Medical arrangement for shutting off a body channel

Abstract

A medical device for shutting off an anatomical channel is provided, including: a band section that can be placed around the body tissue surrounding the body channel and can be closed to form a ring enclosing a passage opening for the body tissue, and that includes a cavity which makes up one part of a receiving chamber of the arrangement, for receiving working fluid; and a pump unit for conveying the working fluid. The passage opening can be made smaller by introducing the working fluid into the cavity. An expansion body is provided having an expansion chamber, and the expansion body is arranged on the band section, on a side of the band section that faces the passage opening, and the expansion chamber can be made bigger by introducing an auxiliary fluid, which is separate from the working fluid, into the expansion chamber.

Claims

1. A medical device for shutting off an anatomical channel, comprising: a band part that is adapted to be placed around body tissue surrounding the anatomical channel and is adapted to be closed to form a ring that encloses a through-opening for the body tissue, and further includes a hollow chamber that forms part of a receiving space that is adapted to receive working fluid; a pump unit that is adapted to convey the working fluid to the hollow chamber such that the through-opening is adapted to be made smaller by introduction of the working fluid into the hollow chamber; and an expansion body with an expansion chamber, the expansion body being arranged at the band part, on a side of the band part directed toward the through-opening, and the expansion chamber being adapted to be made larger by introduction of an auxiliary fluid, separate from the working fluid, into the expansion chamber such that an expansion of the expansion chamber is independent of a filling state of the hollow chamber with the working fluid.

2. The medical device as claimed in claim 1, further comprising an auxiliary fluid container with a storage chamber for the auxiliary fluid, a volume of said storage chamber being variable depending on an ambient pressure, and the auxiliary fluid container being connected to the expansion chamber via an auxiliary fluid line.

3. The medical device as claimed in claim 2, wherein the auxiliary fluid container has a flexible wall delimiting the storage chamber.

4. The medical device as claimed in claim 3, wherein the wall is substantially non-extensible.

5. The medical device as claimed in claim 3, wherein the wall is pliable.

6. The medical device as claimed in claim 2, wherein a pressure of the auxiliary fluid is adapted to rise when a force is exerted on the auxiliary fluid container.

7. The medical device as claimed in claim 1, wherein the pump unit comprises a pump part which has an interior that is adapted to receive the working fluid, and a drive that is adapted to vary a volume of the interior.

8. The medical device as claimed in claim 1, wherein the expansion body arranged at the band part has a bearing surface that is adapted to bear on the body tissue.

9. The medical device as claimed in claim 1, wherein a volume of the expansion chamber is at least substantially equal to zero when the working fluid is at a higher pressure compared to a pressure of the auxiliary fluid.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) Further advantages and details of the invention are explained below with reference to the attached drawings, in which:

(2) FIG. 1 shows a schematic view of a device configured as an artificial urethral sphincter, in a release state of the band part, in which state the ureter is opened;

(3) FIG. 2 shows a view analogous to FIG. 1, in a shut-off state of the band part, in which state the ureter is closed;

(4) FIG. 3 shows a view analogous to FIG. 1, in a stress state of the band part, in which state an additional force is exerted on the ureter;

(5) FIGS. 4 and 5 show oblique views of the free, i.e. not implanted, band part of the device in an opened state and a closed state, specifically corresponding to the release state;

(6) FIG. 6 shows a longitudinal center section (parallel to the longitudinal center axis of the through-opening and extending through the latter) through the band part in the state according to FIG. 5;

(7) FIG. 7 shows a longitudinal center section analogous to FIG. 6, but in the shut-off state of the band part;

(8) FIG. 8 shows a schematic view of a second embodiment of an artificial urethral sphincter, in a shut-off state of the band part, in which state the ureter is closed;

(9) FIG. 9 shows a view analogous to FIG. 8 in a stress state of the band part, in which state an additional force is exerted on the ureter;

(10) FIG. 10 show a schematic view of a variant of the band part according to the second embodiment, in a shut-off state of the band part, in which state the ureter is closed, and

(11) FIG. 11 shows a view, analogous to FIG. 10, in a stress state of the band part, in which state an additional force is exerted on the ureter.

DETAILED DESCRIPTION

(12) A band part 1 of the medical device can be placed in a ring shape around the body tissue 2 surrounding the anatomical channel, here the urethra. The band part 1 has a hollow chamber 3 which extends in the direction of the longitudinal extent of the band part 1, in the illustrative embodiments substantially along the entire length of the band part 1. The band part 1 is thus configured like a hose, with ends closed at both sides.

