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ShockPulse-SE vs. Trilogy Trial: Comparing the Performance of Two Intracorporeal Lithotripters for Removal of Large Renal Calculi

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ClinicalTrials.gov Identifier: NCT03959683
Recruitment Status : Recruiting
First Posted : May 22, 2019
Last Update Posted : May 22, 2019
Sponsor:
Collaborators:
Boston Scientific Corporation
Ohio State University
Mayo Clinic
University of British Columbia
Information provided by (Responsible Party):
Amy Krambeck, MD, Indiana University

Brief Summary:
The purpose of this study is to measure how well two different devices work to break up and remove kidney stones. We are comparing a newer device to an older one to see which one is faster at breaking up kidney stones. We hypothesize that the Trilogy will increase the stone clearance rate by 25% compared to the Shockpulse-SE

Condition or disease Intervention/treatment Phase
Kidney Calculi Device: Trilogy Lithotrite Device: The ShockPulse-SE Lithotripsy System Not Applicable

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Detailed Description:

Large and complex renal calculi, defined as those with a maximum diameter of ≥ 1.5 cm, can be removed from the upper urinary tract by percutaneous nephrolithotomy but the stones usually require fragmentation in order to remove them through the access site. There are a number of commercially available intracorporeal lithotripters used to fragment or break kidney stones to allow elimination including pneumatic, ultrasonic, and combination devices. Each technology has its own relative advantages and disadvantages.

New versions of intracorporeal lithotripter devices have been introduced with improvements meant to address prior functional limitations such as probe clogging or breaking and cumbersome hand piece design.

The Trilogy lithotrite is the newest generation device stone fragmentation device from Boston Scientific. The Trilogy device uses unique technology to efficiently fragment and remove stone material, superior to other devices on the market based on preliminary bench testing. From Olympus, the ShockPulse-SE Lithotripsy System (Cybersonics, Erie, PA, USA) is a constant ultrasonic wave energy lithotripter with intermittent shock wave (ballistic/mechanical) energy. The ShockPulse-SE has a single probe design with an OD of 3.76 mm which allows for larger sized stone fragments to be vacuumed from the urothelium. The larger, single lumen also allows for a high flow rate to reduce probe clogging events. The end result is faster stone clearance rates based on in vitro studies.

The objective of this study is to compare the performance, as measured by the stone clearance rate at time of percutaneous nephrolithotomy, of the ShockPulse-SE Lithotripsy System to the Trilogy lithotrite when used for large complex renal calculi.

The Trilogy has been FDA cleared for fragmentation of urinary tract calculi in the kidney, ureter, and bladder. Trilogy is a combined piezoelectric/pneumatic device capable of fragmenting calculi and aspirating stone debris. The novel technology in Trilogy has been demonstrated in bench testing to more quickly disintegrate stones compared to other devices.

The ShockPulse-SE Lithotripsy System has been FDA cleared fragmentation of urinary tract calculi in the kidney, ureter, and bladder. The ShockPulse-SE System is an electromechanical device capable of fragmenting calculi and aspirating stone debris. The novel technology in the ShockPulse-SE Lithotripsy System uses a single transducer and proprietary ShockPulse technology to generate both low-frequency mechanical impacts and high-frequency ultrasonic energy which quickly disintegrates stones.

Study Objectives To compare the performance, as measured by the stone clearance rate at time of percutaneous nephrolithotomy, of the ShockPulse-SE Lithotripsy System to the Trilogy Lithotrite.

Study Endpoints Primary Endpoint Stone clearance rate defined as the kidney stone surface area measured by preoperative computed tomography (CT) scan divided by the time to remove the targeted stone burden.

Time to remove the targeted stone burden is measured at time the lithotripter unit starts fragmenting the stone to time all fragments are removed from the kidney based on visual inspection. This is prior to final visual inspection of the kidney with a flexible nephroscope.

Additional Endpoints

  1. Device malfunctions
  2. All complications measured by the Clavien Classification of Surgical Complications Stone free status as defined by the presence or absence of stone material on postoperative day 1 CT imaging This study is a post-market, prospective, randomized, multicenter, 2-arm, comparative trial.

