Tip-flexible Semi-rigid Ureterorenoscope Versus Flexible Ureteroscopy in Renal Calculi

NCT ID: NCT02426931

Last Updated: 2015-04-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

280 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-04-30

Study Completion Date

2015-06-30

Brief Summary

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This study evaluates the safety and efficacy of the novel tip-flexible semi-rigid ureterorenoscope for the treatment of renal calculi using a prospective, randomized multicentre trial design. Half of participants will receive retrograde intrarenal surgery using the tip-flexible semi-rigid ureterorenoscope, while the other half participants will receive retrograde intrarenal surgery using the classic flexible ureteroscope.

Detailed Description

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Retrograde intrarenal surgery using flexible ureteroscope has become the first-line treatment for renal calculi \< 3.0 cm and is recommended by the European Association of Urology due to its minimally-invasive nature and satisfactory result.

However, some limitations still remain. Poor maneuverability, extra costs for the ureteral access sheath, and high device vulnerability still preclude flexible ureteroscopy from wider distribution.

Recently, the investigators present a novel ureterorenoscope, which is composed of a retractable rigid sheath and a semi-rigid ureteroscope with a flexible part on the tip. When the flexible tip of the inner shaft maintains within the sheath, working in the "rigid mode", the tip-flexible semi-rigid ureterorenoscope is capable of passing either the orifice or the physiological tortuosity of the ureter with ease. When the inner shaft is extended beyond the sheath, the endoscope is switched to the "flexible mode", capable of performing an intrarenal approach.

This endoscope integrates the classic semi-rigid and flexible ureteroscope both structurally and functionally, and has been approved for clinical application by the China Food and Drug Administration. In this study, transverse comparison is designed to evaluate the safety and efficacy of the tip-flexible semi-rigid ureterorenoscope for the treatment of renal calculi.

Conditions

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Renal Calculi

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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tf-URS

Participants in tf-URS group undergo ureteroscopy using the tip-flexible ureterorenoscope.

Group Type EXPERIMENTAL

the tip-flexible ureterorenoscope

Intervention Type DEVICE

Ureteroscopy will be conducted using the tip-flexible semi-rigid ureterorenoscope to treat renal calculi. Holmium laser and basket can be used to perform the technique.

f-URS

Participants in f-URS group undergo ureteroscopy using the classic flexible ureteroscope.

Group Type ACTIVE_COMPARATOR

the classic flexible ureteroscope

Intervention Type DEVICE

Ureteroscopy will be conducted using the classic flexible ureteroscope (Flex x2 STORZ, Germany) to treat renal calculi. Holmium laser and basket can be used to perform the technique.

Interventions

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the tip-flexible ureterorenoscope

Ureteroscopy will be conducted using the tip-flexible semi-rigid ureterorenoscope to treat renal calculi. Holmium laser and basket can be used to perform the technique.

Intervention Type DEVICE

the classic flexible ureteroscope

Ureteroscopy will be conducted using the classic flexible ureteroscope (Flex x2 STORZ, Germany) to treat renal calculi. Holmium laser and basket can be used to perform the technique.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Subject has provided informed consent and indicated a willingness to comply with study treatments
* Subject has a diagnosis of renal stones according to computer tomography (CT) and intravenous pyelogram (IVP) results
* Subject is a surgical candidate for the ureteroscopic approach
* Subject is 18-80 yrs of age
* Subject has a single stone \< 3 cm in size (IVP), or multiple stones \< 3 cm in cumulative size (IVP)
* Subject has a serum creatinine level within the normal range for the study center

Exclusion Criteria

* Subject needs bilateral procedures within one-stage ureteroscopy
* Subject has an active urinary tract infection (e.g., cystitis, prostatitis, urethritis, etc.)
* Subject has been diagnosed with a urethral stricture or bladder neck contracture
* Subject has been diagnosed with a urinary tract infection related to stone obstruction within two weeks
* Subject has severe hematuria that might blur the vision of the endoscopy
* Subject has a disorder of the coagulation cascade system that would put the subject at risk for intraoperative or postoperative bleeding
* Subject is unable to discontinue anticoagulant and antiplatelet therapy preoperatively (3-5 d)
* Subject has other diseases and could not tolerate the endoscopic surgery
* Subject has any kind of anatomic abnormality of the urinary system that might have an influence on the surgery
* Subject has ipsilateral pre-stenting or previous ureteroscopy within six months
* Subject has been diagnosed with hydronephrosis larger than 3 cm according to the B-scan ultrasonography examination
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Changhai Hospital

