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NCT Number: NCT07714694

Consumer Evaluation of an Investigational Intermittent Catheter

This clinical study is designed to evaluate the initial safety and performance of an investigational intermittent urinary catheter in people who use intermittent catheterization. Participants will use the study catheter and provide feedback on their experience, including ease of insertion, advancement through the urethra, bladder drainage, withdrawal, comfort, confidence, satisfaction, and overall ease of use.

Safety will be evaluated through reported health changes and adverse events. Device performance and user experience will be assessed using participant questionnaires and comparisons with the participant's current intermittent catheter, including questions related to catheter handling, comfort during catheterization, perceived ability to empty the bladder, likelihood of future use, and product preference.

The study is intended to generate descriptive information on the initial clinical use of the investigational catheter and to help characterize its safety, usability, comfort, satisfaction, and performance relative to participants' current intermittent catheter products.

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Key information

Age range

22 year and older

Sex eligibility

Male

Study type

Interventional

Phase

Not applicable

Primary location

Hollister Incorporated

Libertyville, Illinois, 60048, United States

Location status: Recruiting

Location contact

Hollister Incorporated

CONTACT

[email protected]

(847) 680-1000

About this study

This is a prospective, single-arm, fixed-sequence, within-participant clinical evaluation of an investigational intermittent catheter. Eligible adult male participants in the United States who currently use hydrophilic intermittent catheters will first use 30 of their usual catheters and then 30 study catheters. During both catheter-use periods, participants will complete daily questionnaires regarding catheter use and health changes and will complete evaluation forms assessing ease of use, catheter performance, comfort, confidence, satisfaction, and comparative preference. Safety will be evaluated through reported health changes and adverse events. The study is intended to provide descriptive information regarding the initial safety, usability, and performance of the investigational catheter relative to participants' current intermittent catheter products.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • is living in the USA
  • is male
  • is at least 22 years of age
  • can speak, read, and write in English
  • is self-catheterizing 3 or more times a day
  • has been performing unassisted, self-catheterizations, with a Hydrophilic IC, for at least 1 month
  • currently uses one of the hydrophilic ICs (length=40cm; size=Ch. 14) listed below:
  • Hollister Incorporated VaPro Pocket Nelaton Tip (clear protective tip) (SKU 70144)
  • Hollister Incorporated VaPro Pocket Coude (blue protective tip) (SKU 77144)
  • Hollister Incorporated VaPro Coude (blue protective tip) (SKU 73144)
  • Hollister Incorporated VaPro Plus Nelaton (clear protective tip) (SKU 74144)
  • Hollister Incorporated VaPro Plus Pocket Nelaton (clear protective tip) (SKU 71144)
  • Hollister Incorporated Onli Nelaton (SKU: 82144-30)
  • Hollister Incorporated Onli Coudé (SKU: 85144)
  • Wellspect LoFric Origo Nelaton (SKU: 443 14 40)
  • Wellspect LoFric Origo Tiemann/Coudé (SKU: 444 14 40)
  • Wellspect LoFric Origo Flexible Coudé with protective sleeve (SKU: 449 14 40)
  • Wellspect LoFric Origo Flexible Coudé with insertion grip (SKU: 447 14 40)
  • Coloplast SpeediCath Standard Male (SKU: 28414)
  • Coloplast SpeediCath Male Coudé Tip (SKU: 28494)
  • Coloplast SpeediCath Flex Coudé Pro (SKU: 20014)
  • Convatec GentleCath Glide Male Straight Tip (SKU: 421567)
  • Convatec GentleCath Glide Male Tiemann Tip (SKU: 421910)
  • Convatec GentleCath Air Male Straight Tip (SKU:510690)
  • Convatec GentleCath Air Male Coude Tip (SKU:510696)
  • Convatec GentleCath Hydrophilic, 14FR, Straight (SKU: 508996)
  • Convatec GentleCath Hydrophilic, 14FR, Coude (SKU: 509001)
  • Convatec Cure - Hydrophilic Cure Catheter Straight Tip (SKU: HM14)
  • Convatec Cure - Hydrophilic Cure Catheter Coudé Tip (SKU: HM14C)
  • Bard - Magic3® Go Male, 14FR, Straight (SKU:53814G)
  • Bard - Magic3® Go Male, 14FR, Coude (SKU:50814G)
  • Bard - Magic3®, 14FR, Straight (SKU: 53614G)
  • Bard - Magic3®, 14FR, Straight (SKU: 53614) aa. Bard - Magic3®, 14FR, Coude (SKU: 50614)
  • is willing and able to follow the study protocol procedures including completing online questionnaires as demonstrated by signing the Informed Consent
  • is willing to switch from their current, typical intermittent catheter to the study-provided study products (e.g., study catheters) during the latter portion of the study
  • is willing to provide permission via the study informed consent and HIPAA Authorization Form for study staff to contact prescribing healthcare provider for a copy of their active prescription. Alternatively subject can opt to provide study staff with their active prescription.

