INCISING IMPLANT FOR THE PROSTATIC URETHRA
20220096113 · 2022-03-31
Inventors
Cpc classification
A61B2017/00274
HUMAN NECESSITIES
A61B17/320725
HUMAN NECESSITIES
A61B2017/32096
HUMAN NECESSITIES
A61F2/04
HUMAN NECESSITIES
International classification
Abstract
An implant for the prostatic urethra of a subject, the implant including a first frame being closed-shaped, the first frame includes two longitudinal sections; a second frame being closed-shaped, the second frame includes two longitudinal sections, wherein a mid-portion of one of the longitudinal sections of the first frame is connected in at least one of: directly and indirectly, to a mid-portion of one of the longitudinal sections of the second frame; and a third frame being distinct from the first frame and the second frame, the third frame includes a first arm section joined to the first frame, and a second arm section joined to the second frame, the first arm section and the second arm section extend such to be joined together in an apex portion.
Claims
1-11. (canceled)
12. An implant for the prostatic urethra of a subject, the implant comprising: a first frame being closed-shaped, said first frame includes two longitudinal sections; a second frame being closed-shaped, said second frame includes two longitudinal sections, wherein a mid-portion of one of said longitudinal sections of said first frame is connected in at least one of: directly and indirectly, to a mid-portion of one of said longitudinal sections of said second frame; and a third frame being distinct from said first frame and said second frame, said third frame includes a first arm section joined to said first frame, and a second arm section joined to said second frame, said first arm section and said second arm section extend to be joined together in an apex portion.
13. The implant according to claim 12, wherein said first frame, said second frame, and said third frame form a frame of wires.
14. The implant according to claim 12, wherein said implant is configured for applying pressure on tissues of said prostatic urethra.
15. The implant according to claim 13, wherein said wires are flexible, thereby being compressible into a compressed configuration.
16. The implant according to claim 15, wherein said implant is enfolded in a sheath in said compressed configuration.
17. The implant according to claim 13, wherein said wires are flexible, thereby being expandable in an open configuration.
18. The implant according to claim 17, wherein said implant is configured for implantation in the prostatic urethra of said subject, and for applying pressure on surrounding tissues of said prostatic urethra in said open configuration.
19. The implant according to claim 12, further comprising a one-way stopper connected to said first frame and to said second frame, said one-way stopper being elastic.
20. The implant according to claim 12, further comprising a one-way stopper for preventing said implant from migrating back toward the bladder.
21. The implant according to claim 16, wherein said implant is configured for extraction from said subject by pulling and enfolding said implant into said sheath.
22. The implant according to claim 12, wherein said implant is configured to couple with an extraction string for facilitating extraction of said implant from said subject.
23. The implant according to claim 12, wherein said apex portion is distant from said first frame and said second frame, in said open configuration.
24. The implant according to claim 12, wherein said first frame and said second frame symmetrically oppose each other, and are directly connected to each other along each of said mid-portion.
25. A method for deploying an implant configured for implantation in the prostatic urethra of a subject, the method comprising: enfolding said implant into a sheath, thereby compressing said implant into a compressed configuration, said implant being flexible; inserting said implant and at least part of said sheath into a urethra of said subject, until a distal end of said sheath and said implant reach a constricted position within said prostatic urethra; releasing said implant from said sheath until said implant exits said distal end of said sheath, thereby expanding said implant to an open configuration, so that said implant is configured to apply pressure on the inner wall tissues of said prostatic urethra; and retracting said sheath from said subject.
26. The method according to claim 25, further comprising rotating said implant into a desired orientation, after said releasing said implant from said sheath.
27. A method for extracting an implant implanted in the prostatic urethra of a subject, the method comprising: inserting at least part of a sheath into said prostatic urethra of said subject; enfolding said implant by pulling at least part of said implant and pushing said sheath over said implant, thereby compressing said implant from an open configuration into a compressed configuration, said implant being flexible; and retracting said implant and said sheath from said subject.
28. The method according to claim 27, wherein said pulling is facilitated via an extraction string coupled with said implant.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0008] The disclosed technique will be understood and appreciated more fully from the following detailed description taken in conjunction with the drawings in which:
[0009]
[0010]
[0011]
[0012]
[0013]
DETAILED DESCRIPTION OF THE EMBODIMENTS
[0014] The disclosed technique overcomes the disadvantages of the prior art by providing an incising implant to be implanted in the prostatic urethra (or at the vicinity thereof, for example, in the bladder neck). The incising implant includes wires which apply radial force on the surrounding inner wall tissues of the prostatic urethra. Over time, the wires induce infraction and thereby produce longitudinal incisions in the surrounding tissues. The incisions relieve constriction of the prostatic urethra.
