The Effect of Local Anesthetic Solution in the Bladder Prior to Botox Injections in the Bladder

NCT ID: NCT05415865

Last Updated: 2022-09-22

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

PHASE3

Total Enrollment

50 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-09-12

Study Completion Date

2024-05-01

Brief Summary

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The purpose of this study is to investigate the effect of Lidocaine solution versus placebo (isotonic Sodium Chloride NaCl) disposed inside the urinary bladder as intravesical anesthesia prior to onabotulinum toxin A injections in the treatment of urgency urinary incontinence.

Detailed Description

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The aim of the study is to investigate if bladder installed Lidocaine solution have an effect on reported pain during BTX-A injections compared to placebo.

The study participants will be recruited from the existing patient populations enrolled in the BTX-A program of the tertiary Urogynaecological Clinic of Herlev University Hospital.

The participants are randomized to:

1. Active drug: Lidocaine Hydrochloride and Sodium hydrogen carbonate
2. Placebo: Sodium Chloride

The study includes 5 study visits:

Visit 1:

* First treatment day
* Randomization
* Registration of pre-treatment pain relief medications: paracetamol, ibuprofen, or other medications. If pre-treatment pain relief is taken before first treatment, same pain relief should be taken before second treatment day (visit 4) in order to reduce bias
* Registration of antibiotic treatment: current antibiotic treatment or long-term prophylactic antibiotic for prevention of recurrent UTI The participant receives the active treatment or placebo, double-blinded
* The participant is asked to grade the intensity of pain according to VAS score immediately after, and when participant has been dressed after the BTX-A injections

Visit 2 (by telephone):

* Phone consultation 1 week after treatment:
* The participant's experience on the procedure on a 5-point ordinal scale: "1- very unsatisfied", "2- unsatisfied", "3- neither unsatisfied or satisfied", "4- satisfied", "5-very satisfied"

Side effects:

* Questions on symptoms of UTI: dysuria, cloudy urine, pollakiuria, nocturia
* Hematuria
* Inability to empty the bladder
* Other symptoms

(Visit 3:)

* The participant contacts the Clinic for next treatment approximately 6-12 months later
* Sponsor or investigator from the Urogynecological Clinic reach out for the participant asking on symptoms of UUI if the participant has not contacted the clinic within 12 months

Visit 4:

* Second treatment day
* The participant receives the opposite treatment, still double-blinded
* Registration of pre-treatment pain relief medications: paracetamol, ibuprofen, or other medications
* Registration of antibiotic treatment: current antibiotic treatment or long-term prophylactic antibiotic for prevention of recurrent UTI
* The participant is asked to grade the intensity of pain according to VAS score immediately after, and when participant has been dressed after the BTX-A injections

Visit 5(by telephone):

* Phone consultation 1 week after treatment:
* The participant's experience on the procedure on a 5-point scale: "1- very unsatisfied", "2- unsatisfied", "3- neither unsatisfied or satisfied", "4- satisfied", "5-very satisfied"

Side effects:

* Questions on symptoms of UTI: dysuria, cloudy urine, pollakiuria nocturia,
* Hematuria
* Inability to empty the bladder
* Other symptoms

Conditions

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Urge Incontinence Overactive Bladder Anesthesia, Local Pain, Procedural Urinary Tract Infections Hematuria

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

The study is a randomized, controlled, double-blinded, crossover study. The participants are their own control in the evaluation of the effect of intravesical alkalinized Lidocaine solution versus placebo as anesthesia prior to intravesical injection of onabotulinum toxin A. The chosen model is advantageous as a smaller sample size is needed, and error variance is reduced.
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
Region Hovedstadens Apotek, Herlev Hospital produces the Lidocaine solution and the matching placebo solution, performs the randomization, and packages the blinded dosing kits with the order of Lidocaine and placebo in a balanced design (50% Lidocaine at the first treatment). Participants will get consecutive randomization numbers, which specify the dosing kit. Neither the participant, the operator, or the healthcare professional interviewing the participant about her pain score know what solution the participant gets administered.

