CClinicalTrials.gg
Status unknownNCT03283124Updated Mar 5, 2019

Comparing Transvaginal Self-tailored Titanium-coated Polypropylene Mesh Procedure With Mesh-kit Procedure.

An interventional study of pelvic floor reconstructive surgery in Pelvic Organ Prolapse, sponsored by Peking Union Medical College Hospital. Status unknown at 11 sites in China. Open to female participants aged 50 Years to 75 Years. Per ClinicalTrials.gov, last updated 2019-03-05.

Sponsored by Peking Union Medical College Hospital · Not applicable, Interventional, and Treatment

The sponsor has not verified this record recently (last verified Feb 2019), so the status shown — last known as Recruiting — may be out of date.
Phase
Not applicable
Study type
Interventional
Enrollment
312
Allocation
Randomized
Ages
50 Years to 75 Years
Sex
Female
01

Study summary

Pelvic organ prolapse(POP) is a common health problem and has significant negative effects on woman's quality of life. Transvaginal mesh procedure is a durable reconstructive surgery, but the mesh kits are expensive for underdeveloped countries. Our preliminary trial showed that the use of self-tailored mesh had good success rate (91.8% at 1-year follow-up) and low complication rate. The trial is designed to compare self-tailored titanium-coated polypropylene mesh procedure with mesh-kit in the treatment of POP stage III-IV in terms of efficacy, safety and cost-effective .

Read the detailed description

The trial is a randomized controlled multi-center non-inferiority trial. The primary outcome measure is success rate at 1-year follow-up. The second outcomes are subjective improvement of quality of life, complications and costs. Analysis will be performed according to the intention to treat principle. Based on comparable success rate of 90% and 10% as the margin(beta 0.2 and one sided alpha 0.025), about 312 patients in total from 11 centers will be recruited per group including 10% drop-out. The aims of the research are to demonstrate whether self-tailored mesh is non-inferior to the mesh-kit. The finding of this research might influence the treatment selection for POP in China.

02

Conditions studied

  • Pelvic Organ Prolapse
03

Who can participate

Ages eligible
50 Years to 75 Years
Sexes eligible
Female
Accepts healthy volunteers
No

Inclusion criteria

  • Age:More than 50 years old with 3 years after menopause or more than 55 years old, but less than 75 years old.
  • Subject must have severe apical or anterior vaginal prolapse (stage III-IV), with moderate posterior vaginal prolapse(stage I-II). This is defined as ( C > +1cm OR Ba > +1cm, with Bp ≤+1cm by the POP-Q). This is the most common modality of multiple compartment POP in clinic.
  • Subject reports a bothersome bulge they can see or feel per PFDI-20, question 3, response of 2 or higher (i.e., responses of "somewhat", "moderately", or "quite a bit").
  • Desires transvaginal mesh treatment for primary or recurrent, symptomatic uterovaginal prolapse.
  • Concomitant hysterectomy when indicated. But concomitant anti-incontinence surgeries will not be enrolled.
  • Subject is willing and able to comply with the follow-up regimen.

Exclusion criteria

Exclusion Criteria:

  • Subject is pregnant or intends to become pregnant in the future
  • Subject has an active or chronic systemic infection including any gynecologic infection, untreated urinary tract infection (UTI) or tissue necrosis
  • Subject has history of pelvic organ cancer (e.g. uterine, ovarian, bladder, colo-rectal or cervical)
  • Subject has had prior or is currently undergoing radiation, laser therapy, or chemotherapy in the pelvic area
  • Subject has taken systemic steroids (within the last month), or immunosuppressive or immunomodulatory treatment (within the last 3 months)
  • Subject has systemic connective tissue disease (e.g. scleroderma, systemic lupus erythematosus (SLE), Marfan syndrome, Ehlers Danlos, collagenosis, polymyositis, polymyalgia rheumatica)
  • Subject has chronic systemic pain that includes the pelvic area or chronic focal pain that involves the pelvis
  • Subject has uncontrolled diabetes mellitus (DM)
  • Subject has a known neurologic or medical condition affecting bladder function (e.g., multiple sclerosis, spinal cord injury or stroke with residual neurologic deficit)
  • Subject has had previous prolapse repair with mesh in the target compartment
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
312 participants (estimated)

Study arms

  • Active comparator
    self-cut mesh procedure

    This procedure is transvaginal mesh implantation surgery for POP patients. Self-cut mesh procedure is an economic pelvic reconstructive surgical operation with use of specially designed puncture needles and self-cut mesh, which mainly provide anterior and apical compartments support, with posterior compartment reinforced by bridge technique repair. The mesh pieces used in this surgery was cut from a single piece of mesh material(TiLOOP 10\*15cm) which is much cheaper and readily available. Patients could have transvaginal hysterectomy concomitantly.

    Procedure: pelvic floor reconstructive surgery

  • Active comparator
    mesh-kit procedure

    This procedure is transvaginal mesh implantation surgery for POP patients.Mesh-kit procedure is refered to pelvic floor reconstructive surgery with titanium-coated meshes kit(TiLOOP TOTAL6).Patients could have transvaginal hysterectomy concomitantly.