[0015] In accordance with an embodiment of the disclosed technique, the incising implant is formed by three closed-shape wires (or more). The shape of each wire can be roughly divided into a proximal section, a distal end section and two longitudinal sections extending between the proximal and the distal sections. Each wire is made of an elastic material allowing it to be compressed into a sheath, and to assume its original shape when released from the sheath.
[0016] The longitudinal sections of each wire are adjoined with longitudinal sections of adjacent wires. Thereby, the wires are coupled to each other to form a frame of wires. Each wire forms a face of the wire frame, and the adjoined longitudinal sections form the edges of the wire frame. The edges of the wire frame apply radial pressure on the inner wall tissues of the prostatic urethra, thereby creating longitudinal incisions that relieve urethral constriction and increase the urinal passage.
[0017] The wires, when applying pressure on the surrounding tissues, are pressed against one another (i.e., each wire is pressed against adjacent wires to which it is adjoined at the respective longitudinal sections). Thereby, the wires support each other. In other words, when a wire applies a force on a tissue, the tissue applies an opposite force having the same magnitude (in accordance with Newton's third law). The wire is thus pressed against adjoined adjacent wires. These adjoined wires, in turn, are pushed against other tissues. In this manner, the wire frame is self-supporting, obviating the need for an additional supporting element, such as a central support tube. Additionally, each edge of the wire frame is formed by two adjoined wires, doubling the pressure applied on the tissues and allowing for thinner wires.
[0018] In accordance with another embodiment of the disclosed technique, there is thus provided a method for deploying an incising implant in the prostatic urethra of the subject. The method involves enfolding the incising implant within a sheath. The implant is elastic and thereby conforms to the circumference of the enfolding sheath which is smaller than the circumference of the implant. The sheath is inserted into the urethra and is pushed until its distal end extends into the bladder of the subject. The implant is pushed within the sheath until it extends from the distal end of the sheath. Once released from the sheath the elastic implant resumes its original, extended, configuration.
[0019] The implant can include a proximal cap having a proximal niche (or a proximal protrusion). The proximal niche is a non-round niche that can transfer rotary motion from a corresponding pin (or in case of a proximal protrusion—a corresponding niche). Thereby, the user can rotate the implant within the bladder to a desired rotary orientation.
[0020] Thereafter, the implant is pulled back in the proximal direction until it is positioned within the prostatic urethra (and/or the bladder neck). The implant remains within the prostatic urethra for a period of time (e.g., several hours or several day), during which the implant creates longitudinal incisions in the surrounding inner wall tissues of the urethra for relieving urethral constrictions. After the period of time passes, a sheath is inserted into the urethra and enfolds the implant, thereby compressing the implant back to a compressed configuration. Following this, the implant is removed from the urethra via the sheath.
[0021] The terms pressure and force (e.g., applying radial pressure or applying radial force) are employed interchangeably herein below, to describe the operation of the wires of the implant on the surrounding tissues. That is, the wires are described as applying pressure on the tissues, or as applying force on the tissues. Herein below, the terms proximal and distal refer to directions relative to implantable device and the delivery system. In particular, the distal end is the end of the device (or of the system) that is inserted into the body of the patient first and reaches the deepest. The proximal end is the end closer to the exit from the body of the patient.
[0022] Reference is now made to
[0023] The closed shape of each of wires 102 can roughly be divided into a proximal section, a distal section and two longitudinal sections extending between the proximal section and the distal section. For example, the proximal section can be a U-shaped proximal end, from which the longitudinal sections extend. The distal section is the section connecting the longitudinal sections. Each of wires 102 is coupled with adjacent ones of wires 102 on either side thereof. Specifically, the longitudinal sections of each of wires 102 are coupled with longitudinal sections of adjacent wires. For example, one longitudinal section of wire 102A is coupled with a longitudinal section of wire 102B, and the other longitudinal section of wire 102A is coupled with a longitudinal section of wire 102C. The other longitudinal section of wire 102B (not coupled with 102A) is coupled with the other longitudinal section of wire 102C (that is also not coupled with 102A). Proximal cap 106 holds the proximal ends of wires 102 together. Extraction string 108 is coupled with wires 102, or with proximal cap 106.