Scale and Duration A total of 100 participants will be enrolled and treated at 4 study sites (3 USA, 1 Canada). Two sites will enroll 16 participants and 2 will enroll at least 18 participants. Each subject will be followed for approximately 6-12 weeks after the study procedure. It is anticipated for the entire study to last approximately 12 months.

Treatment Assignment The participants will be block randomized 1:1 to either stone removal with the Trilogy or the ShockPulse-SE device. All randomization will occur at the central study site via computer randomization by the statistician to limit selection bias.

Justification for the Study Design This study will compare performance of two devices for the treatment of large renal calculi. The study has been designed as a prospective, multi-centric, randomized, comparative study. The intent of this design is to minimize bias and to allow for statistical comparison of the two treatment groups.

Point of Enrollment A participant will be considered enrolled in the study if they meet all eligibility criteria and after the participant signs and dates the informed consent form (ICF). No study-related procedures can take placed until the ICF is signed.

Withdrawal All participants enrolled in the clinical study (including those withdrawn from the clinical study or lost to follow-up) shall be accounted for and documented. If a participant withdraws from the clinical investigation, the reason(s) shall be reported. If such withdrawal is due to problems related to study device safety or performance, the investigator shall ask for the participant's permission to follow his/her status/condition outside of the clinical study.

Reasons for withdrawal include:

  • Physician discretion
  • Participant choice to withdraw consent
  • Lost to follow-up
  • If the participant dies due to any cause

While study withdrawal is discouraged, participants may withdraw from the study at any time, with or without reason, and without prejudice to further treatment.

If any treated study patient is unable to return to the study center after treatment, efforts will be made to obtain complete follow-up information from the patient's primary physician. The reason for a patient's failure to return for the necessary follow-up visits or for a patient's discontinuance from the study must be determined and recorded in the case report forms (CRF).

All applicable CRFs up to the point of participant withdrawal must be completed. Participants who are "lost to follow up" should have documented attempts to contact them.

Additional data may no longer be collected after the point at which a participant has been withdrawn from the study or withdraws his/her consent, for whatever reason. Data collected up to the point of participant withdrawal may be used for study analysis.

Informed Consent All participants taking part in this clinical study must undergo the informed consent process. Participants must be allowed adequate time to review the consent, raise questions, and make a voluntary decision to participate in the clinical study. Each participant must sign and date the IRB approved informed consent form before any clinical study-related procedures are performed. A copy of signed informed consent form will be provided to the participant for his/her records. A participant's participation in the clinical study begins with the signing and dating of the informed consent form.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 100 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Prospective, randomized, multicenter, 2 arm, comparative trial
Masking: Single (Participant)
Primary Purpose: Treatment
Official Title: A Prospective Randomized Multicenter Trial Comparing Performance of Two Intracorporeal Lithotripters for Removal of Large Renal Calculi
Actual Study Start Date : February 19, 2019
Estimated Primary Completion Date : September 30, 2020
Estimated Study Completion Date : December 31, 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Kidney Stones

Arm Intervention/treatment
Active Comparator: Trilogy device
Trilogy Lithotrite to fragment urinary tract calculi in the kidney, ureter and bladder
Device: Trilogy Lithotrite
The Trilogy has been FDA cleared for fragmentation of urinary tract calculi in the kidney, ureter, and bladder. Trilogy is a combined piezoelectric/pneumatic device capable of fragmenting calculi and aspirating stone debris. The novel technology in Trilogy has been demonstrated in bench testing to more quickly disintegrate stones compared to other devices.

Active Comparator: ShockPulse-SE
ShockPulse-SE Lithotripsy System to fragment urinary calculi in the kidney, ureter and bladder
Device: The ShockPulse-SE Lithotripsy System
The ShockPulse-SE System is an electromechanical device capable of fragmenting calculi and aspirating stone debris. The novel technology in the ShockPulse-SE Lithotripsy System uses a single transducer and proprietary ShockPulse technology to generate both low-frequency mechanical impacts and high-frequency ultrasonic energy which quickly disintegrates stones.




