Urinary Bladder, Underactive Clinical Trial
— AMPLIFYOfficial title:
AMPLIFY: Amplifying Sensation in Underactive Bladder
Verified date | August 2023 |
Source | Duke University |
Contact | Em Abbott, PhD |
Phone | 919-660-5299 |
em.abbott[@]duke.edu | |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
The purpose of this study is to determine the influence of intravesical (bladder) electrical stimulation and intraurethral electrical stimulation on bothersome symptoms and bladder function in neurologically-intact adult women with underactive bladder. The investigators hypothesize that electrical stimulation will decrease bothersome urinary symptoms relative to baseline and increase voided percentage during pressure-flow studies compared to their routine clinical exam.
Status | Recruiting |
Enrollment | 20 |
Est. completion date | December 31, 2024 |
Est. primary completion date | December 31, 2024 |
Accepts healthy volunteers | No |
Gender | Female |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Females ages 18 and older - Able to provide informed consent and agree to the study risks - Willing to withdraw from medications affecting urination for the 48 hours prior to the procedure (e.g., alpha-adrenergic antagonists, cholinergic agonists, cholinesterase inhibitors) - Has the below response to 2 of the 3 questions: 1. Questions regarding self-reported poor sensation during bladder filling or emptying (one or more of the below) - In the past 7 days, where did the participant feel sensations when needing to urinate? Answer: "No" response for Bladder Area - In the past 7 days, how often did the participant have no sensation of urine flow while urinating? Answer: "Most of the time" or "Every time" response - In the past 7 days, how often did the participant feel that the bladder was not completely empty after urination? Answer: "Most of the time" or "Every time" response 2. Questions regarding self-reported bothersome urinary symptoms (one or more of the below) - In the past 7 days, how satisfied was the participant with bladder function? Answer: "Not at all satisfied" or "Somewhat satisfied" response - In the past 7 days, how bothered was the participant by urinary symptoms? Answer: "Very bothered" or "Extremely bothered" response 3. Standard uroflowmetry with a voiding efficiency (voided volume / voided volume + residual volume) of < 80%, voided volume + residual volume must be >150ml for measurement Exclusion Criteria: - Preexisting neurological impairment (e.g., spinal cord injury, multiple sclerosis, Guillain-Barre, cauda equina syndrome, cerebrovascular accident, Parkinson's disease, traumatic brain injury) - Functional obstruction demonstrated by either elevated pelvic floor activity on EMG during standard pressure flow study or high tone pelvic floor on clinical exam) - Pelvic organ prolapse beyond introitus - Active urinary tract infection (candidate would be deferred until treated) - Positive pregnancy test - Less than 6 weeks postpartum - Unevaluated hematuria - Urethral stricture/stenosis - Surgical obstruction i.e., urinary retention due to obstructive sling or other anti incontinence procedure - Surgical procedures to increase bladder capacity (e.g., augmentation cystoplasty) - Active sacral neuromodulation or ongoing posterior tibial nerve stimulation sessions - Botulinum toxin injection in the past six months - History of genitourinary or gastrointestinal cancer |
Country | Name | City | State |
---|---|---|---|
United States | Duke Medical Plaza Patterson Place | Durham | North Carolina |
Lead Sponsor | Collaborator |
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Duke University |
United States,
Bump RC. The urethrodetrusor facilitative reflex in women: results of urethral perfusion studies. Am J Obstet Gynecol. 2000 Apr;182(4):794-802; discussion 802-4. doi: 10.1016/s0002-9378(00)70328-0. — View Citation
Cella D, Smith AR, Griffith JW, Flynn KE, Bradley CS, Gillespie BW, Kirkali Z, Talaty P, Jelovsek JE, Helfand BT, Weinfurt KP; LURN Study Group. A new outcome measure for LUTS: Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index-29 (LURN SI-29) questionnaire. Neurourol Urodyn. 2019 Aug;38(6):1751-1759. doi: 10.1002/nau.24067. Epub 2019 Jun 21. — View Citation
Chapple CR, Osman NI, Birder L, van Koeveringe GA, Oelke M, Nitti VW, Drake MJ, Yamaguchi O, Abrams P, Smith PP. The underactive bladder: a new clinical concept? Eur Urol. 2015 Sep;68(3):351-3. doi: 10.1016/j.eururo.2015.02.030. Epub 2015 Mar 11. — View Citation
Deng H, Liao L, Wu J, Chen G, Li X, Wang Z, Wan L. Clinical efficacy of intravesical electrical stimulation on detrusor underactivity: 8 Years of experience from a single center. Medicine (Baltimore). 2017 Sep;96(38):e8020. doi: 10.1097/MD.0000000000008020. — View Citation
Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008 Jun;9(6):453-66. doi: 10.1038/nrn2401. — View Citation
Gammie A, Kaper M, Dorrepaal C, Kos T, Abrams P. Signs and Symptoms of Detrusor Underactivity: An Analysis of Clinical Presentation and Urodynamic Tests From a Large Group of Patients Undergoing Pressure Flow Studies. Eur Urol. 2016 Feb;69(2):361-9. doi: 10.1016/j.eururo.2015.08.014. Epub 2015 Aug 28. — View Citation