[0024] The following paragraphs describe the use of incising implant 100. Thereafter, the components of incising implant 100 would be elaborately described. Incising implant 100 is temporary implanted in the prostatic urethra for creating longitudinal incisions in the inner wall tissues of the prostatic urethra, thereby relieving urethra constriction.
[0025] Incising implant 100 is implanted by employing a sheath (not shown) for inserting the implant into the urethra. Implant 100 is compressed within the sheath such that the diameter of the circumference of implant 100, illustrated by dotted circle 110, conforms to the inner diameter of the sheath. Wires 102 are made of elastic material, such that when released from the enfolding sheath they regain their original, extended, shape (and the original circumference diameter of implant 100). When positioned in the prostatic urethra, implant 100 is bound by the inner diameter of the urethral walls surrounding it.
[0026] Wires 102 push against the surrounding tissues (i.e., apply a radial outward force on the tissues). Over time, the force applied by wires 102 impairs the blood (and oxygen) supply to the tissues in contact with wires 102, thereby inducing tissues necrosis and creating infarcted incisions. Over time, the incisions become deeper until wires 102 reach their full extent (i.e., until implant 100 regains its original circumference diameter as illustrated by dotted circle 110). It is noted however, that implant 100 can be removed before fully regaining its original shape, in case the incisions are determined to be sufficiently deep to relieve the constriction of the urethra.
[0027] Implant 100 is implanted such that wires 102 are aligned with the longitudinal direction of the urethra. Therefore, wires 102 create longitudinal incisions in the inner wall tissues of the prostatic urethra. That is, the longitudinal incisions are incisions running along the longitudinal axis of the urethra. Put another way, longitudinal incisions are incisions running along (and not across) the urinary passage.
[0028] The period of time required for creating incisions that are sufficient to relieve urethra constriction depends on various factors, such as the level of constriction, the materials of wires 102, the original fully extending shape of wires 102, and the like. Implant 100 can remain in the prostatic urethra for a predetermined period of time. Alternatively, implant 100 can remain implanted until the constriction is sufficiently relieved, as determined by a physician, according to tests (e.g., observations of the implant effect over time), or by the subject himself (e.g., according to what the subject feels when urinating). For example, implant 100 can be implanted for a time period ranging between a one hour and several weeks. The incisions created by implant 100 are created over time without causing pain or bleeding to the subject. After implant 100 is implanted, the subject can be released and resume his regular lifestyle, without any hindrances. After the required period of time, implant is removed from the subject.
[0029] Incising implant 100 is implanted within the prostatic urethra to relieve constriction of the urethra, caused for example by prostatic enlargement. Implant 100 can be positioned in other, or in additional, areas of the urinal passage, such as the bladder neck. Alternatively, implant 100 can be implanted in any tubular organ that requires relief of a constriction, such as tubular organs of the digestion system, blood vessels, and the like.
[0030] Wires 102 (i.e., wires 102A, 102B and 102C) are closed-shaped wires made of elastic material. The material of wires should be elastic enough to allow wires to be compressed within a sheath, and to conform to the inner diameter of the sheath, during insertion into the urethra. The wires should regain their original, extended, shape (and the original circumference diameter) once released from the sheath. Additionally, the wires should be strong enough to apply a force on the surrounding tissues to induce necrosis in the tissues (e.g., a force of 0.5 Newton), and thereby to create infarcted longitudinal incisions. Wires 102 can be made, for example, from Nickel Titanium alloy (Nitinol). Alternatively, implant 100 is made of biodegradable materials, such that there is no need to remove implant 100 from the body of the patient.
[0031] The closed shape of wires can be roughly divided into three sections, a proximal section, a middle section consisting of two longitudinal sections, and a distal section (all not referenced). The proximal section (or proximal end) is U-shaped. The longitudinal sections extend from the arms of the U-shaped proximal end and are connected via the distal section (or distal end). The distal section serves as a support crosspiece connecting the longitudinal sections of the wire. Exemplary closed shapes of the wires are illustrated in
[0032] The longitudinal sections of each of wires 102 are the sections in contact with the surrounding tissues. That is, the longitudinal sections are the sections pushing against the tissues for creating the incisions. The longitudinal sections of each of wires 102 are coupled (i.e., adjoined) with longitudinal sections of adjacent wires. For example, a first longitudinal section of wire 102A is adjoined with a first longitudinal section of wire 102B, a second longitudinal section of wire 102A is adjoined with a first longitudinal section of wire 102C, and a second longitudinal section of wire 102B is adjoined with a second longitudinal section of wire 102C. In this manner, the adjoined wires form together a supporting wire frame, such that each closed-shape wire forms a face of the frame, and each adjoined pair of longitudinal sections of adjacent wires forms an edge of the frame.
