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Kidney CalculiNCT07655050

Antibiotic Irrigation and Suction Ureteral Access Sheath in RIRS

A study testing Standard Retrograde Intrarenal Surgery, Gentamicin Irrigation and Suction-Enabled Ureteral Access Sheath in people with Kidney Calculi and Urolithiasis, run by Hitit University at 2 sites in Turkey (Türkiye).

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Retrograde intrarenal surgery (RIRS) is a widely used treatment for kidney stones; however, postoperative infectious complications remain a significant concern. This prospective randomized factorial trial aims to evaluate whether gentamicin-containing irrigation fluid and the use of a suction ureteral access sheath… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Standard Retrograde Intrarenal Surgery, Gentamicin Irrigation and Suction-Enabled Ureteral Access Sheath
Could I receive a placebo?
No, everyone receives an active treatment
How many people
180 participants
Where
2 sitesTurkey (Türkiye)
Study dates
15 Jun 2026to 8 May 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients scheduled for retrograde intrarenal surgery (RIRS) due to kidney stones
  • Male and female patients aged 18 years or older
  • Patients who voluntarily sign the informed consent form
  • Patients with sterile urine culture or whose preoperative infection has been treated and urine culture has become sterile

Who cannot join

  • Patients with active urinary tract infection before surgery
  • Patients with chronic kidney disease
  • Pregnant patients
  • Patients with allergy to aminoglycoside-group drugs used in the study protocol, specifically gentamicin
  • Cases in which the ureter cannot be accessed and the procedure is postponed by placing a double-J stent instead of performing dilation

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

MUSTAFA SERDAR ÇAĞLAYAN contact

+90 507 431 1951

serdar.09.09@hotmail.com

Turkey (Türkiye)2 sites, 2 recruiting
  • Department of Urology, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Türkiye

    Çorum, Çorum, 19040

    MUSA EKİCİ, +90364 222 11 02, tipfak@hitit.edu.tr

    AHMET TAŞCI

    Not yet recruiting
  • Department of Urology, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Türkiye

    Çorum, Çorum, 19040

    MUSA EKİCİ, +90 505 751 63 41, musaekici@hitit.edu.tr

    MUSTAFA SERDAR ÇAĞLAYAN

    Recruiting

Other trials in Turkey (Türkiye)

About this study

Official title: The Combined Effect of Antibiotic Irrigation and Aspiration Ureteral Access Sheath on Infectious Complications in Retrograde Intrarenal Surgery: A Prospective Randomized Factorial Study

Retrograde intrarenal surgery (RIRS) is a widely used treatment for kidney stones; however, postoperative infectious complications remain a significant concern. This prospective randomized factorial trial aims to evaluate whether gentamicin-containing irrigation fluid and the use of a suction ureteral access sheath can reduce postoperative fever, systemic inflammatory response syndrome (SIRS), and sepsis after RIRS. The study will also investigate the independent and combined effects of these two interventions on infectious outcomes.

Read the detailed description

Subject:

The present study aims to investigate the effects of gentamicin-containing irrigation and the use of a suction ureteral access sheath during retrograde intrarenal surgery (RIRS) on postoperative infectious complications.

Objective:

The aim of this study is to evaluate the independent and combined effects of gentamicin irrigation and a suction ureteral access sheath on postoperative infectious complications following RIRS.

Retrograde intrarenal surgery (RIRS) is a commonly used minimally invasive treatment modality for renal stones, particularly for stones up to 20 mm. Although RIRS is generally considered safe and effective, postoperative infectious complications remain an important clinical concern. Fever, urinary tract infection, systemic inflammatory response syndrome (SIRS), and sepsis may occur even in patients with negative preoperative urine cultures and appropriate perioperative antibiotic prophylaxis.

A potential mechanism for infectious complications after RIRS is increased intrarenal pressure during endoscopic lithotripsy. Elevated intrarenal pressure may promote pyelovenous and pyelolymphatic backflow, allowing bacteria, endotoxins, and inflammatory mediators from the collecting system or stone surface to enter the systemic circulation. Therefore, strategies that reduce bacterial contamination within the renal collecting system and improve intrarenal drainage may help decrease postoperative infectious morbidity.

This study is designed to evaluate two intraoperative strategies intended to reduce infectious complications during RIRS. The first strategy is local antibiotic irrigation using gentamicin-containing saline solution. Gentamicin will be added to the irrigation fluid as a local intraoperative measure rather than as a systemic treatment. This approach is intended to reduce bacterial contamination within the collecting system during lithotripsy. All patients will also receive standard systemic antibiotic prophylaxis according to routine clinical practice.

