Ureteral Stenting After Ureteroscopy for Stone Treatment, A Global Perspective on Indications and Outcomes

NCT ID: NCT03567421

Last Updated: 2021-04-13

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

COMPLETED

Total Enrollment

2348 participants

Study Classification

OBSERVATIONAL

Study Start Date

2018-06-07

Study Completion Date

2019-08-31

Brief Summary

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Background: The exit strategy after ureteroscopy for stone treatment remains a topic for discussion. Current EAU guidelines on urolithiasis state that postoperative stenting is indicated in patients at increased risk of postoperative complications. Stenting is not considered necessary in all other cases, and after uncomplicated procedures.

Objective: To analyse the postoperative ureteral stenting strategy in clinical practice looking at the indication, type of stents used and the duration of stenting after ureteroscopy for stone treatment. Furthermore, the investigators will examine in what setting the stents are being removed postoperatively.

Study design: This study is a prospective, observational, international, multicentre registry study executed by uCARE.

Study population: All patients \>18 years with a ureter or renal stone who are planned for ureteroscopic treatment by semi-rigid and/or flexible ureteroscopy are eligible for this study.

Detailed Description

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BACKGROUND AND RATIONALE

The majority of patients with stones receive an indication for its active removal by ureteroscopy. In the last two decades, endourological treatment techniques have evolved with several technological advances through miniaturisation of ureteroscopes, digital improvements, and optical imaging enhancement techniques leading to a better image quality, and the development of different disposables such as single-use digital ureteroscopes. This advancement has led to an increased number of indications for ureteroscopic treatment. Aside from this, there are no specific contraindications for ureteroscopic treatment, apart from general problems such as being unfit for anaesthesia or the presence of urinary tract infections, according to the EAU guidelines.

The indications for active stone removal of ureteral stones include persistent pain or obstruction, renal insufficiency, and in cases when spontaneous passage is less likely. The indications for active removal of renal stones include stone growth, stone formation in patients who are at high risk for stone formation, symptomatic patients, infection, obstruction, stones larger than 15 mm and the comorbidity profile, social situation and preference of the patient.

The procedure can be performed using semi-rigid instruments, mainly for ureter stones, and/or by flexible ureteroscopes, for complete inspection and treatment of the upper tract.

The exit strategy after stone treatment varies depending on patient characteristics and comorbidity, residual stone load, per-operative details and complications, and surgeons' preference. Stent placement is recommended by the EAU guidelines in case of increased postoperative complications; in cases of residual fragments, bleeding, perforation, pregnancy or urinary tract infections; as well as in all doubtful cases to avoid stressful emergencies.

Postoperative stenting increases postoperative morbidity and urologists should carefully balance the pros and cons of postoperative stenting in each individual case. The ideal stent duration is not known. Ureteral stents are usually removed 1-day postoperatively and most urologists will remove double Js 1-2 weeks postoperatively.

It remains a matter of debate whether to stent a patient postoperatively after a ureteroscopic procedure despite the EAU guidelines statement that routine stenting after an uncomplicated procedure with complete stone removal is not necessary.

STUDY OBJECTIVES

The aim of this registry is to review current clinical practice on postoperative ureteral stenting after ureteroscopy for stone treatment. The investigators will explore the answers to the following questions: What are the indications, predictors and outcomes for stent placement? What types of stents are used and what is the duration for stent placement? Hence, the investigators will assess in what setting the stents are being removed, looking at instrumentation, anaesthetics, and location.

Conditions

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Stone;Renal Stone, Kidney Stone Ureter

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Eligibility Criteria

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Inclusion Criteria

* Patient \>18 years old
* Patient is a candidate for ureteroscopic treatment of a ureter or renal stone by semi-rigid and/or flexible ureteroscopy

Exclusion Criteria

* Patient \<18 years old
Minimum Eligible Age

18 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Société Internationale d'Urologie

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Joyce Baard, MD

Role: PRINCIPAL_INVESTIGATOR

Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

Mihir Desai, MD

Role: STUDY_CHAIR

University of Southern California, United States

Jean de la Rosette, MD

Role: STUDY_DIRECTOR

Istanbul Medipol University, Istanbul, Turkey

Locations

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University of Minnesota

Minneapolis, Minnesota, United States

Site Status

Guangdong Second Provincial General Hospital, The Third Clinical Medical College of Southern Medical University

Guangzhou, Guangdong, China

Site Status

The First Affiliated Hospital of Guangzhou Medical University and Guangdong Key Laboratory of Urology