Study Groups

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Alkalinized Lidocaine, then Placebo

Participants will have Lidocaine Hydrochloride 20 mg/ml, 20 ml and Sodium hydrogen carbonate 1 mmol/ml, 10 ml (ie a total of 30 ml) installed in the bladder for 15 minutes prior to the BTXA-injection procedure.

When signing up for the next BTXA-injection with a wash out period of minimum three months, participants will have the matching placebo containing Sodium Chloride 9 g/L, 20 ml and Sodium Chloride 9 g/L, 10 ml, a total of 30 ml installed in the bladder for 15 minutes prior to the BTXA-injection procedure.

Group Type ACTIVE_COMPARATOR

Alkalinized Lidocaine

Intervention Type COMBINATION_PRODUCT

20 ml of Lidocaine Hydrochloride and 10 ml of Sodium hydrogen carbonate will be pulled up and mixed in a syringe on site, and 30 ml mixed solution in total will afterwards be installed in the bladder with a catheter.

Placebo Sodium Chloride 0.9% Inj

Intervention Type DRUG

20 ml of Sodium Chloride 9 g/L and 10 ml of Sodium Chloride 9 g/L will be pulled up and mixed in a syringe on site, and 30 ml solution in total will afterwards be installed in the bladder with a catheter.

Placebo, then Alkalinized Lidocaine

Participants will have placebo containing Sodium Chloride 9 g/L, 20 ml and Sodium Chloride 9 g/L, 10 ml, a total of 30 ml installed in the bladder 15 minutes prior to the BTXA-injection procedure.

When signing up for the next BTXA-injection with a wash out period of minimum three months, participants will have Lidocaine Hydrochloride 20 mg/ml, 20 ml and Sodium hydrogen carbonate 1 mmol/ml, 10 ml (ie a total of 30 ml) installed in the bladder for 15 minutes prior to the BTXA-injection procedure.

Group Type ACTIVE_COMPARATOR

Alkalinized Lidocaine

Intervention Type COMBINATION_PRODUCT

20 ml of Lidocaine Hydrochloride and 10 ml of Sodium hydrogen carbonate will be pulled up and mixed in a syringe on site, and 30 ml mixed solution in total will afterwards be installed in the bladder with a catheter.

Placebo Sodium Chloride 0.9% Inj

Intervention Type DRUG

20 ml of Sodium Chloride 9 g/L and 10 ml of Sodium Chloride 9 g/L will be pulled up and mixed in a syringe on site, and 30 ml solution in total will afterwards be installed in the bladder with a catheter.

Interventions

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Alkalinized Lidocaine

20 ml of Lidocaine Hydrochloride and 10 ml of Sodium hydrogen carbonate will be pulled up and mixed in a syringe on site, and 30 ml mixed solution in total will afterwards be installed in the bladder with a catheter.

Intervention Type COMBINATION_PRODUCT

Placebo Sodium Chloride 0.9% Inj

20 ml of Sodium Chloride 9 g/L and 10 ml of Sodium Chloride 9 g/L will be pulled up and mixed in a syringe on site, and 30 ml solution in total will afterwards be installed in the bladder with a catheter.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Female, age ≥18 years
* Admitted to treatment with BTX-A injections at the Urogynecological Clinic at Herlev Hospital due to UUI
* Able to read and understand Danish
* The female accepts to receive BTX-A injections as an outpatient treatment without the option of receiving sedative drugs

Exclusion Criteria

* BTX-A allergy
* Neurological disorder that may affect bladder function (e.g. Multiple sclerosis or spinal cord inju-ry)
* Neurological disorder with neuromuscular transmission failure (i.e. Mystenia Gravis)
* Ongoing UTI or symptoms of UTI prior to treatment, assessed by principal investigator
* Any other bladder pathology at the time of cystoscopy if identified (includes trauma, stones, tu-mor)
* Pregnancy/breastfeeding women
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Region Hovedstadens Apotek

OTHER_GOV

Sponsor Role collaborator

Herlev and Gentofte Hospital

OTHER

Sponsor Role lead

Responsible Party

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Meryam El Issaoui

MD, PhD Student

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Niels Klarskov, Prof,MD,DMSc

Role: STUDY_DIRECTOR

Herlev and Gentofte Hospital, University of Copenhagen

Locations

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Kvinde- og Bækkenbundssygdomme, klinik 1

Herlev, Capital Region, Denmark

Site Status RECRUITING

Countries

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Denmark

Central Contacts

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Meryam El Issaoui, MD

Role: CONTACT

+4553252379

Niels Klarskov, Prof,MD,DMSc

Role: CONTACT

+4538681406

Facility Contacts

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Meryam El Issaoui, MD

Role: primary

+4553252379

Niels Klarskov, Professor, DMSc

Role: backup

+4538681406

References

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Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010 Jan;21(1):5-26. doi: 10.1007/s00192-009-0976-9. Epub 2009 Nov 25.