Exclusion criteria

  • is currently receiving chemotherapy, has received chemotherapy within the past 30 days, or is scheduled to receive chemotherapy during the study (i.e., in the next 34 days)
  • is currently undergoing, has previously underwent, or is planning to undergo radiation therapy to the bladder, prostate, or rectum during the study (i.e., in the next 34 days)
  • is currently using one or more of the following oral or injectable steroid therapies for 30 days or more:
  • Acthar Gel
  • corticotropin
  • Agamree
  • vamorolone
  • budesonide
  • Cortef
  • hydrocortisone
  • Cortrophin Gel
  • corticotrophin
  • dexamethasone
  • deflazacort
  • prednisone
  • Emflaza
  • Eohilia
  • fludrocortisone
  • Jaythari
  • Orapred ODT
  • prednisolone
  • Pyquvi
  • Rayos
  • Tarpeyo
  • Uceris
  • currently has urinary tract infection (UTI) symptoms or has been diagnosed with a UTI by a healthcare provider in the last 2 weeks
  • has a retracted penis
  • has skin irritation or lesions (sores) on the penis
  • Performs non-urethral catheterization
  • Has participated in a study involving actual use of a study urethral IC (i.e. inserting/removing) within the last 30 days
  • Is currently an employee of Hollister Incorporated or any other intermittent catheter manufacturer.

Treatment and study plan

An intermittent urethral urinary catheter with a tip, tube and drainage eyelets

Device

An intermittent urethral urinary catheter with a tip, tube and drainage eyelets

Primary outcomes

  1. Incidence of Health Changes and Adverse Events During Usual-Catheter and Investigational-Catheter Use

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Number and nature of participant-reported health changes and adverse events collected during both the control-catheter period and the study-catheter period. Safety events will be categorized by incidence, severity, and relatedness.

  2. Participant-Reported Overall Ease of Use of the Catheter

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported overall ease of use of the catheter, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Very Easy, 2 = Easy, 3 = Neither Easy nor Difficult, 4 = Difficult, and 5 = Very Difficult. Lower scores indicate easier overall use.

Secondary outcomes

  1. Participant-Reported Ease of Inserting the Protective Tip Into the Urethral Opening

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported ease of inserting the protective tip into the urethral opening, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Very Easy, 2 = Easy, 3 = Neither Easy nor Difficult, 4 = Difficult, and 5 = Very Difficult. Lower scores indicate easier insertion. Applicable for the study catheter and usual catheters with a protective tip.

  2. Participant-Reported Ease of Inserting the Catheter Into the Urethral Opening

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported ease of inserting the catheter itself into the urethral opening for usual catheters without a protective tip, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Very Easy, 2 = Easy, 3 = Neither Easy nor Difficult, 4 = Difficult, and 5 = Very Difficult. Lower scores indicate easier insertion.

  3. Participant-Reported Ease of Advancing the Catheter Through the Protective Tip Into the Urethra

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported ease of advancing the catheter through the protective tip into the urethra, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Very Easy, 2 = Easy, 3 = Neither Easy nor Difficult, 4 = Difficult, and 5 = Very Difficult. Lower scores indicate easier advancement.

  4. Participant-Reported Ease of Advancing the Catheter Through the Urethra to the Bladder

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported ease of advancing the catheter through the urethra to the bladder, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Very Easy, 2 = Easy, 3 = Neither Easy nor Difficult, 4 = Difficult, and 5 = Very Difficult. Lower scores indicate easier advancement.

