Urinary Retention Clinical Trial
Official title:
Superficial Peroneal Nerve Neuromodulation for Non-Obstructive Urinary Retention
Millions of Americans are suffering from underactive bladder (UAB). The impact of severe UAB, i.e. non-obstructive urinary retention (NOUR) on quality of life is significant because current treatment for non-obstructive urinary retention requires intermittent self-catheterization or an indwelling suprapubic catheter. Currently an effective drug for non-obstructive urinary retention does not exist. It is a therapeutic challenge for clinicians to successfully treat non-obstructive urinary retention. Sacral neuromodulation has been approved by the FDA since 1999 to treat non-obstructive urinary retention. It achieves >50% improvement in bladder emptying (reducing the frequency of self-catheterization or increasing voided volume) in just over half of the patients. Sacral neuromodulation requires surgical implantation of a stimulator and a lead with 4 electrodes. The surgery and implant are invasive and expensive, preventing a broad application of this effective therapy to many non-obstructive urinary retention patients. The goal of this study is to develop a novel non-invasive neuromodulation therapy for non-obstructive urinary retention as an alternative. Specifically, the investigators will explore the possibility to translate into humans a recent discovery in cats of an excitatory reflex from the superficial peroneal nerve to the bladder to treat non-obstructive urinary retention. Therefore, in this study the investigators propose to develop a non-invasive, transcutaneous neuromodulation therapy for non-obstructive urinary retention that can be administered at home.
Status | Recruiting |
Enrollment | 10 |
Est. completion date | November 30, 2023 |
Est. primary completion date | November 30, 2023 |
Accepts healthy volunteers | No |
Gender | Female |
Age group | 18 Years to 90 Years |
Eligibility | Inclusion Criteria: Able to provide informed consent 1. 18 years of age and older 2. Clinically diagnoses as non-obstructive urinary retention 3. Post Void Residual of 300 mL or greater 4. Currently using daily self-catheterization to empty the bladder 5. Capable of using the toilet independently without difficulty 6. Capable and willing to follow all study-related procedures Exclusion Criteria: 1. Neurologic diagnosis (including diabetes mellitus) 2. Surgery within one year of screening for urinary outlet obstruction 3. Pregnant or planning to become pregnant during study duration 4. OnabotulinumtoxiA use in bladder or pelvic floor muscles with the past year 5. Pacemaker or implantable defibrillator 6. Current Urinary tract or vaginal infections 7. Current Interstim use 8. Current Percutaneous tibial nerve stimulation (PTNS) or transcutaneous electrical nerve stimulation (TENS) use in pelvis or back or legs 9. Investigational drug/ device therapy with the past 4 weeks, 10. Participation in any clinical investigation involving or impacting gynecologic or urinary function with the past 4 weeks, 11. Previous surgery of or damage to the foot or nerves in the foot and leg. |
Country | Name | City | State |
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United States | UPMC Urology | Pittsburgh | Pennsylvania |
Lead Sponsor | Collaborator |
---|---|
Michael Pintauro | Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, University of North Carolina, Chapel Hill |
United States,
26872574
Abarbanel J, Marcus EL. Impaired detrusor contractility in community-dwelling elderly presenting with lower urinary tract symptoms. Urology. 2007 Mar;69(3):436-40. doi: 10.1016/j.urology.2006.11.019. — View Citation
De Ridder D, Ost D, Bruyninckx F. The presence of Fowler's syndrome predicts successful long-term outcome of sacral nerve stimulation in women with urinary retention. Eur Urol. 2007 Jan;51(1):229-33; discussion 233-4. doi: 10.1016/j.eururo.2006.06.031. Epub 2006 Jul 10. — View Citation
Faraj K, Doo F, Boura J, Vereecke A, Chancellor MB. A cross-sectional study in the USA of the epidemiology and quality of life of underactive bladder symptoms. Int Urol Nephrol. 2016 Nov;48(11):1797-1802. doi: 10.1007/s11255-016-1382-0. Epub 2016 Jul 29. — View Citation
Goodwin RJ, Swinn MJ, Fowler CJ. The neurophysiology of urinary retention in young women and its treatment by neuromodulation. World J Urol. 1998;16(5):305-7. doi: 10.1007/s003450050072. — View Citation
Jonas U, Fowler CJ, Chancellor MB, Elhilali MM, Fall M, Gajewski JB, Grunewald V, Hassouna MM, Hombergh U, Janknegt R, van Kerrebroeck PE, Lylcklama a Nijeholt AA, Siegel SW, Schmidt RA. Efficacy of sacral nerve stimulation for urinary retention: results — View Citation
Juszczak K, Drewa T. Pharmacotherapy in detrusor underactivity: A new challenge for urologists and pharmacologists (from lab to clinic). Pharmacol Rep. 2016 Aug;68(4):703-6. doi: 10.1016/j.pharep.2016.03.007. Epub 2016 Mar 19. — View Citation
Kessler TM, Fowler CJ. Sacral neuromodulation for urinary retention. Nat Clin Pract Urol. 2008 Dec;5(12):657-66. doi: 10.1038/ncpuro1251. Epub 2008 Nov 11. — View Citation
Tai C, Shen B, Chen M, Wang J, Roppolo JR, de Groat WC. Prolonged poststimulation inhibition of bladder activity induced by tibial nerve stimulation in cats. Am J Physiol Renal Physiol. 2011 Feb;300(2):F385-92. doi: 10.1152/ajprenal.00526.2010. Epub 2010 Nov 24. — View Citation
Yu M, Uy J, Jiang X, Li X, Jones C, Shen B, Wang J, Roppolo JR, de Groat WC, Tai C. An excitatory reflex from the superficial peroneal nerve to the bladder in cats. Am J Physiol Renal Physiol. 2017 Nov 1;313(5):F1161-F1168. doi: 10.1152/ajprenal.00265.2017. Epub 2017 Aug 30. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Number of voids per subject in 24 hours. | Counted using a patient voiding diary both before and after superficial peroneal nerve stimulation. | 3 weeks | |
Primary | Number of catheterizations per subject in 24 hours. | Counted using a patient voiding diary both before and after superficial peroneal nerve stimulation. | 3 weeks | |
Primary | Volume of urine per void. | Calculated in millimeters both before and after peroneal nerve stimulation. | 3 weeks | |
Primary | Catheterized Post Void Residual volume | Calculated in millimeters both before and after peroneal nerve stimulation. | 3 weeks | |
Primary | Bladder Voiding efficiency | Pre voiding and post voiding ratio that reflects bladder contractility | 3 weeks | |
Primary | Bladder capacity | Calculated by adding the voided volume to the post residual catheterization volume, in milliliters | 3 weeks | |
Secondary | Efficacy of Foot Stimulation | Difference in millimeters of bladder emptying capacity from week 2 to baseline | 2 weeks | |
Secondary | Efficacy of Foot Stimulation | Difference in millimeters of bladder emptying capacity from week 3 to baseline | 3 weeks | |
Secondary | Post-stimulation effect | Difference in millimeters of bladder emptying capacity from week 2 to week 3. | 1 week |
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