OTHER

Sponsor Role collaborator

The First Affiliated Hospital of Guangzhou Medical University

OTHER

Sponsor Role collaborator

Xiangya Hospital of Central South University

OTHER

Sponsor Role collaborator

Ningbo No. 1 Hospital

OTHER

Sponsor Role collaborator

West China Hospital

OTHER

Sponsor Role collaborator

Beijing Tsinghua Changgeng Hospital

OTHER

Sponsor Role collaborator

Yantai Yuhuangding Hospital

OTHER

Sponsor Role collaborator

Ling Li, MD

OTHER

Sponsor Role lead

Responsible Party

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Ling Li, MD

Chief of Department of Urology

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Yinghao Sun, MD

Role: STUDY_CHAIR

Changhai Hospital

Guohua Zeng, MD

Role: PRINCIPAL_INVESTIGATOR

The First Affiliated Hospital of Guangzhou Medical University

Hequn Chen, MD

Role: PRINCIPAL_INVESTIGATOR

Xiangya Hospital of Central South University

Yue Cheng, MD

Role: PRINCIPAL_INVESTIGATOR

Ningbo No. 1 Hospital

Kunjie Wang, MD

Role: PRINCIPAL_INVESTIGATOR

West China Hospital

Jianxing Li, MD

Role: PRINCIPAL_INVESTIGATOR

Beijing Tsinghua Changgeng Hospital

Lei Shi, MD

Role: PRINCIPAL_INVESTIGATOR

Yantai Yuhuangding Hospital

Xiaofeng Gao, MD

Role: PRINCIPAL_INVESTIGATOR

Changhai Hospital

Central Contacts

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Ling Li, MD

Role: CONTACT

086-18019766513

Yonghan Peng, MD

Role: CONTACT

086-13917386896

References

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Aboumarzouk OM, Monga M, Kata SG, Traxer O, Somani BK. Flexible ureteroscopy and laser lithotripsy for stones >2 cm: a systematic review and meta-analysis. J Endourol. 2012 Oct;26(10):1257-63. doi: 10.1089/end.2012.0217. Epub 2012 Jul 30.

Reference Type BACKGROUND
PMID: 22642568 (View on PubMed)

de la Rosette J, Denstedt J, Geavlete P, Keeley F, Matsuda T, Pearle M, Preminger G, Traxer O; CROES URS Study Group. The clinical research office of the endourological society ureteroscopy global study: indications, complications, and outcomes in 11,885 patients. J Endourol. 2014 Feb;28(2):131-9. doi: 10.1089/end.2013.0436. Epub 2013 Dec 17.

Reference Type BACKGROUND
PMID: 24147820 (View on PubMed)

Geavlete P, Multescu R, Geavlete B. Pushing the boundaries of ureteroscopy: current status and future perspectives. Nat Rev Urol. 2014 Jul;11(7):373-82. doi: 10.1038/nrurol.2014.118. Epub 2014 Jun 3.

Reference Type BACKGROUND
PMID: 24890883 (View on PubMed)

Yoon PD, Chalasani V, Woo HH. Use of Clavien-Dindo classification in reporting and grading complications after urological surgical procedures: analysis of 2010 to 2012. J Urol. 2013 Oct;190(4):1271-4. doi: 10.1016/j.juro.2013.04.025. Epub 2013 Apr 11.

Reference Type BACKGROUND
PMID: 23583859 (View on PubMed)

Yinghao S, Yang B, Gao X. The management of renal caliceal calculi with a newly designed ureteroscope: a rigid ureteroscope with a deflectable tip. J Endourol. 2010 Jan;24(1):23-6. doi: 10.1089/end.2009.0030.

Reference Type BACKGROUND
PMID: 20059383 (View on PubMed)

Rebuck DA, Macejko A, Bhalani V, Ramos P, Nadler RB. The natural history of renal stone fragments following ureteroscopy. Urology. 2011 Mar;77(3):564-8. doi: 10.1016/j.urology.2010.06.056. Epub 2010 Dec 15.

