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CompletedNCT01428830Updated Jan 19, 2015

Non-inferiority of Short-term Catheterization Following Fistula Repair Surgery

An interventional study of 7-day catheterization following fistula repair surgery and 14 day catheterization in Vaginal Fistula, sponsored by EngenderHealth. Completed at 8 sites in 8 countries. Open to female participants. Per ClinicalTrials.gov, last updated 2015-01-19.

Sponsored by EngenderHealth · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
524
Allocation
Randomized
Sex
Female
01

Study summary

This facility-based, multi-center randomized controlled trial (RCT) will test the non-inferiority of short-term (7 day) urethral catheterization compared to longer-term (14 day) urethral catheterization in terms of predicting fistula repair breakdown three months following urinary fistula repair surgery. The study will be conducted among 507 women with simple fistula presenting at 8 study sites in Sub-Saharan Africa for fistula repair surgery.

Read the detailed description

A vaginal fistula is a devastating condition, affecting an estimated 2 million girls and women across Africa and Asia. Finding ways of providing services in a more efficient and cost-effective manner, without compromising surgical outcomes and the overall health of the patient, is paramount. Shortening the duration of urethral catheterization following fistula repair surgery would increase treatment capacity (by freeing available bed space and increasing availability of nursing staff), lower costs of services, and potentially lower risk of healthcare-associated infections among fistula patients. There is a lack of empirical evidence supporting any particular length of time for urethral catheterization following fistula repair surgery.

This facility-based, multi-center randomized controlled trial (RCT) will test the non-inferiority of short-term (7 day) urethral catheterization compared to longer-term (14 day) urethral catheterization in terms of predicting fistula repair breakdown. The primary outcome is fistula repair breakdown three months following fistula repair surgery as assessed by a urinary dye test, a routine practice in fistula repair services. t. Secondary outcomes will include repair breakdown one week following catheter removal, intermittent catheterization due to urinary retention and the occurrence of septic or febrile episodes, prolonged hospitalization (defined as a stay at the facility beyond one week following initial catheter removal related to an adverse event), catheter blockage, and self-reported residual incontinence. This study will be conducted among 507 women with simple fistula presenting at 8 study sites for fistula repair surgery over the course of 16-18 months at each site.

02

Conditions studied

  • Vaginal Fistula

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Keywords

  • fistula
  • catheter
  • surgery
  • obstetrics
  • gynecology
  • urology
03

Who can participate

Ages eligible
Child (0–17), Adult (18–64), Older adult (65+)
Sexes eligible
Female
Accepts healthy volunteers
No

Inclusion criteria

  • Have a "simple" fistula, as determined at the end of fistula repair surgery (irrespective of the number of prior repair attempts and the cause of the fistula, with the exceptions noted under the exclusion criteria below)
  • Have a closed fistula at completion of surgery
  • Have a closed fistula 7 days after surgery (i.e. at the time of randomization)
  • Understand study procedures and requirements
  • Agree to return to the facility for one follow-up visit three month after the date of surgery
  • Provide informed consent to participate in the study or in the case of non-emancipated minors, both consent to the study and receive proxy consent to participate in the study
  • Have no contraindications precluding their participation.

Exclusion criteria

Exclusion Criteria:

  • Have a fistula that is determined to be "not simple" (i.e. intermediate or complex)
  • Have a fistula that is radiation-induced, associated with cancer or due to lymphogranuloma venereum (These cases will be excluded because the healing process is very different from fistula resulting from other causes. We expect there to be few cases of these fistulas at the study sites)
  • Have a fistula that is not closed immediately after surgery or 7 days after surgery (i.e. at the time of randomization)
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
524 participants (actual)

Study arms

  • Experimental
    7-day catheterization

    Procedure: 7-day catheterization following fistula repair surgery

  • Active comparator
    14-day catheterization

    Procedure: 14 day catheterization

Interventions

  • Procedure7-day catheterization following fistula repair surgery

    This group will have an indwelling urethral catheter for 7 days following fistula repair surgery.

  • Procedure14 day catheterization

    This group will have an indwelling urethral catheter for 14 days following fistula repair surgery.

05

What researchers measure

Primary outcomes

  1. Fistula repair breakdown three months following fistula repair surgery as assessed by a urinary dye test.

    Time frame: 3 months

Secondary outcomes

  1. Repair breakdown one week following catheter removal

    Time frame: 14 days or 21 days post-repair

  2. Intermittent catheterization due to urinary retention

    Time frame: 7 or 14 days post repair

  3. Prolonged hospitalization

    Time frame: 14 or 21 days post-repair

  4. Catheter blockage

    Time frame: 14 or 21 days post repair

  5. Self-reported residual incontinence

    Time frame: 3 months

  6. The occurrence of septic or febrile episodes

    Time frame: 14 or 21 days post-repair

06

Study locations

8 sites
  • Hôpital Saint Joseph
    Kinshasa, Congo, The Democratic Republic of the
  • Gondar University Hospital
    Gondar, Ethiopia
  • L'Hôpital Préfectoral de Kissidougou
    Kissidougou, Guinea
  • Kenyatta National Hospital
    Nairobi, Kenya
  • National Obstetric Fistula Centre
    Abakaliki, Nigeria
  • Maternité Centrale de Zinder
    Zinder, Niger
  • Aberdeen Women's Centre
    Freetown, Sierra Leone
  • Kagando Hospital
    Kasese District, Uganda
07

References and documents

Publications

  • Barone MA, Widmer M, Arrowsmith S, Ruminjo J, Seuc A, Landry E, Barry TH, Danladi D, Djangnikpo L, Gbawuru-Mansaray T, Harou I, Lewis A, Muleta M, Nembunzu D, Olupot R, Sunday-Adeoye I, Wakasiaka WK, Landoulsi S, Delamou A, Were L, Frajzyngier V, Beattie K, Gulmezoglu AM. Breakdown of simple female genital fistula repair after 7 day versus 14 day postoperative bladder catheterisation: a randomised, controlled, open-label, non-inferiority trial. Lancet. 2015 Jul 4;386(9988):56-62. doi: 10.1016/S0140-6736(14)62337-0. Epub 2015 Apr 21. PubMed 25911172 ↗
  • Barone MA, Frajzyngier V, Arrowsmith S, Ruminjo J, Seuc A, Landry E, Beattie K, Barry TH, Lewis A, Muleta M, Nembunzu D, Olupot R, Sunday-Adeoye I, Wakasiaka WK, Widmer M, Gulmezoglu AM. Non-inferiority of short-term urethral catheterization following fistula repair surgery: study protocol for a randomized controlled trial. BMC Womens Health. 2012 Mar 20;12:5. doi: 10.1186/1472-6874-12-5. PubMed 22433581 ↗
08

Registry details

Key details

Study ID
NCT01428830
Lead sponsor
EngenderHealth
Collaborators
World Health Organization, United States Agency for International Development (USAID)
Responsible party
Sponsor
First posted
Sep 5, 2011
Start date
Jan 2012
Primary completion
Aug 2013
Completion
Aug 2013
Last update
Jan 19, 2015

Study contacts

Mark A Barone, DVM, MS
principal investigator · EngenderHealth
Mariana Widmer
study director · World Health Organization

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Jan 2015. You cannot join it, but the record below documents what was studied.

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