Efficacy of Li-SWT on Persistent Storage Symptoms After Transurethral Surgery for BPO

NCT ID: NCT04437108

Last Updated: 2023-06-15

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

Clinical Phase

NA

Total Enrollment

132 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-07-04

Study Completion Date

2022-07-21

Brief Summary

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comparing the outcome of low-intensity shock wave therapy (Li-SWT) versus solifenacin on persistent storage symptoms after transurethral surgery for benign prostatic obstruction (BPO)

Detailed Description

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Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms (LUTS) in aging men including both voiding and storage symptoms. After prostatectomy, 20-30% of the patients still have persistent storage symptoms. The pathophysiology of persistent storage symptoms after surgical relief of benign prostatic obstruction (BPO) remains unclear. It may be due to bladder changes produced by long standing bladder outlet obstruction (BOO) including bladder ischemia and denervation or it may be related to other factors rather than preoperative BOO such as aging, chronic inflammation or a subtle neurological disorder.

After exclusion of urinary tract infection (UTI) and BOO, antimuscarinics are the commonly used medications for post-prostatectomy persistent storage symptoms. However, these medications are associated with side effects which may interfere with the patient compliance.

Low-intensity shock wave therapy (Li-SWT) is a non invasive procedure that has a beneficial effect in promoting revascularization and enhancing tissue regeneration. It has been applied to the penis for erectile dysfunction and to the perineum for chronic pelvic pain syndrome (CPPS) with encouraging results. In a rat model, it has been reported that defocused Li-SWT leads to improvement of bladder innervation and vascularization.

Based on the previously mentioned studies, the investigators hypothesized that Li-SWT can offer benefit in improvement of persistent storage symptoms after surgical relief of BPO. In the present study, the investigators will evaluate the effect of Li-SWT on persistent storage symptoms after transurethral surgery for BPO compared to antimuscarinics in a randomized controlled trial (RCT).

Conditions

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Overactive Bladder Urinary Incontinence, Urge Urgency-frequency Syndrome Post Prostatectomy

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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Li-SWT

Patients will be treated by 8 sessions of Li-SWT with one week interval. This group is subdivided into 3 subgroups according to the approach through which Li-SWT is applied; suprapubic, perineal and combined approaches

Group Type ACTIVE_COMPARATOR

Li-SWT (suprapubic approach)

Intervention Type PROCEDURE

The patient will be asked to lie in flat dorsal position. A commercially used gel for sonography will be applied to the suprapubic region. The applicator will be placed on suprapubic region with two fingers apart from the symphysis pubis tilting to 45°. Shock waves will be directed to 3 different sites; the midline (over the bladder dome) and 3 cm right and left to the midline (over bilateral bladder walls). The patient will receive 3000 shocks (1000 shocks per site) with energy flux density of 0.12 mJ/mm² and frequency of 4 Hz.

Li-SWT (perineal approach)

Intervention Type PROCEDURE

The patient will be asked to lie in lithotomy position. A commercially used gel for sonography will be applied to the perineum. The applicator will be placed on perineal region. Shock waves will be directed to 3 different sites: the midline and 2 cm above and below the midline. The patient will receive 3000 shocks (1000 shocks per site) with energy flux density of 0.12 mJ/mm² and frequency of 4 Hz.

Li-SWT (combined approach)

Intervention Type PROCEDURE

The patient will receive 3000 shocks; 1500 shocks through suprapubic approach (500 shocks per site) and another 1500 shocks through perineal approach (500 shocks per site) with energy flux density of 0.12 mJ/mm² and frequency of 4 Hz.

Sham treatment

Patients will be treated by 8 sessions of sham treatment with one week interval, applied through suprapubic and perineal approaches.

Group Type SHAM_COMPARATOR

Sham treatment

Intervention Type PROCEDURE

The same technique of Li-SWT will be used but the applicator of the shock wave device will be turned off.

antimuscarinics

Patients will be treated by solifenacin 10 mg once daily for 6 months.

Group Type ACTIVE_COMPARATOR

Solifenacin

Intervention Type DRUG

The patients will be treated by antimuscarinics (solifenacin) which are considered as the conventional treatment of storage symptoms after prostatectomy.

Interventions

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Li-SWT (suprapubic approach)

The patient will be asked to lie in flat dorsal position. A commercially used gel for sonography will be applied to the suprapubic region. The applicator will be placed on suprapubic region with two fingers apart from the symphysis pubis tilting to 45°. Shock waves will be directed to 3 different sites; the midline (over the bladder dome) and 3 cm right and left to the midline (over bilateral bladder walls). The patient will receive 3000 shocks (1000 shocks per site) with energy flux density of 0.12 mJ/mm² and frequency of 4 Hz.

Intervention Type PROCEDURE

Li-SWT (perineal approach)

The patient will be asked to lie in lithotomy position. A commercially used gel for sonography will be applied to the perineum. The applicator will be placed on perineal region. Shock waves will be directed to 3 different sites: the midline and 2 cm above and below the midline. The patient will receive 3000 shocks (1000 shocks per site) with energy flux density of 0.12 mJ/mm² and frequency of 4 Hz.

Intervention Type PROCEDURE

Li-SWT (combined approach)

The patient will receive 3000 shocks; 1500 shocks through suprapubic approach (500 shocks per site) and another 1500 shocks through perineal approach (500 shocks per site) with energy flux density of 0.12 mJ/mm² and frequency of 4 Hz.

Intervention Type PROCEDURE

Sham treatment

The same technique of Li-SWT will be used but the applicator of the shock wave device will be turned off.

Intervention Type PROCEDURE

Solifenacin

The patients will be treated by antimuscarinics (solifenacin) which are considered as the conventional treatment of storage symptoms after prostatectomy.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients have to fulfill all the following criteria to be included in the study:

1. Ability to give informed consent and reply to questionnaires.
2. Average urgency episodes per 24 hrs ≥ 1 and average daytime frequency ≥ 8 during the baseline 3-day voiding diary.
3. Relief of BOO as proved by non-invasive uroflowmetry, pressure flow study (PFS) or urethrocystoscopy.

Exclusion Criteria

* Patients who have any of the following will be excluded from the study:

1. Untreated UTI.
2. BOO such as bladder neck contracture (BNC), residual obstructing adenoma or urethral stricture.
3. Neurogenic lower urinary tract dysfunction (LUTD).
4. Uncontrolled diabetes mellitus.
5. Depression or any psychogenic disorders.
6. Prior radiation therapy to the pelvic area.
7. History of prostate cancer, bladder tumor or intravesical Bacillus Calmette Guerin (BCG) therapy.
8. Poor coagulopathy.
9. Severe cardiovascular disease.
Minimum Eligible Age

50 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Ahmed Mohamed Elshal

UNKNOWN

Sponsor Role collaborator

Mansoura University

OTHER

Sponsor Role lead

Responsible Party

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Mohammed Hegazy

assistant lecturer of urology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mohammed Hegazy

Role: PRINCIPAL_INVESTIGATOR

Urology and nephrology center, Mansoura, Egypt

Mohamed Gaballah

Role: STUDY_DIRECTOR

Urology and nephrology center, Mansoura, Egypt

Khaled Sheir

Role: STUDY_DIRECTOR

Urology and nephrology center, Mansoura, Egypt

Ahmed Elshal

Role: STUDY_DIRECTOR

Urology and nephrology center, Mansoura, Egypt

Locations

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Urology and Nephrology center

Al Mansurah, , Egypt

Site Status

Countries

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Egypt

Other Identifiers

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Li-SWT after relief of BPO

Identifier Type: -

Identifier Source: org_study_id

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