Reference Type BACKGROUND
PMID: 21109293 (View on PubMed)

Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol. 2013 Feb;189(2):580-4. doi: 10.1016/j.juro.2012.08.197. Epub 2012 Oct 8.

Reference Type BACKGROUND
PMID: 22982421 (View on PubMed)

Atis G, Arikan O, Gurbuz C, Yildirim A, Erol B, Pelit S, Ulus I, Caskurlu T. Comparison of different ureteroscope sizes in treating ureteral calculi in adult patients. Urology. 2013 Dec;82(6):1231-5. doi: 10.1016/j.urology.2013.07.021. Epub 2013 Sep 12.

Reference Type BACKGROUND
PMID: 24035032 (View on PubMed)

Perez Castro E, Osther PJ, Jinga V, Razvi H, Stravodimos KG, Parikh K, Kural AR, de la Rosette JJ; CROES Ureteroscopy Global Study Group. Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the Clinical Research Office of the Endourological Society ureteroscopy global study. Eur Urol. 2014 Jul;66(1):102-9. doi: 10.1016/j.eururo.2014.01.011. Epub 2014 Jan 23.

Reference Type BACKGROUND
PMID: 24507782 (View on PubMed)

Karadag MA, Demir A, Cecen K, Bagcioglu M, Kocaaslan R, Altunrende F. Flexible ureterorenoscopy versus semirigid ureteroscopy for the treatment of proximal ureteral stones: a retrospective comparative analysis of 124 patients. Urol J. 2014 Nov 1;11(5):1867-72.

Reference Type BACKGROUND
PMID: 25361706 (View on PubMed)

Wendt-Nordahl G, Mut T, Krombach P, Michel MS, Knoll T. Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Urol Res. 2011 Jun;39(3):185-8. doi: 10.1007/s00240-010-0331-0. Epub 2010 Nov 5.

Reference Type BACKGROUND
PMID: 21052986 (View on PubMed)

Wendt-Nordahl G, Trojan L, Alken P, Michel MS, Knoll T. Ureteroscopy for stone treatment using new 270 degrees semiflexible endoscope: in vitro, ex vivo, and clinical application. J Endourol. 2007 Dec;21(12):1439-44. doi: 10.1089/end.2006.0291.

Reference Type BACKGROUND
PMID: 18186680 (View on PubMed)

Geavlete P, Multescu R, Geavlete B. Retrograde flexible ureteroscopic approach of upper urinary tract pathology: What is the status in 2014? Int J Urol. 2014 Nov;21(11):1076-84. doi: 10.1111/iju.12582. Epub 2014 Aug 1.

Reference Type BACKGROUND
PMID: 25081354 (View on PubMed)

Bedke J, Leichtle U, Lorenz A, Nagele U, Stenzl A, Kruck S. 1.2 French stone retrieval baskets further enhance irrigation flow in flexible ureterorenoscopy. Urolithiasis. 2013 Apr;41(2):153-7. doi: 10.1007/s00240-012-0540-9. Epub 2013 Jan 5.

Reference Type BACKGROUND
PMID: 23503877 (View on PubMed)

Somani BK, Al-Qahtani SM, de Medina SD, Traxer O. Outcomes of flexible ureterorenoscopy and laser fragmentation for renal stones: comparison between digital and conventional ureteroscope. Urology. 2013 Nov;82(5):1017-9. doi: 10.1016/j.urology.2013.07.017. Epub 2013 Aug 31.

Reference Type BACKGROUND
PMID: 24001703 (View on PubMed)

Ozsoy M, Acar O, Sarica K, Saratlija-Novakovic Z, Fajkovic H, Librenjak D, Esen T, Scheffbuch N, Seitz C. Impact of gender on success and complication rates after ureteroscopy. World J Urol. 2015 Sep;33(9):1297-302. doi: 10.1007/s00345-014-1435-x. Epub 2014 Nov 12.

Reference Type BACKGROUND
PMID: 25385490 (View on PubMed)

Other Identifiers

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01

Identifier Type: -

Identifier Source: org_study_id

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