Endosphincter, set for releasable closure of the urethra and met

Details Endosphincter, set for releasable closure of the urethra and met Endosphincter, set for releasable closure of the urethra and met

1998-02-20

2000-02-08

O'Connor, Cary

Surgery

Body inserted urinary or colonic incontinent device or...

604246, A61F 200, A61M 500

Patent

active

06022312&

DESCRIPTION:

BRIEF SUMMARY
FIELD OF THE INVENTION

The invention relates to an artificial endosphincter for the urethra, a set for releasable closure of the urethra, and a method for inserting an endosphincter in the urethra.


BACKGROUND AND SUMMARY OF THE INVENTION

Reference is made initially to DE 28 06 405 A1 as the prior art. According to this publication, an artificial sphincter is frequently implanted in cases of urinary incontinence or as a result of injury of removal of the external urethral sphincter following adenectomy of the prostate, radical prostatectomy, neurogenic urinary incontinence, and hyperactivity of the urethral sphincter and congenital urethral muscle defects. In a pneumatic sphincter referred to therein, an inflatable cuff surrounds the urethra so that the cuff can be inflated, preventing the escape of urine through the urethra. The urethra is released by venting the air from the cuff so that the urinary bladder can be emptied. This device must be implanted. A device for pumping air into the inflatable cuff is impractical and burdensome and may often be unsuitable for the user.
In a mechanical sphincter device also referred to, a coil, ring, or torus surrounds the urethra and is deliberately contractible by a control device by the user, preventing the escape of urine. To control the degree of contraction and to avoid adjustment that requires additional surgery involving bleeding, DE 28 06 405 A1, as an improvement on the device described above, provides a device for preventing the closing force from increasing beyond a predetermined closed position to protect the passageway against excessive or harmful closure.
British Patent 1,174,814 teaches an artificial sphincter with a closing body operated pneumatically, hydraulically, mechanically, or electrically, said body being connected directly or indirectly with an actuating device in order to permit actuation of the body to close or open the passageway.
DE 35 21 602 A1 teaches an endourethral sphincter prothesis which is implantable in the prostate cavity that has been cleared. This prosthesis has a short tubular section surrounded by a housing, said section extending from the neck of the bladder to the urethra. To adapt the sphincter prosthesis to the lumen of the empty prostate capsule, a balloon-like bladder made of thin, rubbery material is located around the prosthesis housing, into which bladder rapidly curing silicone foam is injected so that the bladder adjusts to the inside wall of the prostate capsule.
The tube section inside the housing is surrounded by a pressure cuff or a pinch valve. An actuating device is provided for its actuation, said device comprising a hydraulic chamber located in the lower body of the patient, from which chamber a connecting tube extends to a control pump located in the scrotum, from which a tube in turn leads to the cuff or the pinch valve.
It is also disadvantageous in this regard, even if the prosthesis is located in the wound space left by the prostate so that the valve mechanism does not act on the urethra but upon an artificial tubular section, that the entire device must be implanted, i.e. inserted with bleeding. Moreover, it is complex and cumbersome.
The above publication itself also refers to sphincter prostheses according to Rosen with a hydraulically operated clamp acting on the urethra and a prosthesis according to Kaufmann, Kelami-Affeld, and Scott in which a hydraulic cuff in the filled state exerts compression on the urethra, with the actuating elements for controlling the sphincter prosthesis being located out of the way and free of irritation in the scrotum. The subject of DE 35 21 602 A1 includes an improvement on the latter design in order to avoid precisely the disadvantages caused by the action of the valve or clamp on the urethra itself.
EP 348 114 B1 teaches a likewise implantable, i.e. therefore insertable in an operation involving bleeding, artificial closing muscle for a human passageway in the body, more specifically the male urethra. This has a cuff located around the urethra and, when inflate

REFERENCES:
patent: 3818511 (1974-06-01), Goldberg et al.
patent: 4932938 (1990-06-01), Goldberg et al.
patent: 5112306 (1992-05-01), Burton et al.
patent: 5445626 (1995-08-01), Gigante
patent: 5667486 (1997-09-01), Mikulich et al.

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