News Column

Patent Issued for Pelvic Health Implants and Methods

July 28, 2014



By a News Reporter-Staff News Editor at Gastroenterology Week -- According to news reporting originating from Alexandria, Virginia, by NewsRx journalists, a patent by the inventors Staskin, David R. (New York, NY); Anderson, Kimberly A. (Eagan, MN); Montpetit, Karen Pilney (Mendota Heights, MN); Westrum, Jr., John W. (Prior Lake, MN); Watschke, Brian P. (Eden Prairie, MN); Cox, James E. (Corcoran, MN), filed on November 7, 2007, was published online on July 15, 2014 (see also AMS Research Corporation).

The assignee for this patent, patent number 8777836, is AMS Research Corporation (Minnetonka, MN).

Reporters obtained the following quote from the background information supplied by the inventors: "Pelvic floor disorders include cystocele, rectocele, enterocele, and prolapse such as anal, uterine and vaginal vault prolapse. A cystocele is a hernia of the bladder, usually into the vagina and introitus. These disorders typically result from weakness or damage to normal pelvic support systems.

"In its severest forms, vaginal vault prolapse can result in the distension of the vaginal apex outside of the vagina. An enterocele is a vaginal hernia in which the peritoneal sac containing a portion of the small bowel extends into the rectovaginal space. Vaginal vault prolapse and enterocele represent challenging forms of pelvic disorders for surgeons. These procedures often involve lengthy surgical procedure times.

"Synthetic implants have been used to address pelvic organ prolapse. See Julian, The Efficacy of Marlex Mesh in the Repair of Severe, Recurrent Vaginal Prolapse of the Anterior Midvaginal Wall, Am. J. Obstet Gynec, Vol. 175, No. 6 (1996) (Pps 1472-1475). A hammock-shaped polypropylene mesh is described in Nicita, A New Operation For Genitourinary Prolapse, J. of Urology, Vol. 160, 741-745 (September 1998). The mesh is taut and anchored transversely between the two arcus tendineus of the endopelvic fascia and in the anteroposterior direction between the bladder and uterine necks. The width of the mesh is equal to the anteroposterior dimension of cystocele.

"Migliari et al used a 5.times.5 cm mixed (60% polyglactin 910 and 40% polyester) fiber mesh to treat cystocele. See Migliari et al., Treatment Results Using a Mixed Fiber Mesh in Patients With Grade IV Cystocele, J. of Urology, Vol. 161, 1255-1258 (April 1998). Meshes provided in square or rectangular configurations must be trimmed to form a complex shape. This can add to the length of the surgical procedure.

"Vaginal vault prolapse is often associated with a rectocele, cystocele or enterocele. It is known to repair vaginal vault prolapse by suturing to the utero sacral ligaments, the sacrospinous ligaments or the levator muscles. It is also known to repair prolapse by attaching the vaginal vault through mesh or fascia to the sacrum. Many patients suffering from vaginal vault prolapse also require a surgical procedure to correct stress urinary incontinence that is either symptomatic or latent.

"Italian Patent No. 01299162 describes a first prosthesis mesh having a first section designed to be applied to a bladder cavity and a second section designed to be applied to the bladder below the bladder neck. The first prosthesis includes a pair of flaps that are designed to be applied to the urethropelvic ligament and are separated from the first section by slits. The first prosthesis may be used to treat urogenital prolapse. A second prosthesis for treating rectocele is disclosed. The second prosthesis is separate and distinct from the first prosthesis.

"A sacral colpopexy is a procedure for providing vaginal vault suspension. It may be performed through an abdominal incision or laparoscopically. Complications include mesh infection, mesh erosion, bowel obstruction, and bleeding from the presacral venous complex. Typically, this procedure is accompanied by an abdominal enterocele repair and cul-de-sac obliteration.

"A sacral colpopexy entails suspension of the vaginal cuff to the sacrum with fascia or synthetic mesh. The synthetic mesh is typically carefully customized or assembled into a special shape by the surgeon. A surgeon manually cuts a sheet of the mesh and stitches elements of the mesh to form the special shape. The literature reports surgeons suturing mesh material into various T-shaped articles. See Paraiso et al, Laparoscopic Surgery for Enterocele, Vaginal Apex Prolapse and Rectocele, Int Urogynecol J (1999), 10:223-229.