  5. Participant-Reported Bladder Drainage and Bladder Emptying

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported ease of draining the bladder with the catheter, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Very Easy, 2 = Easy, 3 = Neither Easy nor Difficult, 4 = Difficult, and 5 = Very Difficult. Lower scores indicate easier bladder drainage and emptying.

  6. Participant-Reported Worry That the Catheter Does Not Fully Empty the Bladder

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Assessed on a 5-point ordinal scale coded 1 to 5: 1 = Strongly Agree, 2 = Agree, 3 = Neither Agree nor Disagree, 4 = Disagree, and 5 = Strongly Disagree. Higher scores indicate less worry and a more favorable response.

  7. Occurrence of Urine Flow Restarting Before Complete Catheter Removal

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported occurrence of urine starting to flow again before the catheter was completely removed from the urethra/body. Assessed as Yes or No.

  8. Occurrence of Pausing to Allow Remaining Urine to Drain Through the Catheter

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported occurrence of pausing to allow remaining urine to drain through the catheter during removal. Assessed as Yes or No.

  9. Participant-Reported Actions Taken to Help Remaining Urine Drain Through the Catheter

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported actions taken to help remaining urine drain through the catheter, assessed as a check-all-that-apply item. Each response option will be summarized separately by number of participants selecting it.

  10. Participant-Reported Ease of Withdrawing the Catheter From the Urethra

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported ease of withdrawing the catheter from the urethra, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Very Easy, 2 = Easy, 3 = Neither Easy nor Difficult, 4 = Difficult, and 5 = Very Difficult. Lower scores indicate easier withdrawal.

  11. Participant-Reported Ability to Insert the Catheter Without Contaminating or Touching the Portion That Enters the Body

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported agreement with the statement that the catheter can be inserted without contaminating or touching the portion that enters the body, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Strongly Agree, 2 = Agree, 3 = Neither Agree nor Disagree, 4 = Disagree, and 5 = Strongly Disagree. Lower scores indicate a more favorable response.

  12. Participant-Reported Ability of the Catheter to Support the Recommended Catheterization Schedule

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported agreement with the statement that the catheter helps the participant follow the catheterization schedule recommended by a doctor or nurse, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Strongly Agree, 2 = Agree, 3 = Neither Agree nor Disagree, 4 = Disagree, and 5 = Strongly Disagree. Lower scores indicate a more favorable response.

  13. Occurrence of Discomfort During Catheter Insertion

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported discomfort during catheter insertion, assessed on a 5-point ordinal scale coded 1 to 5: 1 = No discomfort, 2 = A little discomfort, 3 = Some discomfort, 4 = A lot of discomfort, and 5 = Extreme discomfort. Higher scores indicate worse discomfort.

  14. Participant-Reported Type of Discomfort During Catheter Insertion

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported type of discomfort experienced during catheter insertion, assessed as a check-all-that-apply item. Each symptom category will be summarized separately by number of participants selecting it.

  15. Frequency of Discomfort During Catheter Insertion

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported frequency of discomfort during catheter insertion, assessed on a 4-point ordinal scale coded 1 to 4: 1 = Always, 2 = Often, 3 = Sometimes, and 4 = Rarely. Lower scores indicate more frequent discomfort.

  16. Occurrence of Coughing or Deep Breathing to Assist Catheter Insertion Into the Bladder

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported occurrence of coughing and/or taking a deep breath to help the catheter enter the bladder during insertion. Assessed by categorical response: Cough, Deep Breath, Both, or Neither.

  17. Occurrence of Turning or Twisting the Catheter During Advancement Through the Urethra

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported occurrence of turning or twisting the catheter during advancement through the urethra. Assessed as Yes or No.

  18. Participant-Reported Actions Taken During Catheter Insertion

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported actions taken during catheter insertion, assessed as a check-all-that-apply item. Each response option will be summarized separately by number of participants selecting it.

