The Effect of Local Anesthetic Solution in the Bladder Prior to Botox Injections in the Bladder
Study Details
Study Description
Brief Summary
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.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 3 |
Detailed Description
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:
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Active drug: Lidocaine Hydrochloride and Sodium hydrogen carbonate
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Placebo: Sodium Chloride
The study includes 5 study visits:
Visit 1:
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First treatment day
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Randomization
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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
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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
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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):
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Phone consultation 1 week after treatment:
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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:
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Questions on symptoms of UTI: dysuria, cloudy urine, pollakiuria, nocturia
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Hematuria
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Inability to empty the bladder
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Other symptoms
(Visit 3:)
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The participant contacts the Clinic for next treatment approximately 6-12 months later
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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:
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Second treatment day
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The participant receives the opposite treatment, still double-blinded
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Registration of pre-treatment pain relief medications: paracetamol, ibuprofen, or other medications
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Registration of antibiotic treatment: current antibiotic treatment or long-term prophylactic antibiotic for prevention of recurrent UTI
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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):
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Phone consultation 1 week after treatment:
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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:
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Questions on symptoms of UTI: dysuria, cloudy urine, pollakiuria nocturia,
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Hematuria
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Inability to empty the bladder
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Other symptoms
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Active Comparator: 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. |
Combination Product: 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.
Drug: 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.
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Active Comparator: 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. |
Combination Product: 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.
Drug: 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.
|
Outcome Measures
Primary Outcome Measures
- 100 mm Visual Analogue Scale (VAS) score [The participant is handed the VAS in paper form and asked to grade the intensity of pain according to the VAS by making a handwritten mark on the VAS immediately after the BTX-A injections]
The maximum pain score reported by using VAS
Secondary Outcome Measures
- Post-void residual requiring Clean Intermittent Catheterization (CIC) [Phone consultation one week after each treatment]
The participant is contacted after each treatment and asked about any inability to empty the bladder
- Urinary tract infection (UTI) [Phone consultation one week after each treatment]
The participant is contacted after each treatment and asked about symptoms of UTI: Dysuria, cloudy urine, pollakiuria, nocturia
- Hematuria [Phone consultation one week after each treatment]
The participant is contacted after each treatment and asked about blood in the urine
- 5-point rating scale [Phone consultation one week after each treatment]
The participant is contacted one week after every treatment and asked about the experience on the procedure. The participant's experience on the procedure on a 5-point ordinal scale: "1- very unsatis-fied", "2- unsatisfied", "3- neither unsatisfied or satisfied", "4- satisfied", "5-very satisfied"
Eligibility Criteria
Criteria
Inclusion criteria:
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Female, age ≥18 years
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Admitted to treatment with BTX-A injections at the Urogynecological Clinic at Herlev Hospital due to UUI
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Able to read and understand Danish
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The female accepts to receive BTX-A injections as an outpatient treatment without the option of receiving sedative drugs
Exclusion criteria:
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BTX-A allergy
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Neurological disorder that may affect bladder function (e.g. Multiple sclerosis or spinal cord inju-ry)
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Neurological disorder with neuromuscular transmission failure (i.e. Mystenia Gravis)
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Ongoing UTI or symptoms of UTI prior to treatment, assessed by principal investigator
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Any other bladder pathology at the time of cystoscopy if identified (includes trauma, stones, tu-mor)
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Pregnancy/breastfeeding women
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Herlev and Gentofte Hospital
- Region Hovedstadens Apotek
Investigators
- Study Director: Niels Klarskov, Prof,MD,DMSc, Herlev and Gentofte Hospital, University of Copenhagen
Study Documents (Full-Text)
None provided.More Information
Additional Information:
- Abrams P, Cardozo, L, Wagg, A, Wein, A. (Eds) Incontinence 6th Edition. International Continence Society, Bristol UK,: ICI-ICS.; 2017
- Incontinence. International Consultation on Incontinence: ICUD; 2017
Publications
- Birch BR, Miller RA. Absorption characteristics of lignocaine following intravesical instillation. Scand J Urol Nephrol. 1994 Dec;28(4):359-64.
- Coté 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.
- 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.
- 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. Review.
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- 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.
- 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.
- 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.
- Thrasher JB, Peterson NE, Donatucci CF. Lidocaine as a topical anesthetic for bladder biopsies. J Urol. 1991 Jun;145(6):1209-10.
- 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.
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