"A sacral colpopexy can be a tedious, challenging surgical procedure. Average procedure lengths of 247 minutes were reported in Winters et al., Abdominal Sacral Colpopexy and Abdominal Enterocele Repair in the Management of Vaginal Vault Prolapse, Urology 56 (Suppl 6A) (2000): 55-63. At least some of this time can be attributed to the time required for the surgeon to construct an implant. Non-laparoscopic surgical procedure lengths can be shorter, but such procedures involve a large abdominal incision with the attendant risk of morbidity and infection. Many surgeons seek to avoid sacral colpopexy procedures for a variety of different reasons, including the amount of surgical activity in proximity to sensitive areas such as the sacrum.

"It is reported that 72% of patients with vault prolapse had a combination of other pelvic floor defects. See Richter K. Massive Eversion of the Vagina: Pathogenesis, Diagnosis and Therapy of the True Prolapse of the Vaginal Stump, Clin. Obstet Gynecol 25:897-912 (1982). If surgical correction of cystocele, rectocele or stress incontinence is performed in the presence of untreated vaginal vault prolapse, it is speculated that an early recurrence of prolapse is extremely likely. When it is considered that it is often necessary to correct multiple pelvic floor disorders simultaneously, the time factor for surgeons is particularly challenging. See, Diana et al., Treatment of Vaginal Vault Prolapse with Abdominal Sacral Colpopexy Using Prolene Mesh, American Journal of Surgery, Vol. 179, (February 2000), Pps. 126-128.

"A sacrospinous ligament fixation surgical procedure is a procedure that involves attaching the vault of the vagina to the sacrospinous ligament. See Guner et al., Transvaginal Sacrospinous Colpopexy For Marked Uterovaginal and Vault Prolapse, Inter. J. of Gynec. & Obstetrics, 74 (2001) Pps. 165-170. Sacrospinous ligament fixation procedures are believed to require specialized, technical skills. There are additional drawbacks. For example, the procedure tends to place the vagina in an artificial anatomical position (as opposed to a natural position), especially if the procedure is performed unilaterally which tends to pull the vagina to one side.

"U.S. Pat. No. 5,840,011 discloses an implant for suspension of the urinary bladder to treat incontinence. The implant includes four securement appendages. The patent states that two securement appendages are drawn retrosymphyseally between the bladder and vagina and are positioned exactly. The other two securement appendages are fixed to the ligamentum pubicum superior behind the two pubic rami.

"U.S. Pat. No. 6,306,079 discloses a mesh pubovaginal sling comprising two mesh pieces, including a first mesh portion of polypropylene and a second mesh portion comprising an absorbable material. One piece is inserted at the endopelvic fascia and the other at the suprapubic region.

"PCT Publication No. WO 00/64370 (Gaston) describes a device for treating a prolapse by vaginal suspension. The device comprises an elongate, flexible, pierced material, a suture connected to the material and a suture needle joined to the suture. The device is long enough to enable posterior suspension of the vagina at the promontory (i.e. the front upper part of the sacrum). The other end of the device includes a distal portion having a width such that it can cover at least a large part of the posterior part of the vagina, a rounded cut-out with dimensions that enable it to be engaged around the base of the vagina on at least a large part of the lower half of the wall of the vagina. The suture is connected to the article so that it is offset sidewise in relation to the cut-out.

"PCT Publication No. WO 00/27304 (ORY et al.) discloses a suspension device for treating prolapse and urinary incontinence. The device comprises at least one filiform suspension cord with limited elasticity and at least two anchoring parts linked to the ends of the cord.

"U.S. Pat. No. 5,112,344 and PCT Publication No. PCT/US02/32284 disclose surgical devices for female pelvic health procedures. The IVS Tunneller device is available from U.S. Surgical of Norwalk, Conn. The IVS device comprises a fixed delta wing handle, a hollow metal tube and a stylet that is placeable within the tube. The stylet has a rounded plastic tip on one end and an eyelet at the other end. The device may be used to implant a polypropylene tape for infracoccygeal sacropexy and other surgical procedures. See Farnsworth, Posterior Intravaginal Slingplasty (Infracoccygeal Sacropexy) For Severe Posthysterectomy Vaginal Vault Prolapse--A Preliminary Report on Safety and Efficacy, Int. Urogynecol. J. (2002) 13:4-8; Petros, Vault Prolapse II. Restoration of Dynamic Vaginal Supports by Infracoccygeal Sacropexy, an Axial Day-Case Vaginal Procedure, Int Urogynecol J (2001) 12:296-303; and Petros, The Intravaginal Slingplasty Operation, a Minimally Invasive Technique for Cure of Urinary Incontinence in the Female, Aust. NZ J Obstet Gynaecol, (1996); 36: 4:453.