Reference Type BACKGROUND
PMID: 19937315 (View on PubMed)

Vaughan CP, Johnson TM 2nd, Ala-Lipasti MA, Cartwright R, Tammela TL, Taari K, Auvinen A, Tikkinen KA. The prevalence of clinically meaningful overactive bladder: bother and quality of life results from the population-based FINNO study. Eur Urol. 2011 Apr;59(4):629-36. doi: 10.1016/j.eururo.2011.01.031. Epub 2011 Jan 25.

Reference Type BACKGROUND
PMID: 21306820 (View on PubMed)

Irwin DE, Milsom I, Kopp Z, Abrams P; EPIC Study Group. Symptom bother and health care-seeking behavior among individuals with overactive bladder. Eur Urol. 2008 May;53(5):1029-37. doi: 10.1016/j.eururo.2008.01.027. Epub 2008 Jan 16.

Reference Type BACKGROUND
PMID: 18243515 (View on PubMed)

Nitti VW, Ginsberg D, Sievert KD, Sussman D, Radomski S, Sand P, De Ridder D, Jenkins B, Magyar A, Chapple C; 191622-096 Investigators. Durable Efficacy and Safety of Long-Term OnabotulinumtoxinA Treatment in Patients with Overactive Bladder Syndrome: Final Results of a 3.5-Year Study. J Urol. 2016 Sep;196(3):791-800. doi: 10.1016/j.juro.2016.03.146. Epub 2016 Mar 30.

Reference Type BACKGROUND
PMID: 27038769 (View on PubMed)

Nambiar AK, Younis A, Khan ZA, Hildrup I, Emery SJ, Lucas MG. Alkalinized lidocaine versus lidocaine gel as local anesthesia prior to intra-vesical botulinum toxin (BoNTA) injections: A prospective, single center, randomized, double-blind, parallel group trial of efficacy and morbidity. Neurourol Urodyn. 2016 Apr;35(4):522-7. doi: 10.1002/nau.22750. Epub 2015 Mar 8.

Reference Type BACKGROUND
PMID: 25754188 (View on PubMed)

Nickel JC, Moldwin R, Lee S, Davis EL, Henry RA, Wyllie MG. Intravesical alkalinized lidocaine (PSD597) offers sustained relief from symptoms of interstitial cystitis and painful bladder syndrome. BJU Int. 2009 Apr;103(7):910-8. doi: 10.1111/j.1464-410X.2008.08162.x. Epub 2008 Nov 13.

Reference Type BACKGROUND
PMID: 19021619 (View on PubMed)

Henry R, Patterson L, Avery N, Tanzola R, Tod D, Hunter D, Nickel JC, Morales A. Absorption of alkalized intravesical lidocaine in normal and inflamed bladders: a simple method for improving bladder anesthesia. J Urol. 2001 Jun;165(6 Pt 1):1900-3. doi: 10.1097/00005392-200106000-00014.

Reference Type BACKGROUND
PMID: 11371877 (View on PubMed)

Narahashi T, Frazier T, Yamada M. The site of action and active form of local anesthetics. I. Theory and pH experiments with tertiary compounds. J Pharmacol Exp Ther. 1970 Jan;171(1):32-44. No abstract available.

Reference Type BACKGROUND
PMID: 5410936 (View on PubMed)

Henry RA, Patterson L, Nickel C, Morales A. Alkalinized intravesical lidocaine to treat interstitial cystitis: absorption kinetics in normal and interstitial cystitis bladders. Urology. 2001 Jun;57(6 Suppl 1):119. doi: 10.1016/s0090-4295(01)01069-x. No abstract available.