  19. Correct Orientation of the Funnel Notch Before Insertion Among Participants Using a Curved-Tip Catheter

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Among participants using a curved-tip catheter, participant-reported frequency of lining up the notch on the funnel so the tip pointed up before insertion, assessed by ordinal categorical response ranging from all the time to not at all, plus categories for not knowing about the notch or not using a coudé catheter.

  20. Occurrence of Turning the Curved-Tip Catheter During Advancement Into the Bladder

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Among participants using a curved-tip catheter, participant-reported occurrence/frequency of turning the catheter during advancement into the bladder, assessed by ordinal categorical response ranging from all the time to not at all.

  21. Participant-Reported Burden Associated With Orienting or Turning a Curved-Tip Catheter

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported burden associated with lining up the funnel notch and/or turning a curved-tip catheter during insertion, assessed on a 4-point ordinal scale coded 1 to 4: 1 = Much more burdensome, 2 = Moderately more burdensome, 3 = A little more burdensome, and 4 = Not more burdensome. Lower scores indicate greater burden.

  22. Participant-Reported Difficulty Pushing the Catheter Through the Urethra Into the Bladder

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported difficulty/ease of pushing the catheter through the urethra into the bladder, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Very Easy, 2 = Easy, 3 = Neither Easy nor Difficult, 4 = Difficult, and 5 = Very Difficult. Lower scores indicate easier passage.

  23. Occurrence of Discomfort During Bladder Drainage

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported discomfort during bladder drainage, assessed on a 5-point ordinal scale coded 1 to 5: 1 = No discomfort, 2 = A little discomfort, 3 = Some discomfort, 4 = A lot of discomfort, and 5 = Extreme discomfort. Higher scores indicate worse discomfort.

  24. Frequency of Discomfort During Bladder Drainage

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported frequency of discomfort during bladder drainage, assessed on a 4-point ordinal scale coded 1 to 4: 1 = Always, 2 = Often, 3 = Sometimes, and 4 = Rarely. Lower scores indicate more frequent discomfort.

  25. Participant-Reported Discomfort Symptoms During Bladder Drainage

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported discomfort symptoms during bladder drainage, assessed as a check-all-that-apply item. Each symptom category will be summarized separately by number of participants selecting it.

  26. Occurrence of Discomfort During Catheter Removal

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported discomfort during catheter removal, assessed on a 5-point ordinal scale coded 1 to 5: 1 = No discomfort, 2 = A little discomfort, 3 = Some discomfort, 4 = A lot of discomfort, and 5 = Extreme discomfort. Higher scores indicate worse discomfort.

  27. Frequency of Discomfort During Catheter Removal

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported frequency of discomfort during catheter removal, assessed on a 4-point ordinal scale coded 1 to 4: 1 = Always, 2 = Often, 3 = Sometimes, and 4 = Rarely. Lower scores indicate more frequent discomfort.

  28. Participant-Reported Discomfort Symptoms During Catheter Removal

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported discomfort symptoms during catheter removal, assessed as a check-all-that-apply item. Each symptom category will be summarized separately by number of participants selecting it.

  29. Participant-Reported Comfort Using the Catheter

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported agreement with the statement "I feel comfortable using the catheter," assessed on a 5-point ordinal scale coded 1 to 5: 1 = Strongly Agree, 2 = Agree, 3 = Neither Agree nor Disagree, 4 = Disagree, and 5 = Strongly Disagree. Lower scores indicate greater comfort.

  30. Participant-Reported Confidence That the Catheter Will Slide in Comfortably With Each Use

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported agreement with the statement that the catheter will slide in comfortably every time it is used, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Strongly Agree, 2 = Agree, 3 = Neither Agree nor Disagree, 4 = Disagree, and 5 = Strongly Disagree. Lower scores indicate greater confidence.

  31. Participant-Reported Confidence That the Catheter Will Slide in Easily With Each Use

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported agreement with the statement that the catheter will slide in easily every time it is used, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Strongly Agree, 2 = Agree, 3 = Neither Agree nor Disagree, 4 = Disagree, and 5 = Strongly Disagree. Lower scores indicate greater confidence.