Gladh G, Mattsson S, Lindstrom S. Intravesical electrical stimulation in the treatment of micturition dysfunction in children. Neurourol Urodyn. 2003;22(3):233-42. doi: 10.1002/nau.10078. — View Citation
Gustafson KJ, Creasey GH, Grill WM. A urethral afferent mediated excitatory bladder reflex exists in humans. Neurosci Lett. 2004 Apr 22;360(1-2):9-12. doi: 10.1016/j.neulet.2004.01.001. — View Citation
Jeong SJ, Kim HJ, Lee YJ, Lee JK, Lee BK, Choo YM, Oh JJ, Lee SC, Jeong CW, Yoon CY, Hong SK, Byun SS, Lee SE. Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women. Korean J Urol. 2012 May;53(5):342-8. doi: 10.4111/kju.2012.53.5.342. Epub 2012 May 18. — View Citation
Jiang CH, Lindstrom S. Optimal conditions for the long-term modulation of the micturition reflex by intravesical electrical stimulation: an experimental study in the rat. BJU Int. 1999 Mar;83(4):483-7. doi: 10.1046/j.1464-410x.1999.00947.x. — View Citation
Jung SY, Fraser MO, Ozawa H, Yokoyama O, Yoshiyama M, De Groat WC, Chancellor MB. Urethral afferent nerve activity affects the micturition reflex; implication for the relationship between stress incontinence and detrusor instability. J Urol. 1999 Jul;162(1):204-12. doi: 10.1097/00005392-199907000-00069. — View Citation
Kenton K, Simmons J, FitzGerald MP, Lowenstein L, Brubaker L. Urethral and bladder current perception thresholds: normative data in women. J Urol. 2007 Jul;178(1):189-92; discussion 192. doi: 10.1016/j.juro.2007.03.032. Epub 2007 May 17. — View Citation
Lee WC, Wu HP, Tai TY, Yu HJ, Chiang PH. Investigation of urodynamic characteristics and bladder sensory function in the early stages of diabetic bladder dysfunction in women with type 2 diabetes. J Urol. 2009 Jan;181(1):198-203. doi: 10.1016/j.juro.2008.09.021. Epub 2008 Nov 14. — View Citation
Miyazato M, Yoshimura N, Chancellor MB. The other bladder syndrome: underactive bladder. Rev Urol. 2013;15(1):11-22. — View Citation
Osman NI, Chapple CR, Abrams P, Dmochowski R, Haab F, Nitti V, Koelbl H, van Kerrebroeck P, Wein AJ. Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol. 2014 Feb;65(2):389-98. doi: 10.1016/j.eururo.2013.10.015. Epub 2013 Oct 26. — View Citation
Ukimura O, Ushijima S, Honjo H, Iwata T, Suzuki K, Hirahara N, Okihara K, Mizutani Y, Kawauchi A, Miki T. Neuroselective current perception threshold evaluation of bladder mucosal sensory function. Eur Urol. 2004 Jan;45(1):70-6. doi: 10.1016/j.eururo.2003.08.004. — View Citation
Uren AD, Cotterill N, Harding C, Hillary C, Chapple C, Klaver M, Bongaerts D, Hakimi Z, Abrams P. Qualitative Exploration of the Patient Experience of Underactive Bladder. Eur Urol. 2017 Sep;72(3):402-407. doi: 10.1016/j.eururo.2017.03.045. Epub 2017 Apr 8. — View Citation
Yoo PB, Horvath EE, Amundsen CL, Webster GD, Grill WM. Multiple pudendal sensory pathways reflexly modulate bladder and urethral activity in patients with spinal cord injury. J Urol. 2011 Feb;185(2):737-43. doi: 10.1016/j.juro.2010.09.079. Epub 2010 Dec 18. — View Citation
* Note: There are 18 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Voided Percentage | Use of intraurethral electrical stimulation or intravesical electrical stimulation to assess increase in voided percentage during pressure-flow studies. Voided percentage is calculated as voided volume divided by the sum of voided volume and residual volume. | pressure-flow study, up to 30 minutes | |
Primary | Change in Bothersome Symptoms and Sensation | Lower Urinary Tract Dysfunction Research Network Symptom Index-29 (LURN SI-29) to assess whether electrical stimulation decreases urinary bothersome symptoms and increases bladder sensation during filling and emptying. Scores range from 0 (least severe) to 100 (most severe). Higher scores indicate greater severity of lower urinary tract symptoms. | baseline and post study procedures, up to 30 minutes | |
Secondary | Current Perception Threshold | Assess bladder or urethral current perception threshold (CPT) in women with underactive bladder compared to normative values. The CPT value determined by the device is defined as the average of the minimum amplitude of the stimulus consistently detected and the stimulus 40 µA lower that was consistently not detected. | CPT, up to 30 minutes | |
Secondary | Cystometry Volume | Use of intravesical electrical stimulation to assess volumes at cystometric endpoints relative to baseline. Bladder sensation and urgency assessed at volume of first sensation during bladder filling, first desire to void, strong desire to void, and maximum cystometric capacity. | cystometry, up to 30 minutes | |
Secondary | Bladder Contraction Strength | Use of intraurethral electrical stimulation to assess contraction strength relative to baseline. Bladder pressure (cmH2O) is recorded over time during voiding. | pressure-flow study, up to 30 minutes | |
Secondary | Bladder Contraction Duration | Use of intraurethral electrical stimulation to assess contraction duration relative to baseline. Bladder pressure is recorded over time (seconds) during voiding. | pressure-flow study, up to 30 minutes |
Status | Clinical Trial | Phase | |
---|---|---|---|
Recruiting |
NCT04000763 -
Superficial Peroneal Nerve Neuromodulation for Non-Obstructive Urinary Retention
|
N/A |