Hematuria

Researchers are conducting an international, multicenter observational study to understand how patients admitted to hospitals with emergency haematuria are managed. The study aims to identify variations in care, measure outcomes like length of hospital stay, mortality, readmission rates, and resource use, and support the development of future guidelines and trials to improve haematuria management. The study collects detailed data on patient demographics, underlying health conditions, diagnostic procedures, treatments, and outcomes using a standardized form. It includes patients admitted as emergencies with haematuria under urology care. The study observes current hospital management pathways and gathers information through questionnaires to participating sites. Participants will be followed during their hospital stay and for 90 days afterward. Researchers will evaluate length of stay, time to diagnosis, mortality at 30 and 90 days, readmissions, days alive and out of hospital, and healthcare costs. The study uses data analysis to assess factors linked to outcomes and variations in care. Participation involves no changes to treatment as it is observational, and data will be collected consecutively over a 12-month period from multiple centers.

Alport syndrome is a hereditary type IV collagen disease that typically causes kidney failure early in life. This observational study investigates whether various medications can delay disease progression, postpone kidney failure, and improve life expectancy compared to untreated relatives. The study began as a European registry in 2006 and has expanded globally as "Alport XXL" through the International Alport Alliance, focusing on early therapy outcomes in young patients using ACE-inhibitors, Angiotensin-receptor blockers, or their combination. The study collects data on patients at different disease stages, from early microscopic hematuria to kidney failure, to assess the effectiveness of early medication initiation. Patients are grouped by treatment status and disease severity, including untreated relatives and those receiving therapy at various stages. The registry records detailed clinical data, including genetic information, urine albumin levels, kidney function, and medication doses, in a strictly observational manner without intervening in treatment decisions. Participants provide retrospective and prospective data through standardized questionnaires at baseline and follow-up visits. Data collected include kidney function tests, blood pressure, hearing loss, eye involvement, and adverse events. Researchers measure outcomes such as age at kidney failure, life expectancy, kidney function decline, and changes in urinary albumin. The study aims to observe long-term effects of therapies until 2037, supporting improved understanding of treatment timing and effectiveness in Alport syndrome.

This research evaluates the use of oral anticoagulation (OAC) combined with background antiplatelet therapy in patients who develop new-onset post-operative atrial fibrillation (POAF) after isolated coronary artery bypass graft (CABG) surgery. The study aims to assess how effectively this approach prevents thromboembolic events and its safety regarding major bleeding. Patients who decline randomization may join a parallel registry to capture their treatment choices and risk profiles. Participants will be randomly assigned to one of two treatment groups: an experimental arm receiving OAC (either a vitamin K antagonist or a direct oral anticoagulant) along with antiplatelet therapy, or a control arm receiving antiplatelet therapy alone. The anticoagulation treatment lasts 90 days, and patients in the control group who experience recurrent atrial fibrillation after 30 days may switch to OAC. Follow-up includes clinic visits at 90 days and phone calls at 30, 60, and 180 days. A digital health substudy involving a wearable heart monitor for 30 days post-discharge is also offered to some participants. During the study, researchers will monitor outcomes such as death, stroke, transient ischemic attack, myocardial infarction, and thromboembolism up to 180 days after randomization, along with bleeding events at 90 days. Data collection includes medical record reviews, risk profiling, and use of anticoagulants and antiplatelets. Safety and effectiveness will be analyzed by comparing the two treatment strategies. Participation may last up to six months, with assessments conducted in person and by phone.

Heart failure is a global health issue, and left ventricular assist devices (LVADs) like the HeartMate 3 are increasingly used to improve survival for patients with advanced heart failure. Despite advances, complications related to blood compatibility, such as clotting and bleeding, remain serious concerns. This trial investigates the safety and effectiveness of using an antithrombotic regimen without aspirin in patients supported by the HeartMate 3 LVAD, building on previous findings that avoiding aspirin may reduce bleeding without increasing clotting risks. The study is a prospective, randomized, controlled trial comparing two treatment groups of advanced heart failure patients who have been supported by the HeartMate 3 LVAD for more than three months. One group will receive warfarin alone, with doses adjusted to maintain a specific blood clotting goal, while the other group will receive warfarin combined with aspirin, which is the current standard of care. Participants will be randomly assigned to one of these two antithrombotic regimens and followed over time to assess outcomes. Participants will be monitored for one year after randomization, with researchers tracking survival free from major hemocompatibility-related events like stroke, pump thrombosis, and significant bleeding. Secondary outcomes such as rates of bleeding, clotting, stroke, rehospitalization, and economic impact will also be evaluated. The study aims to enroll up to 128 patients to ensure sufficient power and includes regular follow-ups to assess safety, treatment adherence, and clinical events.

Researchers are evaluating the use of a direct oral anticoagulant (DOAC) called apixaban compared to no anticoagulant in patients undergoing abdominal or pelvic surgery. This international, multicenter, randomized controlled trial focuses on patients with a moderate risk of venous thromboembolism (VTE) and bleeding where the benefits and harms of thromboprophylaxis are unclear. The study aims to clarify whether apixaban provides a net benefit or if avoiding anticoagulation is preferable in this population. The trial enrolls 5,436 patients who will be randomly assigned to receive either apixaban 2.5 mg orally twice daily for 28 days alongside standard mechanical prevention or no anticoagulant with standard mechanical prevention alone. Mechanical prophylaxis is provided as standard care in both groups. The study is open-label and compares the outcomes of using apixaban versus no anticoagulation after surgery. Participants will be monitored for 90 days to assess the incidence of VTE, including deep vein thrombosis and pulmonary embolism. Researchers will collect data on symptomatic events and major bleeding. Follow-up visits and assessments will track safety and effectiveness outcomes. The study’s results will help guide decisions about thromboprophylaxis after abdominal and pelvic surgeries in patients at moderate risk.