Primary Outcome Measures :
  1. Stone clearance rate defined as the kidney stone surface area measured by pre-operative computed tomography (CT) scan divided by the time to remove the targeted stone burden. [ Time Frame: Postoperative day 1 ]
    Time to remove the targeted stone burden is measured at time the lithotripter unit starts fragmenting the stone to time all fragments are removed from the kidney based on visual inspection. This is prior to final visual inspection of the kidney with a flexible nephroscope.


Secondary Outcome Measures :
  1. Device malfunctions during intraoperative device use as described by surgeon completing the device questionnaire. [ Time Frame: any malfunctions during intraoperative device use ]
    any malfunctions during intraoperative device use

  2. All complications measured by the Clavien Classification of Surgical Complications [ Time Frame: Intraoperative ]
    Complications as measured by the Clavien Classification of Surgical Complications

  3. Stone free status as defined by the presence or absence of stone material on postoperative CT imaging and at final follow up [ Time Frame: postoperative day 1 ]
    Stone free status must be assessed postoperative day 1 by CT scan.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. ≥ 18 years of age
  2. At least one renal stone > 1.5 cm in maximum diameter as measured on preoperative CT scan
  3. Patient is scheduled to undergo a percutaneous nephrolithotomy procedure
  4. Willing and able to provide informed consent

Exclusion Criteria:

  1. Pregnant
  2. Active urinary tract infection
  3. Prior shock wave lithotripsy within 3 months of study procedure
  4. Multiple percutaneous access sites are anticipated
  5. Unable or unwilling to provide informed consent -

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03959683


Contacts
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Contact: Amy E Krambeck, MD 3179623700 akrambeck@iuhealth.org
Contact: Christa E Stoughton, BS 3179620870 cstoughton@iuhealth.org

Locations
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United States, Arizona
Mayo Clinic Hospital Not yet recruiting
Phoenix, Arizona, United States, 85054
Contact: Mitchell Humphreys, MD    480-342-2951    Humphreys.Mitchell@mayo.edu   
Contact: Vy Nguyen    4803421328    nguyen.vy@mayo.edu   
United States, Indiana
Indiana University Health Physicians Urology Recruiting
Indianapolis, Indiana, United States, 46202
Contact: Amy E Krambeck, MD    317-962-3700    akrambeck@iuhealth.org   
Contact: Christa E Stoughton    3179620870    cstoughton@iuhealth.org   
United States, Ohio
The Ohio State University Not yet recruiting
Columbus, Ohio, United States, 43212
Contact: Michael Sourial, MD    614-293-8000    michael.sourial@osumc.edu   
Contact: Alicia Scimeca    6146856667    alicia.scimeca@osumc.edu   
Canada, British Columbia
The University of British Columbia Not yet recruiting
Vancouver, British Columbia, Canada, V5Z 1M9
Contact: Ben Chew, MD    6048754111 ext 62421    ben.chew@ubc.ca   
Contact: Victor Wong    6048754111 ext 62421    kfvwong@alumni.ubc.ca   
Sponsors and Collaborators
Indiana University
Boston Scientific Corporation
Ohio State University
Mayo Clinic
University of British Columbia
Investigators
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Principal Investigator: Amy E Krambeck, MD Indiana University Health

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Responsible Party: Amy Krambeck, MD, Michael O. Koch Professor of Urology, Indiana University
ClinicalTrials.gov Identifier: NCT03959683     History of Changes
Other Study ID Numbers: 1803658961
First Posted: May 22, 2019    Key Record Dates
Last Update Posted: May 22, 2019
Last Verified: May 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Device Product Not Approved or Cleared by U.S. FDA: No
Pediatric Postmarket Surveillance of a Device Product: No
Additional relevant MeSH terms:
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Kidney Calculi
Nephrolithiasis
Calculi
Pathological Conditions, Anatomical
Kidney Diseases
Urologic Diseases
Urolithiasis
Urinary Calculi