(13) A first and a second closure part 6, 7 are arranged at the two ends of the band part 1. The first closure part 6 has an insertion opening 6a into which a tongue 7a of the second closure part 7 can be inserted and locked therein.

(14) The closure parts 6, 7 thus form a closure with which the band part 1 can be closed to form a ring, in particular a circular ring (cf. FIG. 5). In the closed state, the band part 1 encloses a through-opening 4 for the body tissue 2 surrounding the anatomical channel.

(15) A working fluid, in particular a liquid, e.g. saline solution, is located in the hollow chamber 3. The size of the through-opening 4 depends on the quantity of the working fluid in the hollow chamber 3. The through-opening 4 can be made smaller by introducing working fluid into the hollow chamber 3. A flexible inner portion 1a of the band part 1, which portion is adjacent to the longitudinal center axis 5 of the through-opening 4, is displaced in the direction toward the longitudinal center axis 5, as is known. By removing working fluid from the hollow chamber 3, the through-opening 4 can be made larger again.

(16) FIG. 6 shows the state in which the through-opening 4 is at its largest (wherein the pressure of the working fluid in the hollow chamber 3 corresponds to the ambient pressure). FIG. 7 shows a state in which it is filled with the working fluid, in particular the state in which it is filled to the maximum with working fluid (wherein the pressure of the working fluid in the hollow chamber 3 is above the ambient pressure). The formation of folds, which would occur in particular if the band part is not placed around the ureter, is not shown in FIG. 7. By contrast, a rear portion 1b of the band part 1, set back from the longitudinal center axis 5, can be made stiff in relation to the inner portion 1a, in particular by a reinforcing layer, as a result of which a deformation of the rear portion 1b can be at least largely avoided.

(17) In the closed state of the band part 1 placed around the anatomical channel, said band part 1 can thus adopt a release state, in which the anatomical channel is opened (cf. FIG. 1), and a shut-off state, in which the anatomical channel is closed (cf. FIG. 2). In the release state, the pressure of the working fluid in the hollow chamber 3 can for example correspond to the atmospheric pressure. In the shut-off state, the hollow chamber 3 is filled with such a quantity of working fluid that the anatomical channel is closed.

(18) Various modifications of the design of the band part are conceivable and possible. For example, it would be possible for special closure parts mounted on the band part 1 to be omitted altogether and for the two ends of the band part to be sewn to each other.

(19) The band part 1 can be made from silicone in a known manner. Other biocompatible materials may also be used in principle.

(20) In the illustrative embodiment, an attachment stub 8 is integrally formed on one of the closure parts, the interior of which attachment stub 8 is connected to the hollow chamber 3 via a channel running through the closure part 7. Such an attachment stub could also be provided at another location of the band part. A working fluid line 9 configured as a hose is attached at the attachment stub 8.

(21) The band part 1 is connected via the channel of the working fluid line 9 to a pump part 11 of a pump unit 10, which is spatially separate from the band part 1 (cf. FIGS. 1 to 3). By the use of the pump unit 10, the quantity of working fluid in the hollow chamber 3 of the band part 1 can be changed.

(22) A receiving space for receiving the working fluid (=working fluid receiving space) of the medical device comprises the entire continuous inner space of the device in which working fluid is located during operation. The hollow chamber 3 of the band part 1, the channel of the closure part of the band part 1 extending through the closure part, and the channel of the working fluid line thus each form a part of the receiving space for the working fluid. In the illustrative embodiment, the pump part 11 of the pump unit 10 has an interior 12 which is filled with working fluid and which likewise forms a part of the receiving space of the device.

(23) To fill the receiving space of the medical device with working fluid, a port 18 is present in the customary way. This port 18 can be attached to the pump part 11 via a hose, for example.

(24) In the illustrative embodiments, the pump part 11 is formed by a bellows which is closed by a bottom part 13 and a cover part, the latter constituting an actuating element 14. An electric drive 15 acts on the actuating element 14 via a gear 16, for example a worm gear, in order to change the volume of the interior 12. The gear 16 is expediently self-locking, such that an adopted position of the actuating element 14 is maintained without supply of electrical energy to the drive 15.

(25) In the illustrative embodiment, the pump part 11 thus forms at the same time a reservoir for the working fluid with which the hollow chamber 3 of the band part 1 is filled in order to close the anatomical channel. For example, the pump part 11 could also be formed by a piston-cylinder unit, in which case the actuating element 14 would be formed by the piston of this piston-cylinder unit.