Bladder cancer is a common cancer, especially among men over 50, often caused by smoking and detected late due to few early symptoms. This research aims to evaluate whether routine urine screening every six months for two years can help detect bladder cancer earlier in high-risk patients, such as those with significant smoking history or certain occupational exposures. The study is a single-arm trial comparing results to historical data from standard care. Participants will undergo urinalysis testing every six months for two years. Depending on red blood cell counts in the urine, participants may receive further screening with cystoscopy and upper tract imaging or urine marker testing with Cxbladder triage plus imaging. Those with suspicious findings will receive treatment as per standard practice. This approach is compared to historical controls from SEER registries where bladder cancer was detected by usual care. During the study, patients will complete urine tests bi-annually and may undergo additional procedures based on test results. Researchers will track bladder cancer incidence over five years and secondary outcomes like smoking cessation and screening intervals. The study includes follow-up assessments and monitoring for up to two years to evaluate the effectiveness of this screening approach compared to historical outcomes.

Researchers are studying the use of Bladder EpiCheck, a urine test, to detect urothelial carcinoma in adults aged 45 years or older who have experienced blood in their urine (haematuria). This observational study aims to confirm how accurately the Bladder EpiCheck test identifies urothelial carcinoma compared to standard methods like cystoscopy and pathology when performed. The study focuses on participants undergoing evaluation for haematuria to improve detection methods for bladder-related cancers. Participants will provide a urine sample that will be tested using Bladder EpiCheck. The results of this test will not be shared with the clinical care team or the participant, and their usual medical care will continue unchanged. The study collects data from the standard diagnostic work-up for haematuria, including cystoscopy scheduled within 60 days after enrollment. During the study, participants will provide at least 10 ml of voided urine and undergo standard cystoscopy as part of their routine evaluation. Researchers will assess the sensitivity and specificity of the Bladder EpiCheck test to detect urothelial carcinoma within six months following enrollment. The study includes monitoring for high-grade urothelial carcinoma and compares Bladder EpiCheck's performance to urine cytology. Participation requires adherence to study procedures and will continue through the diagnostic process without altering treatment plans.

Researchers are evaluating the use of prophylactic preoperative tranexamic acid (TXA) and desmopressin in patients with advanced kidney disease undergoing noncardiac surgery. This pilot study aims to assess the feasibility and design of a larger trial, provide preliminary safety and efficacy data, and gather pharmacokinetic information to help select appropriate dosages. The study addresses a gap since patients with severe kidney disease have been excluded from large trials despite bleeding risks during surgery. Participants will be randomly assigned to receive intravenous TXA, desmopressin, both, or placebos shortly before surgery. TXA dosing varies based on kidney function and dialysis status, with either 1000 mg or 500 mg infused over 10 minutes. Desmopressin is given as a 20 mcg infusion over 30 minutes. Placebo infusions use saline solutions matching the timing and volume of the active drugs. Treatment is administered within 20 minutes before the skin incision. During the study, researchers will monitor recruitment rates, drug administration timing, and conduct a 30-day follow-up after surgery. They will assess bleeding outcomes, blood transfusions, surgical complications, cardiovascular events, kidney function changes, and other safety measures. The total observation period includes the day of surgery and 30 days afterward, tracking hospital stay duration and postoperative recovery indicators to evaluate the interventions' impact comprehensively.

This research aims to explore brain activity in children with Overactive Bladder (OAB) and Daytime Urinary Incontinence (DUI) compared to healthy children of similar age and gender. It also investigates whether sacral transcutaneous electric nerve stimulation (TENS) influences brain areas controlling the bladder. The study focuses on children aged 6 to 14 years, as brain activity related to bladder control has not yet been studied in this group, though adult studies suggest increased brain activity may be a factor in OAB and DUI. Participants include children with OAB and DUI who will receive sacral TENS treatment applied for two hours daily over 10 weeks. The study involves two main parts: a cross-sectional comparison between affected and healthy children and an interventional cohort study where children with symptoms undergo sacral TENS. Imaging sessions include structural MRI and functional MRI scans with both full and empty bladder states, performed before and after the treatment. Healthy children will have only baseline imaging. During the study, children and/or their parents complete various assessments including frequency and volume charts, screening tools for attention deficit hyperactivity disorder and autism spectrum disorders, and quality of life questionnaires. Researchers will measure brain activity changes, structural brain differences, and quality of life changes before and after treatment. The primary outcomes focus on brain activity at baseline and after TENS, with secondary outcomes assessing quality of life and urinary symptoms. The study is conducted under careful monitoring to ensure safety and data quality.

Endoscopic sinus surgery (ESS) is a common otolaryngologic procedure that aims to remove the partitions that separate the sinus cavities, remove inflamed tissue, and optimize the sinuses for topical medication use. In this procedure, the surgeon will inject a combination of drugs, local anesthetics, and vasoconstrictors, to reduce bleeding and improve visualization. However, previous studies have shown similar results when injected with only saline. In this study, investigators want to determine if the injection of local anesthesic+vasoconstrictor compared to no injection at all makes any difference in improving the surgeon's visualization during an ESS.