Percutaneous Nephrostomy Versus Stent In Sepsis Trial

NCT ID: NCT02929160

Last Updated: 2022-09-27

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

WITHDRAWN

Clinical Phase

NA

Study Classification

INTERVENTIONAL

Study Start Date

2017-01-01

Study Completion Date

2020-01-31

Brief Summary

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Randomized control trial to compare the efficacy and safety of percutaneous nephrostomy with retrograde ureteric stenting for emergency renal decompression in cases of obstruction and sepsis associated with ureteric calculi.

Detailed Description

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The obstructed kidney in the setting of urosepsis is a urological emergency. Stone manipulation in the setting of active, untreated infection with concomitant urinary tract obstruction can lead to life-threatening sepsis. Therefore, urgent decompression of the collecting system is warranted.

There are two options for urgent decompression of an obstructed collecting system:

1. Image-guided percutaneous nephrostomy tube placement
2. Cystoscopic retrograde placement of a ureteric stent

This strategy allows drainage of infected urine and penetration of antibiotics to the affected renal unit. Definitive stone manipulation should be delayed until the infection is cleared following an appropriate course of antimicrobial therapy.

Both the European Association of Urology (EAU) and the American Urological Association (AUA) provide guidelines for management of an obstructed kidney. Both organisations provide evidence-based statements of the highest recommendation that urgent decompression of the kidney is mandated in the setting of sepsis. However, neither organisation recommend one decompression modality over the other. There is a lack of high quality up-to-date evidence to support a consensus view that one method of decompression is superior to the other.

This study aims to determine the most effective method of renal decompression in cases of obstruction and sepsis associated with ureteric calculi.

Conditions

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Ureteric Calculus Sepsis Hydronephrosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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PCN

Percutaneous nephrostomy

Group Type EXPERIMENTAL

Percutaneous nephrostomy

Intervention Type PROCEDURE

Percutaneous nephrostomy tube insertion under radiological guidance

JJ Stent

Retrograde ureteric JJ stent

Group Type EXPERIMENTAL

Retrograde ureteric JJ stent

Intervention Type PROCEDURE

Retrograde ureteric JJ stent insertion using cystoscopy

Interventions

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Percutaneous nephrostomy

Percutaneous nephrostomy tube insertion under radiological guidance

Intervention Type PROCEDURE

Retrograde ureteric JJ stent

Retrograde ureteric JJ stent insertion using cystoscopy

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Ureteric calculus with proximal hydronephrosis confirmed on CT KUB
* White cell count \>12,000mm3 and/or temperature \>38C

Exclusion Criteria

* Uncorrected coagulopathy
* Urethral or ureteric stricture disease
* Urinary diversion
* Pregnancy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Adelaide and Meath Hospital, incorporating The National Children's Hospital

OTHER

Sponsor Role lead

Responsible Party

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Rustom P Manecksha, MD, FRCS (Urol.)

Consultant Urologist

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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The Adelaide and Meath Hospital, incorporating The National Children's Hospital

Tallaght, Dublin, Ireland

Site Status

St. James's Hospital

Dublin, , Ireland

Site Status

Countries

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Ireland

Other Identifiers

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2016-004022-41

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

AMNCH-GU-2016-1

Identifier Type: -

Identifier Source: org_study_id

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