"A single, rigid, hollow metal tube is associated with the IVS Tunneller device. This single tube passes through two separate regions of the patient's body with the attendant risk of cross contamination. The outer diameter of the tube is also relatively large (about 0.25 inches) with the attendant risk of tissue damage due to a large diameter needle.

"The polypropylene tape supplied with the IVS Tunneller is a thin, rectangular shape, believed to be approximately 8 mm.times.350 mm. The thin, rectangular tape supplied with the IVS Tunneller is not believed to be optimally sized and shaped to afford concomitant procedures such as enterocoele, cystocele and/or rectocoele repairs encountered in many cases. The tape is also inextensible. Under a longitudinal force, the implant is highly resistant to elongation. It is believed that inextensible polypropylene tapes may be apt to exhibit a greater association with erosion and failure."

In addition to obtaining background information on this patent, NewsRx editors also obtained the inventors' summary information for this patent: "In one aspect, the present invention comprises a novel implant suitable for addressing one or more disorders including incontinence, cystocoele, rectocoele, enterocoele and prolapse (e.g. uterine and/or vaginal vault). Preferably, the implant is conformable to irregular surfaces and to accommodate different anatomy shapes and sizes. In one embodiment, the implant is preassembled or pre-cut in a predetermined shape to simultaneously address incontinence and cystocele repairs in a tension-free manner and to afford efficient use of the surgeon's time. In another embodiment, the implant includes features affording convenient assembly of a composite implant so that the implant may be customized according to the surgeon's preference or the needs of a particular surgical procedure. In yet another embodiment, the implant includes indicia for convenient trimming of a bulk implant to address the particular needs of a procedure.

"In one aspect, the present invention comprises a mesh having a major portion that is sized and shaped to afford repair of a cystocele. The implant is preferably secured in the body without lifting the patient's bladder and without placing tension on the bladder. The implant includes a urethral support portion capable of being placed underneath the patient's urethra; and first and second sling appendages to be placed on different sides of the urethra.

"The sling appendages may be sized and shaped to be secured in the patient's abdominal rectus fascia. Alternatively, the sling appendages may be sized and shaped to extend from a region near the patient's urethra to at least the patient's obturator foramen.

"The portion of the implant generally opposite the sling appendages may take a variety of different forms. In one embodiment, the portion of the implant opposite the sling appendages may be designed to merely address a cystocele or both a cystocele and a rectocele. In another embodiment, it may be sufficiently long and appropriately shaped to extend to incisions on opposite sides of the patient's anus. In another embodiment, it may have a length sufficient to afford anchoring in the region of the patient's sacrum, or the sacrospinous ligaments, or the uterosacral ligaments, or the levator ani tissues.

"For certain configurations of implant and for certain uses of the implant (e.g. posterior vaginal vault repair), the present invention comprises constructing the implant from a longitudinally extendable material. This affords an implant that is relatively longitudinally extendable, unlike prior art implants used in posterior vault repair procedures. In this aspect, the present invention comprises a synthetic mesh material having a portion adapted to be secured in the patient's vaginal region, a first posterior securement appendage that is sized, shaped and configured to extend from the patient's vaginal region to a first incision in the patient's buttocks that is lateral to the patient's anus; and a second posterior securement appendage that extends to the opposite side of the patient's anus.

"The bulk material from which the mesh is supplied has at least a Longitudinal Elongation Factor (LEF) of at least 0.06 under a 1/2 pound load. More preferably, the bulk material from which the mesh is supplied has at least a Longitudinal Elongation Factor (LEF) of more than about 0.08 under a 1/2 pound load, even more preferably it is more than about 0.15. Preferably, bulk material from which the mesh is supplied has a Longitudinal Elongation Factor (LEF) of more than about 0.08 under a 1 pound load, more preferably it is more than about 0.1 under a 1 pound load, and even more preferably it is more than about 0.2 under a 1 pound load.

"Preferably, the synthetic mesh materials used comprise bulk knitted polypropylene monofilaments, but a variety of different materials are contemplated. The implant is preferably knitted to be supple, conformable and to afford tissue ingrowth. In one embodiment the implant is a composite constructed of two different implantable materials.

"In another aspect, the present invention comprises a synthetic mesh material having a portion adapted to be secured in the patient's vaginal region, a first posterior securement appendage that is sized, shaped and configured to extend from the patient's vaginal region toward a first incision in the patient's buttocks that is lateral to the patient's anus; a second posterior securement appendage placeable on a side of the patient's anus different than that of the first posterior securement appendage. The implant includes a first flexible insertion sheath associated with at least a portion of the first posterior securement appendage, and a second flexible insertion sheath associated with at least a portion of the second posterior securement appendage.

