resulting from urethral hypermobility and/or intrinsic sphincter deficiency (ISD). The system consists of a unique adjustable polypropylene mesh sling with permanent, self-fixating, polypropylene anchors, an introducer, and a flexible stylet for securing the mesh sling after adjustment.
Primary Outcome Measure Information:
Title
Percentage of Patients Free of Stress Urinary Incontinence
Description
Percentage of patients who are free of stress urinary incontinence, as assessed by a negative (-) Cough Stress Test (CST) and no surgical retreatment, at the 12 month study visit.
Time Frame
12-months post surgical procedure
Title
Percentage of Subjects Who Showed Improvement in Self-reported SUI Symptoms at 12 Months
Description
Improvement was defined as a 25-point decrease (improvement) in Urinary Distress Inventory (UDI-6) score (Range: 0 - 100).
Time Frame
12-months post procedure
Secondary Outcome Measure Information:
Title
Operative, Perioperative and Long-Term Complications During Operative Procedure
Description
Percentage of Patients with Procedure and/or Device Related Adverse Events During the Operative Procedure
Time Frame
1 day
Title
Operative, Perioperative and Long-Term Complications Perioperatively
Description
Percentage of Patients with Procedure and/or Device Related Adverse Events Perioperatively
Time Frame
1-15 days
Title
Operative, Perioperative and Long-term Complications Through 36 Months
Description
Percentage of Patients with Procedure and/or Device Related Adverse Events through 36 months
Time Frame
Day 15 through 36-months post procedure
Title
Change in Post-operative Pain
Description
Mean change in Overall McCarthy Surgical Pain Scale from Day 0 to Day 7. McCarthy Pain Scale is a 50 millimeter line with "No Pain Sensation" noted at the 0 mm mark and "Most Intense Pain Imaginable" noted at the 50 mm mark. Each day, subjects are asked to mark their level of pain somewhere along the line. Change in pain level is reported in millimeters.
Time Frame
0-7 days
Title
Percentage of Subjects Who Showed Improvement in Self-reported SUI Symptoms at 36 Months
Description
Improvement was defined as a 25-point decrease (improvement) in Urinary Distress Inventory (UDI-6) score (Range: 0 - 100).
Time Frame
0-36 Months
Title
Change in Incontinent Impact Questionnaire at 12 Months
Description
Mean change in overall IIQ-7 summary score (range 0 - 100). Scores on the IIQ-7 range from 0 (best outcome) to 100 (worst outcome). For this outcome measure, IIQ-7 at baseline was compared to that administered at 12-months post-surgery.
Time Frame
0-12 months
Title
Change in Incontinent Impact Questionnaire at 36 Months
Description
Mean change in overall IIQ-7 summary score (range 0 - 100). Scores on the IIQ-7 range from 0 (best outcome) to 100 (worst outcome). For this outcome measure, IIQ-7 at baseline was compared to that administered at 36-months post-surgery.
Time Frame
0-36 months
Title
Percentage of Patients With Impression of Improvement With Procedure at 12 Months
Description
Patient satisfaction was assessed using the Patient Global Impression of Improvement (PGII) questionnaire. Patients were considered to be "satisfied" if they felt that their urinary tract condition was "very much better" or "much better" than how it felt before the surgery.
Time Frame
0-12 Months
Title
Percentage of Patients With Impression of Improvement With Procedure at 36 Months
Description
Patient satisfaction was assessed using the Patient Global Impression of Improvement (PGII) questionnaire. Patients were considered to be "satisfied" if they felt that their urinary tract conditio0n was "very much better" or "much better" than how it felt before the surgery.
Time Frame
0-36 Months
10. Eligibility
Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Female, age at least 18 years
Have signed an Informed Consent Form
Has been diagnosed with stress urinary incontinence as documented by: a minimum 30-degree urethral deflection, considered to be a candidate for transobturator repair by consulting surgeon (investigator), has a positive CST
Desires surgical correction of SUI using the Ajust™ Adjustable Single-Incision Sling
Exclusion Criteria:
Patient is actively participating in any other genitourinary clinical trial of an experimental drug or device
Patient is known to be pregnant or desiring future childbearing
Patient has a known urinary tract infection, or known infection in the operative field at the time of device implantation
Patient is unable to have their anticoagulation therapy suspended for the completion of the surgical procedure
Patient requires concurrent correction of pelvic organ prolapse
Patient has a history of previous sling procedure
Patient has known history of detrusor overactivity demonstrated by urodynamics
Patient has known urinary retention
Patient has a current genitourinary fistula or urinary diverticulum
Patient has a prior history of pelvic radiation
Patient has a MESA urge symptom score (% of total possible urge score) that is greater than their MESA stress symptom score (% of total possible stress score)
Any condition in the opinion of the Investigator that would preclude the use of the Ajust™ Adjustable Single-Incision Sling, or preclude the subject from completing the follow-up requirements
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Vincent Lucente, MD
Organizational Affiliation
Institute for Female Pelvic Medicine and Reconstructive Surgery
Official's Role
Principal Investigator
Facility Information:
Facility Name
Clark Center for Urogynecology
City
Newport Beach
State/Province
California
ZIP/Postal Code
92663
Country
United States
Facility Name
Female Pelvic & Urogynecology Institute of Michigan, Grand Rapids Womens Health
City
Grand Rapids
State/Province
Michigan
ZIP/Postal Code
49503
Country
United States
Facility Name
Princeton Urogynecology
City
Princeton
State/Province
New Jersey
ZIP/Postal Code
08540
Country
United States
Facility Name
Institute for Female Pelvic Medicine and Reconstructive Surgery
City
Allentown
State/Province
Pennsylvania
ZIP/Postal Code
18105
Country
United States
Facility Name
Manjon Gynecology
City
Harrisburg
State/Province
Pennsylvania
ZIP/Postal Code
17110
Country
United States
Facility Name
Southern Uroynecology
City
West Columbia
State/Province
South Carolina
ZIP/Postal Code
29169
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
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Clinical Evaluation of Ajust™ in Stress Urinary Incontinence
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