Study to Prevent Postoperative Urinary Retention

Inguinal Hernia Clinical Trial

— STOP-POUR  

Official title:

Randomized, Quadruple Blinded, Placebo Controlled, Multi-centered Trial Investigating Prophylactic Tamsulosin in Prevention of Postoperative Urinary Retention in Men After Endoscopic Total Extraperitoneal Inguinal Hernia Repair

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04491526
• Other study ID #: 2020-00569
• Status: Recruiting
• Phase: Phase 4
• Start date: November 1, 2020
• Est. completion date: June 30, 2025

Study information

• Verified date: March 2023
• Source: Kantonsspital Baden
• Contact: Uwe Bieri, MD
• Phone: +4179 268 78 37
• Email: uwe.bieri[@]gmail.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Post-operative urinary retention (POUR) is a common complication after inguinal hernia repair with a reported incidence up 34%. It can be described as the inability to initiate urination or properly empty one's bladder following surgery. It is usually self-limited, but it requires the use of catheterization to empty the bladder in order to prevent further injury to the bladder or kidneys and to relief the discomfort of a full bladder. Tamsulosin is a medication that is commonly used in men with urinary symptoms related to an enlarged prostate. There is some evidence to suggest that it may also potentially be beneficial for preventing post-operative urinary retention.

The purpose of this study is to determine if tamsulosin ("TAMSULOSIN Mepha Ret Depocaps 0.4 mg") is effective in preventing post-operative urinary retention following endoscopic total extraperitoneal inguinal hernia repair and its impact on hospital length of stay.

Description:

In this RCT subjects are randomly and parallel assigned to one of two groups: one (the experimental group) receiving "Tamsulosin 0.4 mg"/ day, 5 days prior to the day of laparoscopic inguinal hernia repair surgery, at the day of surgery and for 1 day following surgery. (5+1+1), and the other (the control group) receiving one placebo capsule matching the active study drug per day from 5 days prior to the day of surgery, at the day of surgery and for 1 day following surgery. (5+1+1). There will be effective (concealed) randomization of the subjects to the intervention/control groups (to eliminate selection bias and minimize confounding variables). Both groups will be treated identically in all respects except for the intervention being tested and to this end patients, investigators, care providers and outcomes assessors will be blinded to which group an individual is assigned. Group assignment will be performed using a covariate-adaptive allocation procedure to provide a balance for selected covariates (Site, IPSS-Score, Age, "uni- or bilateral surgery" and "history of prostate or bladder surgery". To achieve that; Minimization, first described by Taves [and expanded by Pocock and Simon [the most commonly used covariate-adaptive randomization method will be applied. It achieves the balance in treatment assignments across factor levels by choosing the allocation for the new subject that would lead to the smallest degree of imbalance possible across the set of his baseline characteristics. The two groups are then followed up to 3 days after surgery to see if there are any differences between them in primary and secondary outcomes. Patients are analyzed within the group to which they were allocated, irrespective of whether they experienced the intended intervention (intention to treat analysis). This RCT is designed as a superiority trial and aims to demonstrate the superiority of Tamsulosin in prevention of POUR compared to placebo. We anticipate the detection of a 65% relative risk reduction of POUR in the experimental group in comparison with the placebo group. To detect a 65% reduction of POUR in the experimental group (2.9% anticipated) in comparison with the placebo group (8.3% anticipated) and to assure a study power of 80% with a Fisher's Exact Test and a significance level of 5% and adjusting for a drop-out rate of 2% we need 634 patients in total; 317 in each group. Our target population consists of male patients ≥ 60 yrs, scheduled for elective endoscopic inguinal hernia repair. The studied sample is appropriate to the hypothesis being tested so that any results will be appropriately generalizable.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 634
• Est. completion date: June 30, 2025
• Est. primary completion date: December 30, 2024
• Accepts healthy volunteers: No
• Gender: Male
• Age group: 60 Years and older

Eligibility

Inclusion Criteria:

• Males

• =60 years old

• Planned uni- or bilateral endoscopic total extraperitoneal inguinal hernia repair

• Surgery scheduled more than 6 days from the time of consent

• Informed Consent as documented by signature (Appendix Informed Consent Form)

Exclusion Criteria:

• Orthostatic hypotension (feeling of dizziness after getting up from a sitting or lying position)

• Severe liver disease (Child Pugh C)

• Taking strong inhibitors of CYP3A4 (ketoconazole, itraconazole, clarithromycin, ritonavir, indinavir/ritonavir, lopinavir, or conivaptan)

• Being on alpha-blockers (alfuzosin, doxazosin, prazosin, terazosin, tamsulosin, phenoxybenzamine, or silodosin) or a combination product containing alpha-blocker (duodart)

• History of allergy or sensitivity to tamsulosin or other alpha-blockers (alfuzosin, doxazosin, prazosin, terazosin, or phenoxybenzamine)

• Long term Indwelling urinary or suprapubic catheter

• Status post cystectomy

• Inability to provide informed consent

• Known or suspected non-compliance, drug or alcohol abuse,

• Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, dementia, etc. of the participant,