    Procedure: pelvic floor reconstructive surgery

Interventions

  • Procedurepelvic floor reconstructive surgery

    transvaginal mesh implantation for pelvic organ prolapse

05

What researchers measure

Primary outcomes

  1. surgical "success"

    Subjects will be considered a success if they meet the definitions of anatomic cure and deny vaginal bulging symptoms, and no additional treatment for prolapse(surgical or pessary use). Anatomic cure is defined as leading edge above the hymen (i.e Ba, C, Bp\<0 cm) Symptomatic cure is defined as the absence of vaginal bulge symptoms as indicated by a negative response question 3 of the pelvic floor distress inventory- 20 (PFDI-20): "Do you usually have a bulge or something falling out that you can see or feel in your vaginal area?

    Time frame: up to 36 months after operation

Secondary outcomes

  1. anatomic outcomes

    anatomic outcome of each vaginal segment( anterior, posterior and apical) using POP-Q score.

    Time frame: up to 36 months after operation

  2. symptomatic improvement using validated instruments(PFIQ-7)

    Relief of symptoms using validated instruments(PFIQ-7) .

    Time frame: up to 36 months after operation

  3. symptomatic improvement using validated instruments(PFDI-20)

    Relief of symptoms using validated instruments(PFDI-20) .

    Time frame: up to 36 months after operation

  4. symptomatic improvement using validated instruments(PISQ-12)

    Relief of symptoms using validated instruments(PISQ-12)

    Time frame: up to 36 months after operation

  5. symptomatic improvement using patient global impression of change (PGI-C)

    Relief of symptoms using patient global impression of change (PGI-C)

    Time frame: up to 36 months after operation

  6. intraoperative and post operative complications

    using IUGA/ICS joint terminology CTS coding system and dingo system

    Time frame: up to 36 months after operation

  7. post operative pain

    visual analogue scales (VAS) were used to evaluate the degree of pain.

    Time frame: within 3 days after operation

  8. Hospital costs

    hospitlization expenses

    Time frame: up to 4 weeks after operation

06

Study locations

11 of 11 sites recruiting
  • Peking Union Medical College Hospital
    Beijing, Beijing, China
    • Juan Chen · Contact
    Recruiting
  • Fosha Maternal and Child Health Care Hospital
    Foshan, Guangdong, China
    • Yuling Wang · Contact
    Recruiting
  • The First Affiliated Hospital of Guangzhou Medical College
    Guangzhou, Guangdong, China
    • xiaowei zhang · Contact
    Recruiting
  • Changsha Maternal and Child Health Care Hospital
    Changsha, Hunan, China
    • Binan Wang · Contact
    Recruiting
  • The second Xiangya Hospital of Central South University
    Changsha, Hunan, China
    • guangshi Tao · Contact
    Recruiting
  • Wuxi Maternal and Child Health Care Hospital
    Wuxi, Jiangsu, China
    • Jian Gong · Contact
    Recruiting
  • Qilu Hospital of Shandong University
    Jinan, Shandong, China
    • Peishu Liu · Contact
    Recruiting
  • Shanxi Provincial People's Hospital
    Xi'an, Shanxi, China
    • Xiangyang Jiang · Contact
    Recruiting
  • Sichuan University West China Second University Hospital
    Chengdu, Sichuan, China
    • Ping Wang · Contact
    Recruiting
  • the First Affiliated Hospital of Xinjiang Medical University
    Ürümqi, Xinjiang, China
    • Gulina Ababaikeli · Contact
    Recruiting
  • the People's Hospital of Xinjiang Uygur Autonomous Region
    Ürümqi, Xinjiang, China
    • Hatiguli Nisier · Contact
    Recruiting
07

References and documents

Publications

  • Chen J, Yu J, Morse A, Tao G, Gong J, Wang B, Wang Y, Ababaikeli G, Jiang X, Liu P, Zhang X, Nisier H, Wang P, Funfgeld C, Huang K, Zhang H, Sun X, Zhu L. Effectiveness of Self-cut vs Mesh-Kit Titanium-Coated Polypropylene Mesh for Transvaginal Treatment of Severe Pelvic Organ Prolapse: A Multicenter Randomized Noninferiority Clinical Trial. JAMA Netw Open. 2022 Sep 1;5(9):e2231869. doi: 10.1001/jamanetworkopen.2022.31869. PubMed 36112377 ↗
  • Chen J, Yu J, Morse A, Funfgeld C, Huang K, Gong J, Tao G, Wang B, Wang Y, Jiang X, Ababaikeli G, Liu P, Nisier H, Zhang X, Wang P, Sun X, Zhu L. Self-cut titanium-coated polypropylene mesh versus pre-cut mesh-kit for transvaginal treatment of severe pelvic organ prolapse: study protocol for a multicenter non-inferiority trial. Trials. 2020 Feb 26;21(1):226. doi: 10.1186/s13063-019-3966-3. PubMed 32102687 ↗

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT03283124
Lead sponsor
Peking Union Medical College Hospital
Collaborators
Shanghai Medstron Medical Co.Ltd, LinkDoc Technology (Beijing) Co. Ltd., Chinese Academy of Medical Sciences
Responsible party
Sponsor
First posted
Sep 14, 2017
Start date
Jan 12, 2018
Primary completion
Jan 12, 2020 (estimated)
Completion
Jan 12, 2022 (estimated)
Last update
Mar 5, 2019

Study contacts

Lan Zhu
Contact
zhu_julie@sina.com
86-10-69155749
Juan Chen
Contact
pumchcj@sina.com
86-10-69155749
Lan Zhu
principal investigator · Peking Union Medical College Hospital

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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