Guangzhou, , China

Site Status

Ningbo First Hospital, The Affiliated Hospital of Ningbo University

Ningbo, , China

Site Status

Renji Hospital, School of Medicine, Shanghai Jiao Tong University

Shanghai, , China

Site Status

Shanghai Changhai Hospital, Second Military Medical University

Shanghai, , China

Site Status

Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology

Wuhan, , China

Site Status

Aretaieion Hospital

Athens, , Greece

Site Status

Sismanoglio General Hospital

Athens, , Greece

Site Status

University of Crete, Department of Urology

Heraklion, , Greece

Site Status

Department of Urology, University Hospital of Larissa

Larissa, , Greece

Site Status

1st Department of Urology, Aristotle University

Thessaloniki, , Greece

Site Status

Jawahar Lal Nehru (JLN) Medical College

Ajmer, Rajasthan, India

Site Status

Kulkarni Reconstructive Urology Center

Pune, , India

Site Status

Department of Urology, Hasan Sadikin Hospital/Padjadjaran University

Bandung, , Indonesia

Site Status

Department of Urology, Sanglah Hospital/Udayana University

Denpasar, , Indonesia

Site Status

Department of Urology, Cipto Mangunkusumo Hospital/University of Indonesia

Jakarta, , Indonesia

Site Status

Department of Urology, Saiful Anwar Hospital/Brawijaya University

Malang, , Indonesia

Site Status

Department of Urology, Dr. Soetomo Hospital/Airlangga University

Surabaya, , Indonesia

Site Status

Department of Urology, Sardjito Hospital/Gadjah Mada University

Yogyakarta, , Indonesia

Site Status

Shahid Beheshti Hospital, Hamadan University of Medical Sciences

Hamadan, , Iran

Site Status

University of Basra, College of Medicine, Urology Department

Basra, , Iraq

Site Status

Pandya Memorial Hospital

Mombasa, , Kenya

Site Status

Selayang Hospital

Batu Caves, , Malaysia

Site Status

Serdang Hospital

Kajang, , Malaysia

Site Status

Kuala Lumpur Hospital

Kuala Lumpur, , Malaysia

Site Status

University of Malaya

Kuala Lumpur, , Malaysia

Site Status

Sarawak General Hospital

Kuching, , Malaysia

Site Status

Department of Urology, St. John Clinical Hospital of Emergency

Bucharest, , Romania

Site Status

International Medical Center

Jeddah, , Saudi Arabia

Site Status

King Abdulaziz University

Jeddah, , Saudi Arabia

Site Status

Prince Sultan Military Medical City

Riyadh, , Saudi Arabia

Site Status

Sefako Makgatho Health Sciences University

Ga-Rankuwa, , South Africa

Site Status

SMG-SNU Boramae Medical Center

Seoul, , South Korea

Site Status

Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung

Kaohsiung City, , Taiwan

Site Status

Department of Urology, Cardinal Tien Hospital

New Taipei City, , Taiwan

Site Status

Department of Urology, En Chu Kong Hospital

New Taipei City, , Taiwan

Site Status

Department of Urology, National Taiwan University Hospital

Taipei, , Taiwan

Site Status

Department of Urology, Cukurova University, Adana

Adana, , Turkey (Türkiye)

Site Status

Baskent University, Faculty of Medicine, Department of Urology

Ankara, , Turkey (Türkiye)

Site Status

Department of Urology, Gazi University

Ankara, , Turkey (Türkiye)

Site Status

Department of Urology, Hacettepe University

Ankara, , Turkey (Türkiye)

Site Status

Cerrahpasa School of Medicine Istanbul University

Istanbul, , Turkey (Türkiye)

Site Status

Department of Urology, University of Health Sciences, Bağcılar Hospital

Istanbul, , Turkey (Türkiye)

Site Status

Istanbul Medipol University, Department of Urology

Istanbul, , Turkey (Türkiye)

Site Status

Department of Urology, 9 Eylul University

Izmir, , Turkey (Türkiye)

Site Status

Konya Meram Education & Research Hospital

Konya, , Turkey (Türkiye)

Site Status

Necmettin Erbakan University, Meram Medical School

Konya, , Turkey (Türkiye)

Site Status

Selcuk University Selcuklu Medical School

Konya, , Turkey (Türkiye)

Site Status

Department of Urology, Bulent Ecevit University

Zonguldak, , Turkey (Türkiye)

Site Status

Countries

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United States China Greece India Indonesia Iran Iraq Kenya Malaysia Romania Saudi Arabia South Africa South Korea Taiwan Turkey (Türkiye)

References

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Türk C, Knoll T, Petrik A, et al. EAU Guidelines on Urolithiasis 2016. Available at: https://uroweb.org/wp-content/uploads/EAU-Guidelines-Urolithiasis-2016-1.pdf

Reference Type BACKGROUND

Legemate JD, Wijnstok NJ, Matsuda T, Strijbos W, Erdogru T, Roth B, Kinoshita H, Palacios-Ramos J, Scarpa RM, de la Rosette JJ. Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones. World J Urol. 2017 Oct;35(10):1497-1506. doi: 10.1007/s00345-017-2028-2. Epub 2017 Mar 20.

Reference Type BACKGROUND
PMID: 28321499 (View on PubMed)

ICH Harmonised Tripartite Guideline. Guideline for Good Clinical Practice E6(R2). Available at: http://www.ich.org/products/guidelines/efficacy/article/efficacy-guidelines.html. Accessed March 25, 2018.

Reference Type BACKGROUND

Other Identifiers

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uCARE 2018-001

Identifier Type: -

Identifier Source: org_study_id

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