clinical investigation of gt urological, llc's artificial urinary sphincter (relief ii)

Conditions: Male Stress Urinary Incontinence

Summary: the purpose of this investigation is to demonstrate the safety and efficacy of the gtu artificial urinary sphincter device in restoring continence in males who have confirmed urinary stress incontinence for a minimum of 12 months with primary etiology being radical prostatectomy or transurethral resection of the prostate (turp).

prospective, non-randomized multi-center study testing the safety and efficacy of the gtu artificial urinary sphincter device in males with urinary incontinence. up to 20 sites in europe, australia \& new zealand a sample size of 73 subjects is estimated to provide 80% power for efficacy. accounting for 10% attrition, 82 subjects will be enrolled to provide non-missing data on 73 subjects. first subject enrolment: july 2014 last subject enrolment: september 2015 last subject follow-up: september 2016 study primary endpoint completion: january 2016 each subject will be followed for approximately 14 months. study duration is approximately 27 months. subjects will be evaluated at the screening, pre-implant, implant, 6 weeks post implant for device activation, 1-month, 2-month, 3-month, 6-month, and 12-month post device activation. the sponsor (gt urological, llc) will work with a contract research organization (cro) to assist in investigative site monitoring for this clinical investigation.

Eligibility criteria:
inclusion criteria: 1. males \> 21 years 2. willing/able to sign informed consent 3. has undergone radical prostatectomy or transurethral resection of the prostate or other prostate surgery prior to 6 months of the time of enrollment 4. primary stress urinary incontinence confirmed urodynamically as dominant form of ui 5. failed conservative incontinence treatment (see list below) for at least 6 months 1. pelvic exercises and bladder training 2. drug therapy 3. biofeedback 4. electrical stimulation 5. behavioral therapy 6. subject has severe urinary incontinence defined by: a. one 24-hour pad weight test ≥300 gm 7. max urethral closure pressure \< 30 cm h2o 8. bladder capacity \> 250 ml 9. post void residual urine \< 50 ml 10. abnormal/poor compliance bladder defined by \<30-40cm h2o. 11. willing/able to comply with follow-up activities 12. is an appropriate surgical candidate as determined by the investigator 13. negative urine culture prior to surgery 14. cognitive/manual capability to operate device exclusion criteria: 1. subjects considered to be vulnerable 2. refuses or unable to sign the informed consent 3. cannot comply with study requirements, follow-up visits and tests 4. currently enrolled or plans to enroll in another investigational device or drug clinical trial or has completed an investigational study within 2 weeks 5. estimated life span \< 5 years 6. recent or planned surgeries within 3 months before or 12 weeks after the implant procedure 7. primary urge incontinence, mixed incontinence with a predominant urgency component, or urinary incontinence due to or complicated by bladder outlet obstruction 8. has had implantation of artificial urinary sphincter prosthesis, sling, or other urogenital implant 9. has had proact device explanted and the urethra is compromised as assessed by the investigator 10. demonstrated bladder outlet obstruction (boo) as measured by the pressure flow cystometry 11. neurogenic bladder dysfunction not treatable/controllable by pharmacological or alternative methods 12. uncontrolled diabetes mellitus defined as persistent blood sugar level recordings of \>12mmol/l (216. mg/dl) and a glycosylated hemoglobin (hba1c) of \>9% (75mmol/mol) over the preceding 3 months 13. active abscess or infection 14. bladder neck or urethral stricture disease requiring \> 2 regular instrumentation or dilation proximal to or at the level of the urethral sheath 15. bladder cancer or transitional cell carcinoma requiring regular cystoscopy and/or rapidly progressive prostatic or testicular cancer 16. needs self-intermittent catheterization 17. diagnosed disease precluding subject from being able to recall or summarize urinary status 18. diagnosed disease or medical condition (e.g., parkinson's) precluding subject from being physically capable of manipulating the device 19. history of bleeding diathesis or cannot stop usage of an anti-coagulant until the international normalized ratio (inr) is below 1.5 or quick value \>70 20. uses an indwelling catheter or condom catheter for treatment of incontinence and is not willing to discontinue use for study assessments 21. abnormal prostate screening antigen (psa), according to site's laboratory standards, unless further investigation confirms no signs of local recurrence 22. known allergy to device material 23. active or recurrent urinary tract infections (utis) . recurrent defined as \> 4 times over the past year 24. urodynamic testing shows significant incontinence caused by factors other than stress incontinence 25. no anatomic abnormalities of the urethra, scrotum or penis judged to prevent implantation

Keywords: sui, incontinence, sphincter