• Participation in another study with investigational drug within the 30 days preceding and during the present study,

• Previous enrolment into the current study

Related Conditions & MeSH terms

• Hernia
• Hernia, Inguinal
• Inguinal Hernia
• Urinary Retention

Intervention

Drug:
• TAMSULOSIN Mepha Ret Depocaps 0.4 mg
0.4mg/day Tamsulosin hydrochloride ("TAMSULOSIN Mepha Ret Depocaps 0.4 mg") from 5 days prior to the day of surgery, at the day of surgery and for 1 day following surgery. (5+1+1)
• Control Intervention
One placebo capsule matching the active study drug per day from 5 days prior to the day of surgery, at the day of surgery and for 1 day following surgery. (5+1+1)

Locations

Country	Name	City	State
Switzerland	Kantonsspital Baden	Baden	Aargau

Sponsors (1)

Lead Sponsor	Collaborator
Antonio Nocito, MD

Country where clinical trial is conducted

Switzerland, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Post operative urinary retention (Need for any catheterization postoperatively)	Need for any catheterization postoperatively (Yes/No)	up to 3 days after surgery
Secondary	Time to first voiding after surgery	secondary outcomes in Non-POUR Patients	up to 3 days after surgery
Secondary	Urinary Volume measurement at defined points in time (n)	secondary outcomes in all Patients	up to 12 hours after surgery
Secondary	Volume of first micturition after surgery	secondary outcomes in Non-POUR Patients	up to 12 hours after surgery
Secondary	Post-operative Pain (Quantity of Pain / VAS-Score)	Quantity of pain is verified at arrival in the PACU and at every 6 hours by the nursing staff, using the standardised numeric rating scale. The Numeric Rating Scale (NRS-11) is an 11-point scale for patient self-reporting of pain. It is for adults and children 10 years old or older.	up to 3 days after surgery
Secondary	Need for opioid analgesics post operatively	secondary outcomes in all Patients	up to 3 days after surgery
Secondary	Quantity of post-operative opioid use (opioid dosage will be converted to oral morphine equivalence dose)	opioid use is documented in the patient's record, opioid dosage will be converted to oral morphine equivalence dose	up to 3 days after surgery
Secondary	Intraoperative applications of opioid analgesics (Yes/No)	Opioid use during surgery is documented in the patient's record, this is a binary endpoint opioid use; (yes/ no)	intra-operative period
Secondary	Quantity of intra-operative opioid use opioid dosage will be converted to oral morphine equivalence dose)	Opioid use during surgery is documented in the patient's record, opioid dosage will be converted to oral morphine equivalence dose	intra-operative period
Secondary	Amount of intraoperative fluid administration	Intraoperative fluid administration (in milliliter) is documented in the patient's record	intra-operative period
Secondary	International Prostate Symptom Score (IPSS score) pre-surgery (-5d)	0-7 Mildly symptomatic / 8-19 Moderately symptomatic / 20-35 Severely symptomatic	min. 5 days prior to surgery
Secondary	International Prostate Symptom Score (IPSS score) post-surgery (3d)	0-7 Mildly symptomatic / 8-19 Moderately symptomatic / 20-35 Severely symptomatic	3 days post surgery
Secondary	Change in International Prostate Symptom Score (IPSS score) from baseline prior to surgery (-5d) to day 3(+3d) after surgery	0-7 Mildly symptomatic / 8-19 Moderately symptomatic / 20-35 Severely symptomatic	3 days post surgery
Secondary	Side-effects of study medication (orthostatic hypotension, retrograde ejaculation, Floppy-Iris-Syndrom)	Will be documented in the patient record by the study personnel, binary endpoint (Yes/No)	5 days prior to surgery (-5d) to day 3(+3d) after surgery
Secondary	In hospital complications (using the evaluated standard classification for complication in surgery (Classification Grade I-V) )	secondary outcomes in all Patients	as long as the patient is labeled inpatient, on average 1-3 days
Secondary	Length of hospital stay in days (Inpatients)	secondary outcomes in all Patients	as long as the patient is labeled inpatient, on average 1-3 days
Secondary	Time to discharge after surgery in hours (outpatients)	secondary outcomes in all Patients	up to 12 hours after surgery
Secondary	Residual urinary volume after catherization	secondary outcomes in POUR Patients	up to 12 hours after surgery
Secondary	Macrohematuria	secondary outcomes in POUR Patients	3 days post surgery
Secondary	Relevant injury to the urethra (Presence of a Via falsa diagnosed by a urologist)	secondary outcomes in POUR Patients	3 days post surgery
Secondary	Catheter-related infections	secondary outcomes in POUR Patients	3 days post surgery
Secondary	Catheter-related bladder discomfort ( (Ggrading according to the 3three Ggrades (mild, moderate, severe)	secondary outcomes in POUR Patients	3 days post surgery
Secondary	Prostatitis	secondary outcomes in POUR Patients	3 days post surgery
Secondary	Failed first trial without catheter (TWOC: need for a second catheter insertion due to insufficient voiding after TWOC).	secondary outcomes in POUR Patients	1 day post surgery