(26) The electric drive 15 is controlled by a control electronics unit 17 of the pump unit 10, which also has a battery (not shown) for supplying electric current to the drive 15. The control electronics unit 17 is operated by the user via a suitable user interface (not shown). The user interface can be an operating unit that is linked to the control electronics unit 17 by wire or by radio and that has corresponding switches.

(27) The user interface can be arranged outside the body. Implantation of the user interface is conceivable and possible. A separate user interface could in principle also be omitted, in which case at least one operating element activatable by the user would be arranged at the pump unit 10. This would accordingly have to be able to be activated from outside the body.

(28) The components of the pump unit 10 are arranged in a housing 19. The housing 19 is made of a biocompatible material or is encased by such a material.

(29) The medical device moreover has an auxiliary fluid container 22 with a storage chamber 23 filled with auxiliary fluid during operation of the device. The auxiliary fluid container 22 is expediently implanted in the body. The auxiliary fluid container 22 has a flexible wall delimiting the storage chamber 23. This flexible wall can be designed to be at least substantially non-extensible.

(30) “Substantially non-extensible” denotes the material property of the wall of the auxiliary fluid container 22 whereby, starting from a state of maximum deployment, the volume of the storage chamber 23 increases by less than 10%, preferably by less than 5%, when the pressure of the auxiliary fluid in the auxiliary fluid container 22 increases by 0.1 bar. The auxiliary fluid container 22 could have a reinforcement, which expediently has an elastic modulus of at least 1,000 N/mm.sup.2, preferably of at least 5,000 N/mm.sup.2.

(31) In the illustrative embodiment, the wall of the auxiliary fluid container 22 is also designed to be pliable, i.e. the wall does not return spontaneously to an earlier shape. The wall of the auxiliary fluid container 22 could in this case be formed, for example, of a plastic film. According to the illustrative embodiments shown, the auxiliary fluid container 22 can therefore expediently fold up, wherein the volume of the storage chamber 23 can be varied by folding up or folding out of the auxiliary fluid container 22, depending on an ambient pressure (=internal body pressure).

(32) The pressure of the auxiliary fluid expediently corresponds to the ambient pressure (=internal body pressure) during operation of the device.

(33) The wall of the auxiliary fluid container 22 is expediently made of a biocompatible material, e.g. polyamide or silicone, or is encased by such a material. The optional reinforcement can be embedded in this material.

(34) The storage chamber 23 of the auxiliary fluid container 22 is fluidically connected by an auxiliary fluid line 24 to an expansion chamber 21 of an expansion body 20. The storage chamber 23, the inner channel of the auxiliary fluid line 24 and the expansion chamber 21 each form a part of an auxiliary fluid receiving space of the medical device. The auxiliary fluid receiving space signifies the entire inner space of the device in which auxiliary fluid is located during operation of the device.

(35) The auxiliary fluid, separate from the working fluid, could be introduced into the auxiliary fluid line 24 via a port (not shown in detail) or directly into the storage chamber 23. The auxiliary fluid is expediently a liquid, e.g. saline solution.

(36) In the first illustrative embodiment, the expansion body 20 is arranged in the receiving space of the device filled with working fluid, namely in the interior 12 of the pump part 11.

(37) The volume of the expansion chamber 21 can be increased by introduction of auxiliary fluid into the expansion chamber 21 by unfolding or stretching of the expansion body 20. If the increase in volume is effected purely by unfolding, the expansion body 20 can be made of a non-extensible material, such that the maximum volume of the expansion chamber 21 is limited. Therefore, an increase in the pressure of the working fluid (as explained further below) is limited by the limitation of the volume of the expansion chamber 21. However, the volume of the expansion chamber 21 can be increased by an elastically extensible design of the expansion body 20.

(38) The expansion body 20 can also be designed to be pliable, i.e. the expansion body 21 is then dimensionally unstable, as is indicated in FIGS. 1 and 2.

(39) At least in the shut-off state of the band part 1 shown in FIG. 2, the auxiliary fluid is at a lower pressure than the working fluid. The expansion chamber 21 of the expansion body 20 is preferably folded up completely. Therefore, there is at least substantially no auxiliary fluid present in the expansion chamber 21. In other words, the auxiliary fluid is thus forced out of the expansion chamber 21 into the storage chamber 23 of the auxiliary fluid container 22 on account of the higher pressure of the working fluid acting on the expansion body 20. The volume of the expansion chamber 21 is therefore at least substantially equal to zero. In a modified embodiment, this could in principle also be otherwise.

