CClinicalTrials.gg
Status unknownNCT03755089OPILUpdated May 29, 2020

Oral vs Intravesical Analgesia for Office Bladder Botox Injections

A Phase 4 interventional study of Phenazopyridine and Lidocaine 2% Injectable Solution in Overactive Bladder Syndrome, Urge Incontinence and Urinary Incontinence, sponsored by Women and Infants Hospital of Rhode Island. Status unknown at 1 site in United States. Open to female participants aged 18 Years to 99 Years. Per ClinicalTrials.gov, last updated 2020-05-29.

Sponsored by Women and Infants Hospital of Rhode Island · Phase 4, Interventional, and Treatment

The sponsor has not verified this record recently (last verified May 2020), so the status shown — last known as Recruiting — may be out of date.
Phase
Phase 4
Study type
Interventional
Enrollment
110
Allocation
Randomized
Ages
18 Years to 99 Years
Sex
Female
01

Study summary

OnabotulinumtoxinA (Botox®) bladder injections are a highly effective treatment for overactive bladder and urgency urinary incontinence. The procedure is typically performed in the office setting with one of two medications to control comfort. However, the effectiveness of these medications has never been compared. The goal of this study is to determine which medication is better at providing comfort during bladder Botox® injections.

Read the detailed description

The primary aim of this randomized clinical trial is to compare the analgesic effect of oral phenazopyridine to that of intravesical lidocaine during intradetrusor injections of onabotulinumtoxinA performed for idiopathic overactive bladder. The investigators will achieve this by measuring the mean visual-analog pain scores (VAS) in women who are randomized to receive either oral phenazopyridine or intravesical lidocaine.

Secondary aims include assessment of:

  1. Overall Patient Satisfaction: To compare overall patient satisfaction with the onabotulinumtoxinA injection procedure in women randomized to pre-procedure oral phenazopyridine versus those randomized to intravesical lidocaine instillation.
  2. Ease of Procedure: To compare the physician's perception of ease of onabotulinumtoxinA injection procedure in women randomized to pre-procedure oral phenazopyridine versus those randomized to intravesical lidocaine instillation.
  3. Office Efficiency/Total Appointment Duration: To compare total appointment time or total time spent in an office exam/procedure room in women randomized to pre-procedure oral phenazopyridine versus those randomized to intravesical lidocaine instillation.
02

Conditions studied

  • Overactive Bladder Syndrome
  • Urge Incontinence
  • Urinary Incontinence
  • Detrusor Hyperreflexia
  • Detrusor Instability
03

Who can participate

Ages eligible
18 Years to 99 Years
Sexes eligible
Female
Accepts healthy volunteers
No

Inclusion criteria

  • Non-pregnant, adult females 18 years of age or older
  • Diagnosis of idiopathic overactive bladder
  • Planning office-based bladder injection of onabotulinumtoxinA
  • Willing and able to complete all study related items and interviews
  • Grossly neurologically normal on exam

Exclusion criteria

Exclusion Criteria:

  • Known neurologic diseases (multiple sclerosis, Parkinson Disease, CVA within 6 months, myasthenia gravis, Charcot-Marie-Tooth disease, peripheral neuropathy, and complete spinal cord injury) believed to affect urinary function
  • Planned injection of >100 units of onabotulinumtoxinA
  • OnabotulinumtoxinA given for another indication within the previous 3 months (if cumulative dose would total >400 units)
  • Any intradetrusor onabotulinumtoxinA injections in the previous 12 months
  • Serum creatinine level greater than twice the upper limit of normal within the year prior to enrollment
  • Allergy to lidocaine
  • Allergy to onabotulinumtoxinA
  • Allergy to phenazopyridine
  • Untreated urinary tract infection (UTI)
  • Currently pregnant or lactating.
  • Known urinary retention (post-void residual >200mL) and inability to perform intermittent self-catheterization
  • Uninvestigated hematuria (gross or microscopic)
  • Current or prior bladder malignancy
  • Previous bladder augmentation or surgically altered detrusor muscle
  • Prior pelvic radiation
  • Primary language other than English or Spanish
04

Study design

Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
110 participants (estimated)

Study arms

  • Active comparator
    Oral Phenazopyridine

    Patients randomized to the oral phenzopyridine arm will receive 200mg phenazopyridine to take by mouth 1-2 hours before their scheduled procedure.

    Drug: Phenazopyridine

  • Active comparator
    Intravesical Lidocaine

    Patients randomized to the intravesical lidocaine arm will have the bladder back-filled with 30mL 2% lidocaine for the 20 minutes immediately preceding their procedure.

    Drug: Lidocaine 2% Injectable Solution

Interventions

  • DrugPhenazopyridine

    200mg PO Phenazopyridine taken 1-2 hours prior to the Botox® injection procedure

  • DrugLidocaine 2% Injectable Solution

    30mL 2% lidocaine instilled into the bladder lumen 20 via a urinary catheter 20 minutes prior to the Botox® injection procedure

05

What researchers measure

Primary outcomes

  1. Analgesic Effect Measured with 100mm Visual Analog Scale

    The visual analog scale is a visual representation of pain severity rated from 0 (no pain) to 10 (worst pain imaginable). Therefore higher numbers represent more pain.The scale is represented visually using a 100 millimeter line and patients indicate their level of pain by pointing to a location on the line.

    Time frame: Immediately post-procedure

Secondary outcomes

  1. Overall Patient Satisfaction

    Overall patient satisfaction with the onabotulinumtoxinA injection procedure in women randomized to pre-procedure oral phenazopyridine versus those randomized to intravesical lidocaine instillation. Overall satisfaction will be measured with a single-item question utilizing a Likert scale with options ranging from very satisfied to very unsatisfied.

    Time frame: Immediately post-procedure

  2. Ease of Procedure

    Physician's perception of ease of onabotulinumtoxinA injection procedure in women randomized to pre-procedure oral phenazopyridine versus those randomized to intravesical lidocaine instillation. This will be measured with a single item, five point Likert scale with options ranging from no difficulty to great difficulty.

    Time frame: Immediately post-procedure

  3. Office Efficiency/Total Appointment Duration

    Total appointment time or total time spent in an office exam/procedure room in women randomized to pre-procedure oral phenazopyridine versus those randomized to intravesical lidocaine instillation. This will be measured by subtracting the appointment start time (time the patient was placed in the exam room) from the appointment end time (time of patient check-out).

    Time frame: Immediately post-procedure

06

Study locations

1 of 1 sites recruiting
  • Women & Infants Hospital of Rhode Island
    Providence, Rhode Island 02903, United States
    Recruiting
07

References and documents

Publications

  • Stewart LE, Siddique M, Jacobs KM, Raker CA, Sung VW. Oral phenazopyridine vs intravesical lidocaine for bladder onabotulinumtoxinA analgesia: a randomized controlled trial. Am J Obstet Gynecol. 2022 Aug;227(2):308.e1-308.e8. doi: 10.1016/j.ajog.2022.05.025. Epub 2022 May 14. PubMed 35580634 ↗

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT03755089
Lead sponsor
Women and Infants Hospital of Rhode Island
Responsible party
Sponsor
First posted
Nov 27, 2018
Start date
Nov 1, 2018
Primary completion
Mar 1, 2021 (estimated)
Completion
Mar 1, 2021 (estimated)
Last update
May 29, 2020

Study contacts

Lauren E Stewart, MD
Contact
lstewart@wihri.org
401-453-7560 ext. 48762
Lauren E Stewart, MD
principal investigator · Women and Infants Hospital of Rhode Island

Oversight

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

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