Surgery – Means for introducing or removing material from body for... – Treating material introduced into or removed from body...
Patent
1998-09-16
2000-05-23
Thaler, Michael H.
Surgery
Means for introducing or removing material from body for...
Treating material introduced into or removed from body...
604 8, A61M 2510
Patent
active
060661135
DESCRIPTION:
BRIEF SUMMARY
The present invention relates to a system of apparatus for treating the ureter and/or the pyelo-ureter junction.
Blockages in the ureter which are generally caused by constriction thereof (in medical terms: a stenosis) can lead to serious medical problems such as pain, inflammation of the ureter wall and prevention of urine drainage from the kidney.
A constriction in the pyelo-ureter junction or more distally in the ureter was until recently treated by means of an operation termed pyeloplasty or ureterdlasty. This meant that the kidney is exposed following a rather large incision in the flank whereafter the pyelum is surgically corrected.
This operation has recently been replaced by an endoscopic method wherein a nefrostomy catheter is placed into the surgically expanded pyelum. Under nefrostomy it is to be understood: arranging an alternative deviation for urine drainage by means of a catheter which is placed into the pyelum via the back, or rather the kidney, this being carried out in the X-ray department and usually not done under general anaesthetic. In spite of local anaesthetic, this operation can however be very painful. A pyeloscopy is subsequently carried out, wherein the pyelum is treated with a scope, which can be introduced in one or two ways: a flexible fibre glass scope. This operation is usually impossible when the ureter is constricted. back into the pyelum after the above mentioned nefrostomy has been carried out.
This second operation is carried out under general anaesthetic in the operating theatre.
By these known treatments, a guide wire is manipulated through the constriction from the pyelum through the bladder with the aid of the scope, over which guide wire a PTA balloon is pushed.
A PTA balloon, or rather a "percutaneous transluminal angioplasty balloon" is a catheter balloon which is commonly used to widen blood vessel constrictions, and introduced by means of a guide wire which has been pushed into the blood vessel wall. Depending on the balloon diameter, this can resist a maximum pressure of between 4 to .+-.17 atm.
This balloon is expanded to a pressure of 10-17 atmospheres in order to stretch and widen the ureter wall at the position of the stenosis.
The balloon is subsequently removed. Whilst the guide wire remains, the constriction is further widened in the longitudinal direction by one or more surgical incisions.
An endopyelotomy stent is then pushed over the wire and into the bladder. This is a catheter having a curled end situated in the pyelum, whereby the other end is curled in the bladder in order not to project into the bladder wall. This stent functions to keep open the constriction in order to prevent a relapse.
This catheter has a maximum diameter of 4.7 mm and cannot be introduced into the ureter from the bladder due to the constriction. After a period of roughly six weeks, the catheter can be pulled out of the ureter from the bladder. During this period, the ureter has had time enough to heal around this catheter and to widen. Through a channel in the catheter, urine drainage is carried out during these six weeks.
An object of the present invention is to provide a system wherein treatment of the ureter and/or the pyelo-ureter junction is less stressful for the patient.
SUMMARY OF THE INVENTION
There is provided according to the present invention a system for treating the ureter and/or the pyelo-ureter junction.
Since the widening means which preferably comprise a first balloon, are introduced via a guiding means from the bladder, admission of a patient into a hospital, whereby nefrostomy as well as endopyelotomy. under general anaesthetic and the accompanying uncomfortable and costly circumstances are required, is avoided.
The system preferably further comprises keeping open means in order to keep open the now widened constriction, wherein the keeping open means preferably comprise a second balloon.
The inventor has found that a constriction such as in the pyelo-ureter junction can be expanded under high pressure, and kept in this expanded, widened state at a l
REFERENCES:
patent: 4155364 (1979-05-01), Boxer
patent: 4571239 (1986-02-01), Heyman
patent: 4575371 (1986-03-01), Nordqvist et al.
patent: 5002558 (1991-03-01), Klein et al.
patent: 5024655 (1991-06-01), Freeman et al.
patent: 5312430 (1994-05-01), Rosenbluth et al.
patent: 5318529 (1994-06-01), Kontos
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