(40) In FIG. 1, which relates to the release state of the band part 1, the expansion chamber 21 is shown folded up completely, i.e. with a volume substantially equal to zero. This is the case if the auxiliary fluid is at a lower pressure than the working fluid and/or if the auxiliary fluid is forced out of the expansion chamber 21 by the elasticity of the expansion body 20 when there is equality of the pressure (of the auxiliary fluid and of the working fluid). A certain residual volume of the expansion chamber 21 may also be present in the release state.

(41) If the pressure within the body (=internal body pressure) rises, for example during a coughing fit, a force brought about by the internal body pressure acts directly on the auxiliary fluid container 22. When a force acts on the auxiliary fluid container 22, the pressure of the auxiliary fluid increases correspondingly. If the internal body pressure, and therefore the pressure of the auxiliary fluid, is greater than the pressure of the working fluid, the auxiliary fluid container 22 is compressed and auxiliary fluid is forced out of the storage chamber 23 into the expansion chamber 21. If the expansion body 20 sets an elastic restoring force counter to the expansion of the expansion chamber 21, this elastic restoring force can also be overcome by the pressure of the auxiliary fluid (the expansion body 20 is thus expanded only when the ambient pressure exceeds the pressure of the working fluid to such an extent that the elastic restoring force is also overcome by the pressure of the auxiliary fluid). The resulting increase of the volume of the expansion chamber 21 leads to an increase of the pressure in the interior 12 of the pump part 11. Working fluid is ejected from the interior 12 and introduced into the hollow chamber 3 of the band part 1. The inner portion 1a of the band part 1 is displaced in the direction toward the longitudinal center axis 5, and an additional force is applied to the body tissue 2 guided through the through-opening 4. This state of the band part 1 is referred to in this document as the stress state and is shown in FIG. 3.

(42) As the internal body pressure, and therefore the pressure of the auxiliary fluid, subsequently decreases again such that the pressure of the auxiliary fluid is less than the pressure of the working fluid (if appropriate plus the elastic restoring force of the expansion body), the volume of the storage chamber 23 of the auxiliary fluid container 22 increases as it receives auxiliary fluid discharged from the expansion chamber 21 of the expansion body 20. After the stress event, the band part 1 is thus once again located in the shut-off state (cf. FIG. 2).

(43) When the anatomical channel is to be opened from the shut-off state of the band part 1, e.g. to pass urine, i.e. when the band part 1 adopts the release state (see FIG. 1) by displacement of working fluid from the hollow chamber 3 into the interior 12 of the pump part 11, and when there is also no stress event, the volume of the expansion chamber 21 remains substantially equal to zero or relatively slight. Therefore, during the adjustment of the band part 1 from the shut-off state to the release state, and vice versa, no auxiliary fluid or only a little auxiliary fluid has to be conveyed from the expansion chamber 21 into the storage chamber 23 of the auxiliary fluid container 22. The quantity of working fluid to be displaced can thus be minimized, and the associated energy consumption for displacement of working fluid can be reduced. The interval for charging or replacing the battery of the control electronics unit 17 can thus be lengthened.

(44) FIGS. 8 and 9 show a second illustrative embodiment of a medical device according to the invention. The structure of the pump unit 10 and of the auxiliary fluid container 22 corresponds to that of the first illustrative embodiment, and therefore the explanations concerning the second illustrative embodiment focus mainly on the differences in relation to the first illustrative embodiment. Apart from the differences set out below, the explanations concerning the first illustrative embodiment also apply to the second illustrative embodiment. Thus, in terms of the configuration of the closure parts 6, 7 of the band part 1, which are shown only schematically in FIGS. 8 and 9, reference is also made to the explanations concerning the first illustrative embodiment.

(45) In the medical device according to the second illustrative embodiment, provision is made that the expansion body 20 is arranged at the band part 1, on a side of the band part 1 directed toward the through-opening 4, i.e. on the inner portion 1a. This is shown schematically in FIGS. 8 and 9, wherein the expansion chamber 21 extends in the direction of the longitudinal extent of the band part 1, substantially along the entire length of the band part 1. Therefore, in the second illustrative embodiment, the expansion body 20 is configured as a hose closed at both ends.

(46) In the closed state of the band part 1, the expansion body 20 arranged at the band part 1 has, in relation to the circumferential direction of the longitudinal center axis 5, a substantially encircling bearing surface 20a for bearing on the body tissue 2.

(47) In the shut-off state of the closed band part 1, the hollow chamber 3 is filled with such a quantity of working fluid that the anatomical channel is closed (cf. FIG. 8).

