InterStim® Sacral Nerve Modulation Cycling Study
Primary Purpose
Urinary Urge Incontinence
Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
InterStim® (Device Programming)
Sponsored by
About this trial
This is an interventional treatment trial for Urinary Urge Incontinence focused on measuring Urinary, Urge, Incontinence
Eligibility Criteria
Inclusion Criteria:
- Implanted with either Neurostimulator Model 3023 (InterStim) or Neurostimulator Model 3058 (InterStim II) for at least 3 months
- Implanted with tined lead models 3889 or 3093
- Tined lead is located at S3 as determined by sensory or motor responses or x-ray or fluoroscopy
- Currently showing some efficacy with an InterStim device but has the potential to be optimized per the opinion of the Investigator
- Primary diagnosis before InterStim implant is urinary urge incontinence.
- Must be willing to maintain her current regimen (dosage and frequency) of any overactive bladder (OAB) medication (anticholinergic, antimuscarinic or Myrbetriq (Mirabegron)) or tricyclic antidepression medication over the study duration, if applicable.
- Female subject 18 years of age or older
- Willing and able to accurately complete voiding diaries and questionnaires, attend visits (within the visit windows +7 days), and comply with the study protocol that includes maintenance of InterStim programming settings over the course of the study
- Have had no more than one (InterStim) reprogramming at or within 28 days at or prior to randomization
Able to consent to participate by signing the Informed Consent Form
Exclusion Criteria:
- History of Multiple sclerosis
- History of Reiter's syndrome
- History of spinal cord injury or a cerebral vascular accident (CVA)
- History of diabetes unless the diabetes is well-controlled through diet and/or medications
- Active symptomatic urinary tract infection (UTI)
- Stress incontinence as the primary diagnosis
- Urgency frequency as a primary diagnosis
- Pelvic pain of uncertain etiology that is not associated with a voiding dysfunction or where pelvic pain is the primary diagnosis
- Interstitial cystitis as the primary diagnosis
- Urinary retention as the primary diagnosis
- Treatment of urinary symptoms with botulinum toxin in the past 12 months or any plan to have botulinum toxin treatment during the study
- Bilateral lead placement
- Have other implantable neurostimulator, pacemaker, or defibrillator
- Have knowledge of planned diathermy, microwave exposure, high output ultrasonic exposure, RF energy exposure, or MRI scans not included within the scanning conditions provided within the MRI Guidelines for InterStim Therapy neurostimulation systems.
- Have an anticipated system modification within the next 5 months
- Women who are pregnant or planning to become pregnant (women of child-bearing potential must undergo a pregnancy test, with a clear negative result, no more than 7 days prior to randomization visit)
- Subjects who frequently use the patient programmer to change device program settings ("frequently" is defined as at least once a day and does not include shutting off the device for safety purposes)
- Characteristics indicating a poor understanding of the study or characteristics that indicate the subject may have poor compliance with the study protocol.
- Study site personnel will contact the Medtronic Study Manager (or designee) to determine if a potential subject who plans to enroll in an investigational device or drug trial, or is currently enrolled in an investigational device or drug trial is eligible for this study
Sites / Locations
- Pinellas Urology, Inc.
- University of Iowa Healthcare
- Metro Urology
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm 5
Arm Type
Other
Other
Other
Other
Other
Arm Label
Continuous
Cycling Parameter #1
Cycling Parameter #2
Cycling Parameter #3
No Stimulation
Arm Description
The device parameter will be continuous.
The device parameter will be cyclic program #1.
The device parameter will be cyclic program #2.
The device parameter will be cyclic program #3.
Following the randomized portion of the study, an assessment was conducted to estimate the effect of a month of no stimulation on incontinence.
Outcomes
Primary Outcome Measures
Number of Urinary Urge Incontinent (UUI) Episodes Per Day - Randomized Portion
Urinary urge incontinent episodes were collected through a diary on daily basis for approximately 4 weeks when subjects were under each cycling setting. Only the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.
Secondary Outcome Measures
Degree of Urgency - Randomized Portion
Each UUI episode was rated on following scales: 0=None, 1=Mild, 2=Moderate, 3=Severe, which were collected through a diary on daily basis for approximately 4 weeks when subjects were under each cycling setting. The average degree of urgency per UUI episode was calculated from the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.
Number of Pads Used Per Day - Randomized Portion
Number of pad use were collected through a diary on daily basis for approximately 4 weeks when subjects were under each cycling setting. Only the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.
Global Response Assessment (GRA) - Randomized Portion
Summary statistics of GRA at different cycling settings are provided. The GRA assessed incontinence symptoms as compared to symptoms prior to subject's entry into the study. Subjects were asked how much their incontinence changed since starting the study: markedly worse, moderately worse, mildly worse, same, slightly improved, moderately improved, or markedly improved. The responses to the symptom change were categorized into three levels for the analysis: worse (markedly worse, moderately worse, mildly worse), same (same), better (slightly improved, moderately improved, or markedly improved).
