Trial Assessing Renal Damage During Ureteroscopy

NCT ID: NCT05350423

Last Updated: 2023-12-07

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

108 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-10-22

Study Completion Date

2022-11-28

Brief Summary

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This is an ongoing randomized controlled trial of patients undergoing URSLL with unilateral non-obstructing renal stones. Patients are randomized to undergo URSLL with either the TFL or Ho:YAG laser. Each patient's urine is collected immediately pre-op (V1), 1 hour post-op (V2), and 10 days post-op (POD#10, V3). Samples are analyzed by enzyme-linked immunosorbent assay (ELISA) for the following biomarkers: Kidney injury molecule-1 (KIM-1), Neutrophil gelatinase-associated lipocalin (NGAL), and β2-microglobulin (β2M), then normalized to urine creatinine.

Detailed Description

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Patients scheduled for ureteroscopic laser lithotripsy (URSLL) will be screened and if eligible and agreeable, enrolled into the study. Patients will then be randomized preoperatively via block randomization in groups of 5 to receive lithotripsy with either Ho:YAG or TFL laser intraoperatively. All patients enrolled will have a ureteral stent placed at the end of the procedure.

After induction of anesthesia but before any surgical intervention, the surgeon will empty the bladder and collect a sample of urine that will serve as the "Preoperative Urine Sample". One hour following the end of the procedure, a second sample of urine will be collected from the Foley catheter that will serve as the "Immediate Post-Op Urine Sample". A third and final urine sample of urine will be collected approximately 10 days postoperatively just prior to stent removal and serve as the "Follow-up urine sample". Patients for whom all three urine specimens are collected will be considered to have completed the study. Immediately after collection, the samples will be stored in a freezer at -80 ºC. All samples will be analyzed for biomarkers of renal parenchymal injury to determine differences between pre- and postoperative concentrations. The biomarkers that will be quantified include Kidney Injury Molecule-1 (KIM-1), Neutrophil gelatinase-associated lipocalin (NGAL), and Beta-2-microglobulin (B2M).

Concentrations of urinary biomarkers are determined in duplicate from urine samples using the multiplex cytokine panel \[MILLIPLEX MAP Human Kidney Injury Panel 1 (KIM-1), Panel 2 (N-GAL2) and Panel 3 (B2 microglobulin)- Millipore Corp., Burlington, MA\] as per manufacturer's instructions. The urine samples were 1:2 diluted for Panel 1, 1:100 diluted for Panel 2 and 1:500 diluted for Panel 3. The kit provided lyophilized pre-mixed standard was reconstituted and used to generate 6-point serial dilutions and run on assay plate along with the samples. Analyte median fluorescent intensity (MFI) values were obtained.

Anticipate enrollment is 108 patients total (54 in each cohort) to adequately power the study based upon an alpha of 0.05 statistical power of 0.80.

Conditions

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Nephrolithiasis

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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Thulium Fibre Laser (TFL)

Patients who are randomized to undergo ureteroscopic laser lithotripsy with the Thulium fibre laser (TFL)

Group Type EXPERIMENTAL

Thulium Fibre Laser

Intervention Type DEVICE

The TFL is a relatively new laser in the field of urology. First introduced on the market in 2017, it offers theoretically superior stone dusting qualities and smaller fiber sizes to allow for better irrigation.

Holmium:Yttrium-Aluminum-Garnet (Ho:YAG)

Patients who are randomized to undergo ureteroscopic laser lithotripsy with the Holmium:Yttrium-Aluminum-Garnet (Ho:YAG) laser

Group Type EXPERIMENTAL

Holmium:Yttrium-Aluminum-Garnet

Intervention Type DEVICE

The Ho:YAG is currently the most commonly used laser in the field of urology and for the better part of the last 3 decades has been considered the gold standard for laser lithotripsy.

Interventions

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Thulium Fibre Laser

The TFL is a relatively new laser in the field of urology. First introduced on the market in 2017, it offers theoretically superior stone dusting qualities and smaller fiber sizes to allow for better irrigation.

Intervention Type DEVICE

Holmium:Yttrium-Aluminum-Garnet

The Ho:YAG is currently the most commonly used laser in the field of urology and for the better part of the last 3 decades has been considered the gold standard for laser lithotripsy.

Intervention Type DEVICE

Other Intervention Names

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TFL Ho:YAG

Eligibility Criteria

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Inclusion Criteria

* Age greater than or equal to 18 years
* Patients undergoing unilateral ureteroscopic laser lithotripsy for the treatment of non-obstructing renal stones
* Total stone burden between 5 and 20 mm

Exclusion Criteria

* Presence of pre-existing indwelling ureteral stent
* Presence of hydronephrosis preoperatively (on either side)
* CKD as defined by eGFR \< 60 mL/min
* GU anatomical anomalies (including urinary diversion, solitary kidney, ureteral stricture disease, ureteropelvic junction obstruction)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Icahn School of Medicine at Mount Sinai

OTHER

Sponsor Role lead

Responsible Party

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Mantu Gupta

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mantu Gupta

Role: PRINCIPAL_INVESTIGATOR

Department of Urology, Icahn School of Medicine at Mount Sinai

Locations

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Mount Sinai West

New York, New York, United States

Site Status

Countries

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United States

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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GCO# 21-0054

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

STUDY-21-00084

Identifier Type: -

Identifier Source: org_study_id