(48) When working fluid is drained off, the band part 1 adopts the release state (not shown) in which the anatomical channel is opened.

(49) If, starting from the shut-off state of the band part 1 shown in FIG. 8, the pressure within the body (=internal body pressure) increases in the presence of a stress event, this internal body pressure acts on the auxiliary fluid container 22, analogously to the first illustrative embodiment. If the internal body pressure, and therefore the pressure of the auxiliary fluid, is greater than the counter-pressure applied by the body tissue 2 to the expansion body 20, the auxiliary fluid container 22 is compressed and auxiliary fluid is conveyed out of the storage chamber 23 into the expansion chamber 21 of the expansion body 20. If the expansion body 20 sets an elastic restoring force counter to the expansion of the expansion chamber 21, this elastic restoring force can also be overcome by the pressure of the auxiliary fluid. As a result of the increase in the volume of the expansion chamber 21, the expansion body 20 acts with a compressing effect directly on the body tissue 2 surrounding the anatomical channel, in order to ensure reliable shutting-off of the anatomical channel during a stress event (cf. the stress state of the band part 1 shown in FIG. 9, in which state an additional force is applied to the body tissue 2 guided through the through-opening 4). The body tissue 2 itself is not indicated in FIGS. 8 and 9.

(50) When the internal body pressure again reaches a basic state, i.e. without a stress event being present, the auxiliary fluid flows back out of the expansion chamber 21 into the auxiliary fluid container 22 (cf. the shut-off state of the band part 1 shown in FIG. 8).

(51) In the second illustrative embodiment, the reverse flow of the auxiliary fluid into the auxiliary fluid container 22 is thus effected by the counter-pressure exerted by the body tissue 2, together with the pressure exerted on the expansion body 20 by the hollow chamber 3 filled with working fluid. If the expansion body 20 sets an elastic restoring force counter to the expansion of the expansion chamber 21, this elastic restoring force can have a supporting effect in the reverse flow of the auxiliary fluid.

(52) In the second illustrative embodiment, provision can be made that the expansion body 20 and the band part 1 are formed materially in one piece. Provision is expediently made that the expansion body 20 in the second illustrative embodiment is designed to be elastically extensible. In another embodiment, however, provision could also be made that the expansion body 20 is designed to be substantially non-extensible and/or pliable.

(53) In the second illustrative embodiment, the band part 1 and/or the expansion body 20 could be made of a biocompatible material, e.g. silicone.

(54) In the second illustrative embodiment, an attachment stub (not shown in detail) for connecting the band part 1 to the auxiliary fluid line 24 is integrally formed on the closure part 7. The interior of the attachment stub is connected to the expansion chamber 21 via a channel running through the closure part 7. Such an attachment stub could also be provided at another location of the expansion body 20 or of the band part 1.

(55) FIGS. 10 and 11 show a variant of the band part 1 according to the second illustrative embodiment, wherein the differences in relation to the band part 1 shown in FIGS. 8 and 9 are discussed in particular below.

(56) In the modified form of the band part 1 shown in FIGS. 10 and 11, the expansion body 20 extends in the direction of the longitudinal extent of the band part 1 over about half the length of the band part 1. In the shut-off state of the band part 1 shown in FIG. 10, the through-opening 4 is not circular, in contrast to the second illustrative embodiment. In the closed state of the band part 1, the bearing surface 20a of the expansion body 20 extends over 180° of the circumference of the through-opening 4 with respect to a circumferential direction starting from the longitudinal center axis 5.

(57) In other respects, the band part 1 according to the modification shown in FIGS. 10 and 11 behaves analogously to the band part 1 of the second illustrative embodiment of the medical device when a stress event occurs, which is why reference is made to the relevant explanations concerning the second illustrative embodiment.

(58) Besides the pump unit shown in the illustrative embodiments, the medical device could in principle also be used in combination with a pump unit that is commonly known from the prior art and that can be actuated manually, for example.

KEY TO THE REFERENCE NUMBERS

(59) 1 band part 1a inner portion 1b rear portion 2 body tissue 3 hollow chamber 4 through-opening 5 longitudinal center axis 6 first closure part 6a insertion opening 7 second closure part 7a tongue 8 attachment stub 9 working fluid line 10 pump unit 11 pump part 12 interior 13 bottom part 14 actuating element 15 drive 16 gear 17 control electronics unit 18 port 19 housing 20 expansion body 20a bearing surface 21 expansion chamber 22 auxiliary fluid container 23 storage chamber 24 auxiliary fluid line