Percentages of subjects reported worse, same or better under each cycling setting since starting the study are presented.
Number of UUI Episodes Per Day - no Stimulation
UUI episodes were collected through a diary on daily basis for approximately 4 weeks when subjects were under no stimulation. Only the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.
Degree of Urgency - no Stimulation
Each UUI episode was rated on following scales: 0=None, 1=Mild, 2=Moderate, 3=Severe, which were collected through a diary on daily basis for approximately 4 weeks when subjects were under no stimulation. The average degree of urgency per UUI episode was calculated from the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.
Number of Pads Used Per Day - no Stimulation
Number of pad use were collected through a diary on daily basis for approximately 4 weeks when subjects were under no stimulation. Only the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.
Global Response Assessment - no Stimulation
Summary of GRA under no stimulation setting is provided. The GRA assessed incontinence symptoms as compared to symptoms prior to subject's entry into the study. Subjects were asked how much their incontinence changed since starting the study: markedly worse, moderately worse, mildly worse, same, slightly improved, moderately improved, or markedly improved. The responses to the symptom change were categorized into three levels for the analysis: worse (markedly worse, moderately worse, mildly worse), same (same), better (slightly improved, moderately improved, or markedly improved).
Adverse Events - no Stimulation
Summary of adverse device effects when subjects were under no stimulation is provided. Percentage of subjects experiencing any type of Adverse Device Effect under no stimulation is presented.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT01957137
Brief Title
InterStim® Sacral Nerve Modulation Cycling Study
Official Title
InterStim® Sacral Nerve Modulation Cycling Study
Study Type
Interventional
2. Study Status
Record Verification Date
November 2017
Overall Recruitment Status
Completed
Study Start Date
September 2013 (undefined)
Primary Completion Date
November 2015 (Actual)
Study Completion Date
November 2015 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
MedtronicNeuro
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
The study will assess the effects of different InterStim cycling settings on urinary urge incontinence.
Detailed Description
This feasibility study will assess the following outcomes:
Voiding diaries
Patient reported assessments of response or satisfaction
Adverse events
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Urinary Urge Incontinence
Keywords
Urinary, Urge, Incontinence
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
Participant
Allocation
Randomized
Enrollment
30 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Continuous
Arm Type
Other
Arm Description
The device parameter will be continuous.
Arm Title
Cycling Parameter #1
Arm Type
Other
Arm Description
The device parameter will be cyclic program #1.
Arm Title
Cycling Parameter #2
Arm Type
Other
Arm Description
The device parameter will be cyclic program #2.
Arm Title
Cycling Parameter #3
Arm Type
Other
Arm Description
The device parameter will be cyclic program #3.
Arm Title
No Stimulation
Arm Type
Other
Arm Description
Following the randomized portion of the study, an assessment was conducted to estimate the effect of a month of no stimulation on incontinence.
Intervention Type
Device
Intervention Name(s)
InterStim® (Device Programming)
Primary Outcome Measure Information:
Title
Number of Urinary Urge Incontinent (UUI) Episodes Per Day - Randomized Portion
Description
Urinary urge incontinent episodes were collected through a diary on daily basis for approximately 4 weeks when subjects were under each cycling setting. Only the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.
Time Frame
4 weeks
Secondary Outcome Measure Information:
Title
Degree of Urgency - Randomized Portion
Description
Each UUI episode was rated on following scales: 0=None, 1=Mild, 2=Moderate, 3=Severe, which were collected through a diary on daily basis for approximately 4 weeks when subjects were under each cycling setting. The average degree of urgency per UUI episode was calculated from the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.
Time Frame
4 week
Title
Number of Pads Used Per Day - Randomized Portion
Description
Number of pad use were collected through a diary on daily basis for approximately 4 weeks when subjects were under each cycling setting. Only the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.
Time Frame
4 weeks
Title
Global Response Assessment (GRA) - Randomized Portion
Description
Summary statistics of GRA at different cycling settings are provided. The GRA assessed incontinence symptoms as compared to symptoms prior to subject's entry into the study. Subjects were asked how much their incontinence changed since starting the study: markedly worse, moderately worse, mildly worse, same, slightly improved, moderately improved, or markedly improved. The responses to the symptom change were categorized into three levels for the analysis: worse (markedly worse, moderately worse, mildly worse), same (same), better (slightly improved, moderately improved, or markedly improved).
Percentages of subjects reported worse, same or better under each cycling setting since starting the study are presented.
Time Frame
4 weeks
Title
Number of UUI Episodes Per Day - no Stimulation
Description
UUI episodes were collected through a diary on daily basis for approximately 4 weeks when subjects were under no stimulation. Only the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.
Time Frame
4 Weeks
Title
Degree of Urgency - no Stimulation
Description
Each UUI episode was rated on following scales: 0=None, 1=Mild, 2=Moderate, 3=Severe, which were collected through a diary on daily basis for approximately 4 weeks when subjects were under no stimulation. The average degree of urgency per UUI episode was calculated from the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.