Reference Type BACKGROUND
PMID: 11378101 (View on PubMed)

Yanagi H, Sankawa H, Saito H, Iikura Y. Effect of lidocaine on histamine release and Ca2+ mobilization from mast cells and basophils. Acta Anaesthesiol Scand. 1996 Oct;40(9):1138-44. doi: 10.1111/j.1399-6576.1996.tb05577.x.

Reference Type BACKGROUND
PMID: 8933856 (View on PubMed)

Pereira E Silva R, Ponte C, Lopes F, Palma Dos Reis J. Alkalinized lidocaine solution as a first-line local anesthesia protocol for intradetrusor injection of onabotulinum toxin A: Results from a double-blinded randomized controlled trial. Neurourol Urodyn. 2020 Nov;39(8):2471-2479. doi: 10.1002/nau.24519. Epub 2020 Sep 21.

Reference Type BACKGROUND
PMID: 32956506 (View on PubMed)

Nitti VW, Dmochowski R, Herschorn S, Sand P, Thompson C, Nardo C, Yan X, Haag-Molkenteller C; EMBARK Study Group. OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. J Urol. 2013 Jun;189(6):2186-93. doi: 10.1016/j.juro.2012.12.022. Epub 2012 Dec 14.

Reference Type BACKGROUND
PMID: 23246476 (View on PubMed)

Duthie JB, Vincent M, Herbison GP, Wilson DI, Wilson D. Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD005493. doi: 10.1002/14651858.CD005493.pub3.

Reference Type BACKGROUND
PMID: 22161392 (View on PubMed)

Dmochowski R, Chapple C, Nitti VW, Chancellor M, Everaert K, Thompson C, Daniell G, Zhou J, Haag-Molkenteller C. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. J Urol. 2010 Dec;184(6):2416-22. doi: 10.1016/j.juro.2010.08.021. Epub 2010 Oct 16.

Reference Type BACKGROUND
PMID: 20952013 (View on PubMed)

Cote TR, Mohan AK, Polder JA, Walton MK, Braun MM. Botulinum toxin type A injections: adverse events reported to the US Food and Drug Administration in therapeutic and cosmetic cases. J Am Acad Dermatol. 2005 Sep;53(3):407-15. doi: 10.1016/j.jaad.2005.06.011.

Reference Type BACKGROUND
PMID: 16112345 (View on PubMed)

Thrasher JB, Peterson NE, Donatucci CF. Lidocaine as a topical anesthetic for bladder biopsies. J Urol. 1991 Jun;145(6):1209-10. doi: 10.1016/s0022-5347(17)38577-4.

Reference Type BACKGROUND
PMID: 2033694 (View on PubMed)

Thrasher JB, Kreder KJ, Peterson NE, Donatucci CF. Lidocaine as topical anesthesia for bladder mappings and cold-cup biopsies. J Urol. 1993 Aug;150(2 Pt 1):335-6. doi: 10.1016/s0022-5347(17)35477-0.

Reference Type BACKGROUND
PMID: 8326556 (View on PubMed)

Birch BR, Miller RA. Absorption characteristics of lignocaine following intravesical instillation. Scand J Urol Nephrol. 1994 Dec;28(4):359-64. doi: 10.3109/00365599409180513.

Reference Type BACKGROUND
PMID: 7886411 (View on PubMed)

El Issaoui M, Elmelund M, Klarskov N. Alkalinised lidocaine as an anaesthetic before onabotulinumtoxinA injections. a randomised trial. BJU Int. 2025 Apr;135(4):638-647. doi: 10.1111/bju.16647. Epub 2025 Jan 11.

Reference Type DERIVED
PMID: 39797697 (View on PubMed)

Related Links

Access external resources that provide additional context or updates about the study.

https://www.ics.org/education/icspublications/icibooks/6thicibook

Abrams P, Cardozo, L, Wagg, A, Wein, A. (Eds) Incontinence 6th Edition. International Continence Society, Bristol UK,: ICI-ICS.; 2017

https://www.ics.org/education/icspublications/icibooks/6thicibook

Incontinence. International Consultation on Incontinence: ICUD; 2017

Other Identifiers

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BTXA2021

Identifier Type: -

Identifier Source: org_study_id

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