  32. Participant-Reported Confidence That the Catheter Allows the Bladder to Empty Fully

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported agreement with the statement that the catheter allows the bladder to empty fully, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Strongly Agree, 2 = Agree, 3 = Neither Agree nor Disagree, 4 = Disagree, and 5 = Strongly Disagree. Lower scores indicate greater confidence.

  33. Participant-Reported Confidence in Successfully Using the Catheter

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported agreement with the statement "I am confident I can successfully use the catheter," assessed on a 5-point ordinal scale coded 1 to 5: 1 = Strongly Agree, 2 = Agree, 3 = Neither Agree nor Disagree, 4 = Disagree, and 5 = Strongly Disagree. Lower scores indicate greater confidence.

  34. Time to Participant-Reported Confidence in Using the Catheter

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported time required to feel confident using the catheter, assessed on an 11-category ordinal scale: Less than 1 day, 1 day, 2 days, 3 days, 4 days, 5 days, 6 days, 1 week, 1 week to 10 days, More than 10 days, or I still do not feel confident. Lower categories indicate earlier confidence.

  35. Participant-Reported Ability of the Catheter to Support Confidence During Use

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported agreement with the statement that the catheter allows the participant to feel confident, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Strongly Agree, 2 = Agree, 3 = Neither Agree nor Disagree, 4 = Disagree, and 5 = Strongly Disagree. Lower scores indicate greater confidence.

  36. Participant-Reported Confidence When the Catheter Was Inserted

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported confidence when the catheter was inserted, assessed on a 4-point ordinal scale coded 1 to 4: 1 = Very confident, 2 = Somewhat confident, 3 = A little confident, and 4 = Not confident. Lower scores indicate greater confidence.

  37. Participant-Reported Ability of the Catheter to Help the Participant Feel Confident When Used

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported agreement with the statement that the catheter helps the participant feel confident when used, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Strongly Agree, 2 = Agree, 3 = Neither Agree nor Disagree, 4 = Disagree, and 5 = Strongly Disagree. Lower scores indicate greater confidence.

  38. Participant-Reported Overall Satisfaction With the Catheter

    Time frame: Through completion of both catheter-use periods, approximately 6 to 20 days

    Participant-reported overall satisfaction with the catheter, assessed on a 5-point ordinal scale coded 1 to 5: 1 = Very satisfied, 2 = Satisfied, 3 = Neither satisfied nor dissatisfied, 4 = Dissatisfied, and 5 = Very dissatisfied. Lower scores indicate greater satisfaction.

  39. Participant-Reported Bladder Emptying Time With the Investigational Catheter Compared With the Participant's Current Intermittent Catheter

    Time frame: At completion of the study-catheter period, approximately 6 to 20 days after starting the control-catheter period

    Participant-reported comparison of how long it took to empty the bladder with the investigational catheter relative to the participant's current intermittent catheter. Assessed by categorical comparative response.

  40. Participant-Reported Advancement Performance of the Investigational Catheter Compared With the Participant's Current Intermittent Catheter

    Time frame: At completion of the study-catheter period, approximately 6 to 20 days after starting the control-catheter period

    Participant-reported comparison of how the investigational catheter performed when advancing through the urethra into the bladder to drain urine relative to the participant's current intermittent catheter. Assessed by categorical comparative response.

  41. Participant-Reported Likelihood of Using the Investigational Catheter if Commercially Available in the Participant's Usual Type and Package

    Time frame: At completion of the study-catheter period, approximately 6 to 20 days after starting the control-catheter period

    Participant-reported likelihood of using the investigational catheter if it were commercially available in the participant's usual type and package, assessed by ordinal categorical response. More favorable responses indicate greater likelihood of use.

  42. Participant-Reported Overall Catheter Preference Between the Investigational Catheter and the Participant's Current Intermittent Catheter

    Time frame: At completion of the study-catheter period, approximately 6 to 20 days after starting the control-catheter period

    Participant-reported overall preference between the investigational catheter and the participant's current intermittent catheter, assessed by categorical response indicating preferred catheter.

Sponsors and collaborators

Lead sponsor

Hollister Incorporated

Industry

Registry information

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
Jul 20, 2026
Registry last updated
Jul 20, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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