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Comparison Between Two Shock Wave Regimens for Treating Urinary Stones

Primary Purpose

Urinary (Renal or Ureteral) Stones

Status
Completed
Phase
Not Applicable
Locations
Brazil
Study Type
Interventional
Intervention
extracorporeal shockwave lithotripsy (SWL)
Sponsored by
University of Sao Paulo General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Urinary (Renal or Ureteral) Stones focused on measuring kidney calculi, urolithiasis, urologic surgical procedures, extracorporeal shockwave lithotripsy

Eligibility Criteria

6 Years - 80 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • patients with renal or ureteral stones from 5 to 20 mm

Exclusion Criteria:

  • pregnancy
  • coagulation disturbs and antiplatelet treatment
  • urinary tract infection
  • aortic aneurism bigger than 2 cm
  • clinical contraindication to general anesthesia
  • refusal in participating of the protocol

Sites / Locations

  • University of Sao Paulo General Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

swl 3000 impulses- 60 imp/min

swl- 4000 impulses - 90 impulses /min

Arm Description

patients in this group were submitted to extracorporeal shockwave lithotripsy (SWL) 3000 impulses at 60 impulses per minute under general anesthesia. Unique session

patients in this group were submitted extracorporeal shockwave lithotripsy (swl) to 4000 impulses at 90 impulses per minute under general anesthesia- unique session

Outcomes

Primary Outcome Measures

abdominal ultrasound and abdominal x rays (KUB)
patients submitted to SWL in two different regimens were submited to renal ultrasound and abdominal x rays (KUB) three months after procedure to check the occourrence of stone-free status, residual fragments or unmodified stone.

Secondary Outcome Measures

adverse effects of the two different regimens
patients submitted to two different SWL regimens were followed clinically and submited to renal ultrasound and abdominal x ray to check the occurrence of adverse effects like hematoma or peri renal collections.

Full Information

First Posted
October 5, 2010
Last Updated
October 14, 2010
Sponsor
University of Sao Paulo General Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT01222325
Brief Title
Comparison Between Two Shock Wave Regimens for Treating Urinary Stones
Official Title
Comparison Between Two Shock Wave Regimens Using Frequencies of 60 and 90 Impulses Per Minute for Urinary Stones
Study Type
Interventional

2. Study Status

Record Verification Date
August 2009
Overall Recruitment Status
Completed
Study Start Date
June 2008 (undefined)
Primary Completion Date
November 2008 (Actual)
Study Completion Date
August 2009 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
University of Sao Paulo General Hospital

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
In order to check if a reduction in the frequency and total number of shocks delivered during extracorporeal shockwave lithotripsy (SWL) results in a great number of stone-free patients,the investigators compared two different ways of treating urinary stones using SWL.
Detailed Description
Purpose: Two different regimens of SWL delivery for treating urinary stones were compared. Methods: After informed consent, patients with previously untreated renal and ureteric stones were admitted for an initial treatment by SWL between June 2008 and May 2009. Patients were randomly divided into two groups; one group received 3000 impulses at a rate of 60 impulses per minute, and the other received 4000 impulses at a rate of 90 impulses per minute. Patients submitted to re-treatment of the same stone were excluded. All treatments were done using the Dornier Compact Delta lithotripter. Stones were located by x-ray or ultrasound. Prior to treatment, patients were submitted to laboratory tests and a cardiologic evaluation when indicated. Urinary infections were treated prior to the SWL session. All procedures were performed under general anesthesia. Briefly, Tramadol 1-2 mg/kg associated to Propofol 2.5-3.0 mg/kg and scopolamine were employed in the majority of the procedures. Patients received 50-100 mg of diluted Tramadol and 20 mg of scopolamine just before the beginning of the SWL session and Propofol was maintained on continuous bomb infusion during the treatment and interrupted three minutes before the end of the session. All patients were maintained under spontaneous breathing, and a facial or a laryngeal oxygen mask was used according to the anesthesiologist's judgment. The potency of the lithotripter was increased progressively by 300 shocks until reaching the final stage, which occurred at a mean of 1500 shocks. The maximum potency employed was level 4 (equivalent to 14 kV) for renal stones and level 6 (16 kV) for ureteric stones. All patients were treated on an outpatient basis and were discharged from the hospital six hours after treatment. All patients received non-steroidal anti-inflammatory drugs (NSAIDs) and Dipyrone in combination with to Hyoscine for three days postoperatively unless contraindicated and were instructed to come to the emergency department in case of severe pain, fever or hematuria. The final results for each patient were assessed with a kidney and urinary bladder scan (KUB) plus an abdominal ultrasound three months after the procedure. Success was defined as stone-free status or the detection of residual fragments ≤ 3 mm on final evaluation. Partial fragmentation was considered to have occurred if a significant reduction in the stone burden was observed but residual fragments bigger than 3 mm remained. We evaluated overall stone-free rates, the incidence of unchanged stones and the occurrence of partial fragmentation as well as the occurrence of significant complications in both groups. The sample size required was based on the assumption that the estimated success rate would be 70% in the 3000 impulses at 60 impulses per minute group and 50% in the 4000 impulses at 90 impulses per minute group, with a type I error of 0.05 and a type II error of 0.05 (power of 80%). This yielded a projected sample size of 93 stones in each group. Data were analyzed using the Fischer's exact, Chi-square and Mann-Whitney tests; a level of significance of 5% was adopted.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Urinary (Renal or Ureteral) Stones
Keywords
kidney calculi, urolithiasis, urologic surgical procedures, extracorporeal shockwave lithotripsy

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
302 (Actual)

8. Arms, Groups, and Interventions

Arm Title
swl 3000 impulses- 60 imp/min
Arm Type
Active Comparator
Arm Description
patients in this group were submitted to extracorporeal shockwave lithotripsy (SWL) 3000 impulses at 60 impulses per minute under general anesthesia. Unique session
Arm Title
swl- 4000 impulses - 90 impulses /min
Arm Type
Active Comparator
Arm Description
patients in this group were submitted extracorporeal shockwave lithotripsy (swl) to 4000 impulses at 90 impulses per minute under general anesthesia- unique session
Intervention Type
Procedure
Intervention Name(s)
extracorporeal shockwave lithotripsy (SWL)
Other Intervention Name(s)
lithotripsy, shock waves
Intervention Description
patients were submitted to one session SWL at a Dornier Compact Delta lithotripter under general anesthesia under supervision of an anesthesiologist and an urologist.
Primary Outcome Measure Information:
Title
abdominal ultrasound and abdominal x rays (KUB)
Description
patients submitted to SWL in two different regimens were submited to renal ultrasound and abdominal x rays (KUB) three months after procedure to check the occourrence of stone-free status, residual fragments or unmodified stone.
Time Frame
3 months
Secondary Outcome Measure Information:
Title
adverse effects of the two different regimens
Description
patients submitted to two different SWL regimens were followed clinically and submited to renal ultrasound and abdominal x ray to check the occurrence of adverse effects like hematoma or peri renal collections.
Time Frame
3 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: patients with renal or ureteral stones from 5 to 20 mm Exclusion Criteria: pregnancy coagulation disturbs and antiplatelet treatment urinary tract infection aortic aneurism bigger than 2 cm clinical contraindication to general anesthesia refusal in participating of the protocol
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
eduardo mazzucchi, md
Organizational Affiliation
univesrity of sao paulo general hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Sao Paulo General Hospital
City
Sao Paulo
ZIP/Postal Code
05403-000
Country
Brazil

12. IPD Sharing Statement

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Comparison Between Two Shock Wave Regimens for Treating Urinary Stones

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