The second strategy is the use of a suction-enabled ureteral access sheath. This device is intended to improve fluid evacuation, reduce intrarenal pressure, and facilitate the removal of stone dust, debris, and potentially contaminated fluid during the procedure. By improving drainage from the collecting system, suction-assisted RIRS may theoretically reduce pyelovenous backflow and the risk of postoperative systemic inflammatory or infectious events.

The study uses a 2×2 factorial design, which allows simultaneous evaluation of the independent effects of gentamicin irrigation and suction-enabled ureteral access sheath use, as well as their combined effect. This design is useful because both interventions target different mechanisms that may contribute to infectious complications: local bacterial contamination and elevated intrarenal pressure. The factorial structure will also allow assessment of whether the combination of these two approaches provides an additive or synergistic benefit compared with either intervention alone.

All procedures will be performed under general anesthesia in the lithotomy position using standard endourological techniques. Irrigation will be performed with normal saline under low-pressure conditions. In the gentamicin irrigation groups, 80 mg gentamicin will be added to each 3 L bag of normal saline. In the suction groups, a suction-enabled ureteral access sheath will be used during flexible ureteroscopy. Stone fragmentation will be performed with a holmium:YAG laser using a dusting technique, and a double-J ureteral stent will be placed at the end of the procedure according to the study protocol.

This trial may provide clinically relevant evidence regarding infection-prevention strategies in RIRS. If gentamicin irrigation, suction-assisted access sheath use, or their combination is shown to reduce postoperative infectious complications without compromising surgical success, these approaches may contribute to safer perioperative management in endourological stone surgery.

Being tested
Standard Retrograde Intrarenal Surgery, Gentamicin Irrigation, Suction-Enabled Ureteral Access Sheath
Keywords
Retrograde intrarenal surgery, Kidney stone, Gentamicin, Irrigation fluid, Infectious complications, Urinary tract infection, SEPSİS
Medical subject headings
Kidney Calculi, Urolithiasis, Urinary Tract Infections, Toxemia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Standard Retrograde Intrarenal SurgeryProcedure or surgery

    Also called Standard RIRS Flexible Ureteroscopy

    Standard retrograde intrarenal surgery will be performed under general anesthesia in the lithotomy position. A guidewire will be advanced to the renal pelvis under fluoroscopic guidance, and a ureteral access sheath will be placed when appropriate. Flexible ureteroscopy will be performed, and stones will be fragmented using a holmium laser with the dusting technique. Standard saline irrigation will be used during the procedure.

  • Gentamicin IrrigationDrug

    Also called Gentamicin-Containing Irrigation Local Antibiotic Irrigation Intervention Description:

    Gentamicin-containing irrigation fluid will be used during retrograde intrarenal surgery. In the gentamicin irrigation groups, 80 mg gentamicin will be added to each 3 L bag of normal saline irrigation solution. This intervention will be used as a local intraoperative irrigation strategy to reduce bacterial contamination within the renal collecting system and is not intended as systemic antibiotic treatment.

  • Suction-Enabled Ureteral Access SheathDevice

    Also called Suction UAS Aspiration Ureteral Access Sheath Suction-Assisted Ureteral Access Sheath

    A suction-enabled ureteral access sheath will be used during retrograde intrarenal surgery in the suction groups. The device is intended to improve fluid evacuation from the renal collecting system, reduce intrarenal pressure, and facilitate removal of irrigation fluid, stone dust, and debris during flexible ureteroscopy.

Study groups in NCT07655050
Study groupRoleWhat they receive
Standard RIRSExperimentalParticipants in this arm will undergo standard retrograde intrarenal surgery using standard saline irrigation and a standard ureteral access sheath. This arm will serve as the control group for comparison with gentamicin irrigation, suction-enabled ureteral access sheath use, and the combined intervention.
Receives: Procedure: Standard Retrograde Intrarenal Surgery
Standard RIRS With Gentamicin IrrigationExperimentalArm Description: Participants in this arm will undergo standard retrograde intrarenal surgery using gentamicin-containing irrigation fluid. Gentamicin will be added to normal saline irrigation solution during the procedure. A standard ureteral access sheath will be used without suction assistance.
Receives: Procedure: Standard Retrograde Intrarenal Surgery; Drug: Gentamicin Irrigation
Suction RIRSExperimentalParticipants in this arm will undergo retrograde intrarenal surgery using a suction-enabled ureteral access sheath. The suction-enabled sheath will be used to improve fluid evacuation and reduce intrarenal pressure during the procedure. Standard saline irrigation will be used without gentamicin.
Receives: Device: Suction-Enabled Ureteral Access Sheath
Suction RIRS With Gentamicin IrrigationExperimentalParticipants in this arm will undergo retrograde intrarenal surgery using both gentamicin-containing irrigation fluid and a suction-enabled ureteral access sheath. Gentamicin will be added to normal saline irrigation solution, and the suction-enabled sheath will be used to improve fluid evacuation and reduce intrarenal pressure during the procedure.
Receives: Drug: Gentamicin Irrigation; Device: Suction-Enabled Ureteral Access Sheath