[0033] When the longitudinal sections of wires 102 are pushed against the surrounding tissues (i.e., as implant 100 tries to regain its original shape while being bound by the urethra inner walls), the surrounding tissues apply an opposite force on wires 102 in accordance with the third law of Newton. Each of wires 102 is pushed against the adjacent wires to which it is adjoined. The wire frame increases the structural stability of implant 100 and allowing implant 100 to apply sufficient force for creating the incisions in the surrounding tissues. Thus, the wire frame obviates the need for an additional support element, such as a central support tube.
[0034] In the example set forth in
[0035] The wounding of wires 102 can be achieved, for example, by twisting the longitudinal sections around each other and thermally treating implant 100 for stabilizing the winding. Wires 102 can be wound around each other by being placed in a mold having rotating elements that grab the longitudinal sections and wound them around each other.
[0036] In the example set forth in
[0037] Proximal cap 106 is coupled with the proximal ends of wires 102 for coupling wires 102 together. Thereby, the wire frame is further strengthened. Put another way, proximal cap 106 helps to maintain the structure of implant 102 (i.e., increases the structural stability) by further adjoining wires 102 to each other.
[0038] In the example set forth in
[0039] Proximal cap 106 can include a proximal non-round niche (e.g., niche 502 of
[0040] Anchoring leaflet 104 serves as a one-way stopper allowing implant to move from the bladder into the prostatic urethra and preventing implant 100 from migrating back toward the bladder by being stuck against one of the urethral sphincters. Leaflet 104 can be a wire leaflet (e.g., as depicted in
[0041] Extraction string 108 enables the physician to extract implant 100. Specifically, the distal end of string 108 is coupled with implant 100, and the proximal end of string 108 extends outside of the body of the subject. The physician can insert an extraction sheath into the urethra along string 108 for enfolding implant 100. The physician can extract the enfolded implant by pulling string 108. String 108 is strong enough for pulling implant 100 without being torn (e.g., the thickness and materials of string 108 allow pulling implant 100 via string 108). String 108 can be a single strand or a woven bundle of strands for further fortifying it.
[0042] Incising implant 100 is deployed such that it does not extend distally beyond the bladder neck of the subject (i.e., does not extend into the bladder). Specifically, wires 102 do not come into contact with the tissues of the bladder itself. Thereby, implant 100 does not irritate the bladder of the patient.
[0043] In accordance with an embodiment of the disclosed technique, the incising implant is colored in such a manner that enables the physician to easily position it in order. For example, the wires of the implant are color coded such that sections that should be positioned on top are colored blue, and sections that should be positioned on the bottom are colored white. The physician can observe the implant in the bladder via a cystoscope, and rotate the implant to the desired orientation according to the colors of the implant.
[0044] Reference is now made to
[0045] The closed shape of each of wires 202 is depicted in
[0046] Wires 202 are not wound around each other. Instead, wires 102 can be adjoined to one another (i.e., the longitudinal sections are adjoined to longitudinal sections of adjacent wires) by various manners. For example, the wires are welded together, glued together, or coupled by a coupling mechanism or element (e.g., coupling thread binding the longitudinal sections together).
[0047] In the example set forth in
[0048] Reference is now made to
[0049] Reference is now made to
[0050] Reference is now made to
[0051] With reference to
[0052] With reference to
[0053] With reference to
[0054] With reference to
[0055] Thereby, implant 500 is implanted within the prostatic urethra and starts applying radial outward force on the surrounding tissues of the inner walls of the urethra for creating longitudinal incisions. Implant 500 is left within the prostatic urethra for a selected time period (e.g., ranging between one hour and several weeks. Thereafter implant 500 is removed as would be detailed below. Alternatively, implant 500 is made of biodegradable materials and simply dissolves after a selected time period.
[0056] With reference to
[0057] It will be appreciated by persons skilled in the art that the disclosed technique is not limited to what has been particularly shown and described hereinabove. Rather the scope of the disclosed technique is defined only by the claims, which follow.