Time Frame
4 weeks
Title
Number of Pads Used Per Day - no Stimulation
Description
Number of pad use were collected through a diary on daily basis for approximately 4 weeks when subjects were under no stimulation. Only the last 7-day diaries were used for the analysis. The first 3 weeks were used as an adjustment period.
Time Frame
4 Weeks
Title
Global Response Assessment - no Stimulation
Description
Summary of GRA under no stimulation setting is provided. The GRA assessed incontinence symptoms as compared to symptoms prior to subject's entry into the study. Subjects were asked how much their incontinence changed since starting the study: markedly worse, moderately worse, mildly worse, same, slightly improved, moderately improved, or markedly improved. The responses to the symptom change were categorized into three levels for the analysis: worse (markedly worse, moderately worse, mildly worse), same (same), better (slightly improved, moderately improved, or markedly improved).
Time Frame
4 Weeks
Title
Adverse Events - no Stimulation
Description
Summary of adverse device effects when subjects were under no stimulation is provided. Percentage of subjects experiencing any type of Adverse Device Effect under no stimulation is presented.
Time Frame
4 Weeks
10. Eligibility
Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Implanted with either Neurostimulator Model 3023 (InterStim) or Neurostimulator Model 3058 (InterStim II) for at least 3 months
Implanted with tined lead models 3889 or 3093
Tined lead is located at S3 as determined by sensory or motor responses or x-ray or fluoroscopy
Currently showing some efficacy with an InterStim device but has the potential to be optimized per the opinion of the Investigator
Primary diagnosis before InterStim implant is urinary urge incontinence.
Must be willing to maintain her current regimen (dosage and frequency) of any overactive bladder (OAB) medication (anticholinergic, antimuscarinic or Myrbetriq (Mirabegron)) or tricyclic antidepression medication over the study duration, if applicable.
Female subject 18 years of age or older
Willing and able to accurately complete voiding diaries and questionnaires, attend visits (within the visit windows +7 days), and comply with the study protocol that includes maintenance of InterStim programming settings over the course of the study
Have had no more than one (InterStim) reprogramming at or within 28 days at or prior to randomization
Able to consent to participate by signing the Informed Consent Form
Exclusion Criteria:
History of Multiple sclerosis
History of Reiter's syndrome
History of spinal cord injury or a cerebral vascular accident (CVA)
History of diabetes unless the diabetes is well-controlled through diet and/or medications
Active symptomatic urinary tract infection (UTI)
Stress incontinence as the primary diagnosis
Urgency frequency as a primary diagnosis
Pelvic pain of uncertain etiology that is not associated with a voiding dysfunction or where pelvic pain is the primary diagnosis
Interstitial cystitis as the primary diagnosis
Urinary retention as the primary diagnosis
Treatment of urinary symptoms with botulinum toxin in the past 12 months or any plan to have botulinum toxin treatment during the study
Bilateral lead placement
Have other implantable neurostimulator, pacemaker, or defibrillator
Have knowledge of planned diathermy, microwave exposure, high output ultrasonic exposure, RF energy exposure, or MRI scans not included within the scanning conditions provided within the MRI Guidelines for InterStim Therapy neurostimulation systems.
Have an anticipated system modification within the next 5 months
Women who are pregnant or planning to become pregnant (women of child-bearing potential must undergo a pregnancy test, with a clear negative result, no more than 7 days prior to randomization visit)
Subjects who frequently use the patient programmer to change device program settings ("frequently" is defined as at least once a day and does not include shutting off the device for safety purposes)
Characteristics indicating a poor understanding of the study or characteristics that indicate the subject may have poor compliance with the study protocol.
Study site personnel will contact the Medtronic Study Manager (or designee) to determine if a potential subject who plans to enroll in an investigational device or drug trial, or is currently enrolled in an investigational device or drug trial is eligible for this study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Steven W Siegel, MD
Organizational Affiliation
Metro Urology
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Shaw Zhou, MD
Organizational Affiliation
Pinellas Urology, Inc.
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Karl Kreder, Jr., MD, MBA
Organizational Affiliation
University of Iowa Healthcare
Official's Role
Principal Investigator
Facility Information:
Facility Name
Pinellas Urology, Inc.
City
Saint Petersburg
State/Province
Florida
ZIP/Postal Code
33710
Country
United States
Facility Name
University of Iowa Healthcare
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
Facility Name
Metro Urology
City
Woodbury
State/Province
Minnesota
ZIP/Postal Code
55125
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
28914707
Citation
Siegel S, Kreder K, Takacs E, McNamara R, Kan F. Prospective Randomized Feasibility Study Assessing the Effect of Cyclic Sacral Neuromodulation on Urinary Urge Incontinence in Women. Female Pelvic Med Reconstr Surg. 2018 Jul/Aug;24(4):267-271. doi: 10.1097/SPV.0000000000000457.
Results Reference
result
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InterStim® Sacral Nerve Modulation Cycling Study
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