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Postoperative Fever

    Postoperative fever will be defined as a body temperature greater than 38°C occurring within the first 48 hours after retrograde intrarenal surgery.

    Measured: Within 48 hours after surgery

  2. Systemic Inflammatory Response Syndrome

    Systemic inflammatory response syndrome will be defined as the presence of at least two of the following criteria: body temperature greater than 38°C or less than 36°C, heart rate greater than 90 beats/min, respiratory rate greater than 20 breaths/min, or white blood cell count greater than 12,000/mm³ or less than 4,000/mm³.

    Measured: Within 48 hours after surgery

  3. Sepsis

    Sepsis will be defined as systemic inflammatory response syndrome in the presence of confirmed or suspected infection after retrograde intrarenal surgery.

    Measured: Within 48 hours after surgery

Secondary outcomes (5)
  1. Stone-Free Rate

    Stone-free status will be evaluated using non-contrast computed tomography. Residual fragments of 4 mm or less will be considered clinically insignificant.

    Measured: 4 weeks after surgery

  2. Change in White Blood Cell Count

    White blood cell count will be assessed before and after surgery to evaluate postoperative inflammatory response.

    Measured: Baseline and within 48 hours after surgery

  3. Change in Serum Creatinine

    Serum creatinine levels will be assessed before and after surgery to evaluate renal function changes.

    Measured: Baseline and within 48 hours after surgery

  4. Urine Culture Positivity

    Postoperative urine culture results will be evaluated to identify urinary tract infection and causative microorganisms.

    Measured: Within 48 hours after surgery

  5. Blood Culture Positivity

    Postoperative blood culture results will be evaluated in patients with suspected systemic infection to identify bloodstream infection and causative microorganisms.

    Measured: Within 48 hours after surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Jun 2026
  2. Study start15 Jun 2026
  3. Primary completion8 Feb 2027 (estimated)
  4. Study completion8 May 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Factorial
Model description
Participants will be randomized into four parallel study arms using a 2×2 factorial design. The two factors evaluated in the study are gentamicin-containing irrigation and the use of a suction-enabled ureteral access sheath during retrograde intrarenal surgery. This design will allow assessment of the independent effects of each intervention as well as their combined effect on postoperative infectious complications.
Masking
None (open label)
Enrolment
180 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07655050
Sponsor's protocol ID
ETIK-2026-22
Status last verified
Jun 2026
First submitted
8 Jun 2026
Last updated
24 Jun 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Zhong W, Leto G, Wang L, Zeng G. Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy: a study of risk factors. J Endourol. 2015 Jan;29(1):25-8. doi: 10.1089/end.2014.0409.

    PubMed 24999535
  • Rai A, Aro T, Lynch E, Tabib C, Mikhail D, Wang D, Abraham A, Hoenig D, Smith A, Okeke Z. Novel Irrigation Protocol for Renal Pelvis Sterilization During Percutaneous Nephrolithotomy: A Pilot Study. J Endourol. 2021 Sep;35(9):1320-1325. doi: 10.1089/end.2020.0695. Epub 2021 May 10.

    PubMed 33752442
  • Corrales M, Sierra A, Doizi S, Traxer O. Risk of Sepsis in Retrograde Intrarenal Surgery: A Systematic Review of the Literature. Eur Urol Open Sci. 2022 Aug 30;44:84-91. doi: 10.1016/j.euros.2022.08.008. eCollection 2022 Oct.

    PubMed 36071820

Questions about this trial

What is this clinical trial studying?

A study testing Standard Retrograde Intrarenal Surgery, Gentamicin Irrigation and Suction-Enabled Ureteral Access Sheath in people with Kidney Calculi and Urolithiasis, run by Hitit University at 2 sites in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 24 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact MUSTAFA SERDAR ÇAĞLAYAN (+90 507 431 1951, serdar.09.09@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Postoperative Fever (time frame: Within 48 hours after surgery). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07655050, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Jun 2026.

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