"Preferably, the first and second posterior securement appendages have distal end regions adapted to be secured in the patient's ischioanal or ischiorectal fossa. Alternatively, the first and second posterior securement appendages have distal end regions adapted to be secured in the patient's sacrospinous ligaments or the uterosacral ligaments or levator ani tissue.

"In another aspect, the present invention comprises an implant assembly suitable for placement through incisions in the patient's buttocks on opposite sides of the anus. The novel implant assemblies include one or more of: i) connectors for associating the implant assembly with the distal end of an insertion needle, ii) dilators for dilating tissue, iii) insertion sheaths, iv) tensioning sutures, and v) an elongatable, conformable mesh.

"In another aspect, the present invention comprises a surgical implant for addressing incontinence and cystocele disorders comprising a synthetic mesh material having a cystocele repair portion adapted to be secured in the patient's vaginal region, a first posterior securement appendage that is sized, shaped and configured to extend from the patient's vaginal region toward a first incision in the patient's buttocks; and a second posterior securement appendage opposite the first. The implant includes a urethral support portion capable of being placed underneath the patient's urethra; a first sling appendage for securement on a first side of the patient's urethra; and a second sling appendage for securement on a side of the patient's urethra generally opposite the first.

"In another aspect, the present invention comprises a synthetic mesh material having a portion adapted to be secured in the patient's vaginal region. The mesh has a first posterior securement appendage that is sized, shaped and configured to extend from the patient's vaginal region toward a first incision in the patient's buttocks; and a second posterior securement appendage opposite the first. In this embodiment, the first and second posterior securement appendages include a connector for associating the first and second posterior securement appendages with a distal end of an insertion needle.

"The present invention includes surgical kits comprising first and second insertion needles having distal ends. Preferably, the first and second insertion needles are configured so that their distal ends may be initially inserted through an incision in the patient's buttocks and then passed through tissue, emerging through a vaginal incision. The kits also include an implant comprising a synthetic mesh material having a portion adapted to be secured in the patient's vaginal region to repair, for example, a vaginal vault prolapse. The mesh has a first posterior securement appendage that is sized, shaped and configured to extend from the patient's vaginal region toward a first incision in the patient's buttocks; and a second posterior securement appendage generally opposite the first. Preferably, this embodiment includes first and second flexible insertion sheaths associated with at least a portion of the first and second posterior securement appendages.

"In another embodiment, the present invention comprises a synthetic mesh having a major portion, and at least four projections extending from the major portion. One of the projections is adapted to be placed on a first side of the patient's urethra and extend from the patient's urethral region to the patient abdominal rectus fascia, and another of the projections is adapted to be placed on a side of the patient's urethra generally opposite the first side. This embodiment preferably includes at least one connector (preferably four) for associating the implant with at least one (preferable four) insertion needle.

"In another aspect, the present invention comprises a modular assembly for affording construction of a surgical implant for addressing one or more pelvic floor disorders. The assembly comprises an anterior element for affording a sling-like implant; a posterior element for securement in a posterior region of the patient's body; and a cystocele repair portion for affording repair of a cystocele, wherein the cystocele repair portion may be associated with either the anterior element or the posterior element or both elements. Preferably the assembly includes a means for facilitating association between elements of the assembly. Also preferably, the cystocele repair portion includes indicia to facilitate trimming to adjust the implant to different sizes. A rectocele repair portion may also be provided.

"In yet another aspect, the present invention comprises novel surgical procedures that utilize the novel implants and implant assemblies."

For more information, see this patent: Staskin, David R.; Anderson, Kimberly A.; Montpetit, Karen Pilney; Westrum, Jr., John W.; Watschke, Brian P.; Cox, James E.. Pelvic Health Implants and Methods. U.S. Patent Number 8777836, filed November 7, 2007, and published online on July 15, 2014. Patent URL: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=8777836.PN.&OS=PN/8777836RS=PN/8777836

Keywords for this news article include: AMS Research Corporation, Bladder Disease, Digestive System Diseases, Gastroenterology, Gastrointestinal Diseases, Hernias, Hydrocarbons, Medical Devices, Organic Chemicals, Polyenes, Polypropylenes, Prosthetics, Rectal Diseases, Rectocele, Surgery, Urology.

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Source: Gastroenterology Week


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