Combined Use of a Medical Device and a Dietary Complement in Patient Urinary pH Control in Patients With an Implanted Double J Stent.
- Conditions
- Stent Complications
- Interventions
- Combination Product: Lit control pHDown
- Registration Number
- NCT03343275
- Lead Sponsor
- Devicare S.L.
- Brief Summary
This study evaluates the effectivity in urinary pH Control and the prevention of calcification in Double J stent using a device combined with the intake of dietary supplements. Every patient will receive hygienic-dietary indications.
Patients will also take one out of the three dietary supplements regarded within the study (pH Up, pH Down and Cysteine) to control the adequate pH level, always following medical indications.
- Detailed Description
Several studies have shown the importance of urinary pH Control (pHv) to determine the frequency of stent incrustation, this measure being a variable to be taken into account in the management of catheterized patients. However, the level of pHv is influenced by multiple factors, so its routine control is difficult to interpret. The nucleation pH (pHn) was described on 1999: the pH where the incrustation starts to form. In his study he observed that the pH of the patients who developed a stent blockage and the pH of those who were not very similar (7.46 and 7.38 respectively), but observed that the pHv of the patients who did not have incrustations was much lower and therefore had a much wider safety margin.
As already mentioned, pHv is influenced by different factors, but it is especially sensitive to diet. For this reason, hygienic and dietetic interventions (exercise, diet, fluid intake, etc.) are one of the preventive measures of incrustation of the stent of great utility, although its effectiveness is subject to patient adherence.
Lit-control®pH Down is a dietary supplement with an acidifying effect on urine, which helps in the prevention of complications arising from the alkalinization of urine. It contains L-methionine, phytin (calcium-magnesium phytate salt), zinc and vitamin A. The two active components in pHv acidification are L-methionine and phytin,while zinc and vitamin A increase the action of phytin. Specifically, zinc favors the affinity of its affinity for calcium phosphate and vitamin A prevents its degradation by alkaline phosphatase.
L-methionine is an essential amino acid that plays an important role in metabolic processes. It is normally acquired through food and absorbed in the small intestine to be metabolized in the liver via cysteine to sulphate and protons. Consequently, its administration produces a significant reduction of urinary pH.
According to the European Association of Urology (UAE), urinary acidification with L-methionine up to pH 5.8 - 6.2 is recommended as a therapeutic measure for calculations of struvite, calcium phosphate and ammonium urate at doses of 600- 1500 mg / day. This recommendation is based on the results observed in 1996, where an acidification of the pH of the urine of the patients was observed from 7.5 to 5.5 after the administration of 1500-3000 mg / day (3-6 capsules) of 500mg / day. Also in the study of Hesse 1999 a significant reduction in urinary pH was observed up to pH = 6.0 after the administration of a single dose of 1500 mg of L-methionine, maintaining this effect for 24h. In addition, a significant reduction was observed versus the control group in terms of the relative supersaturation for struvite and brushite in the urine of 24h. In another more recent study, the authors studied the circadian course of urinary pH after the administration of 1500 mg of L-methionine. They observed a strong decrease in urinary pH up to 2h after the administration of the amino acid that remained at significantly low levels for 8h, resulting in a pH level for 24h between 5.98 and 6.32. Therefore, in order to guarantee therapeutic doses of L-Methionine (1500mg / day), the Lit-control®pH Down regimen to follow would be equivalent to 3 capsules per day (500 mg / capsule).
On the other hand, the device Lit-control® pH Meter is a medical device that allows patients to self-monitor their pHv daily in their own home, allowing a thorough control of the pH and the level of risk of incrustation. The device has been validated for use in lithiasic patients, with applicability in the treatment of other urological pathologies related to the acid-base balance of urine, calcifications of urinary stents, cystitis, urinary tract infections, painful bladder syndrome and bladder hyperactive
The objective of this study is to evaluate the effectiveness of the food supplement Lit-control®pH Down in the prevention of double J stent incrustation and in the control of urinary pH together with the use of the device Lit-control® pH meter
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 105
- Age ≥18 years old
- Patients which have been recently implanted a Double J stent (less than a week implant) or who have planned their implant and have been recommended with pH control to avoid incrustation/calcification.
- Patients who accept their participation in the study and give their informed consent
- Patients with base pathologies wich , based on clinical criteria, aren´t sensitive about the study dietary supplement indications.
- Patients which have programmed the stent extraction 3 weeks before base visit.
- Uric and cystinuric patients which requires pH control different from the established study protocol .
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo Lit control pHDown Placebo: * Pharmaceutical form: capsules * Administration : oral * Dose: 3 capsules/day. • Sanitary product : Lit-Control® pH Meter * In vitro diagnosis sanitary product * Use:Urinary pH evaluation Experimental Lit control pHDown Dietary supplement : Lit-Control® pH Down * Pharmaceutical form: capsules * Administration : oral * Dose: 3 capsules/day. • Sanitary product : Lit-Control® pH Meter * In vitro diagnosis sanitary product * Use:Urinary pH evaluation
- Primary Outcome Measures
Name Time Method Incrustation Score 2 days 0 (No incrustation); 1(Sporadic incrustation less than 1-2 mm); 2 (Wide area calcifications more than 1-2 mm) ; 3 (Total obstruction)
Urinary pH level 2 times/day Stent implant cause 2 months Medical evaluation and diagnosis leading to stent implant
Self-control below values 6.2 2 times/day
- Secondary Outcome Measures
Name Time Method Anatomic alterations on the urinary system 2 months Medical evaluation on the different alterations present in the urinary system.
Previous uropathic obstructive incidence 2 months Number of obstructions in the past two months.
Date of past stent implants 2 months pH control: Total time 2 times/day Complications associated with stent implant 2 months Treatment adherence 2 months The clinical will evaluate the patient treatment adherence by means of Morisky-Green test
Stent extraction data 2 months Possibility of complications during the extraction, date of extraction, intervention type, intervention duration
Blockage risk factor 1 month prior intervention Evaluation by clinical evaluation
Date of stent extraction 2 months Type of previous stent 2 months Description of the previous stent
2 hours urine analysis :Fasting 2 hours Urine culture 48 hours Number of different symptoms associated with the previous calcification 2 months Different symptomatology associated with the previous calcification
Trial Locations
- Locations (9)
Hospital Universitari de Bellvitge
🇪🇸Hospitalet De Llobregat, Barcelona, Spain
Complejo Hospitalario Universitario de Santiago de Compostela
🇪🇸Santiago de compostela, Galicia, Spain
Hospital Universitario La Paz
🇪🇸Madrid, Spain
Hospital Universitario de Valme
🇪🇸Sevilla, Andalucía, Spain
Hospital Clínico Universitario San Cecilio
🇪🇸Granada, Spain
Hospital Álvaro Cunqueiro
🇪🇸Vigo, Pontevedra, Spain
Fundació Puigvert
🇪🇸Barcelona, Spain
Hospital Universitario Rio Hortega
🇪🇸Valladolid, Spain
Hospital Universitari i Politècnic La Fe
🇪🇸Valencia, Spain