The present disclosure generally relates to medical devices, and more particularly to ureteral stents for enhancing patient comfort.
Ureteral stents may be used to create a pathway for urinary drainage from the kidney to the bladder in patients with ureteral obstruction or injury. Ureteral stents may also be used to enhance or otherwise protect the integrity of the ureter in a variety of surgical applications. A number of clinical conditions can produce interruption in urine flow including, for example, intrinsic obstruction of the ureter due to tumor growth, stricture or stones, compression of the ureter due to extrinsic tumor growth, stone fragment impaction in the ureter following extracorporeal shock wave lithotripsy, and ureteral procedures such as endopyelotomy and ureteroscopy. Stents may be used to treat or avoid obstructions of the ureter (such as ureteral stones or ureteral tumors) that disrupt the flow of urine from the corresponding kidney to the bladder. Serious obstructions of the urinary tract may cause urine to back up into the kidney and thereby threaten renal function. Ureteral stents may also be used after endoscopic inspection of the ureter.
Ureteral stents may be generally tubular in shape, terminating in two opposing ends: a kidney distal end and a urinary bladder proximal end. One or both of the ends of the stent may be coiled in a pigtail spiral or J-shape. This structure may reduce or prevent unintentional upward and/or downward migration of the stent in the lumen of the ureter, which may be caused by a patient's day-to-day physical activities. A kidney end coil is configured to retain the stent within the renal pelvis and to reduce or prevent unintended migration of the stent down the ureter. The bladder end coil is positioned in the bladder, and is configured to reduce or prevent unintended stent migration upward toward the kidney. The bladder end-coil also may be used to aid in retrieval and/or removal of the stent.
A ureteral stent may assist in the flow of urine from the kidney to the bladder. The region referred to as the ureteral vesical junction is a small area of the ureter that is immediately upstream, relative to normal urine flow, of the bladder. The ureteral vesicle junction is more sensitive, i.e., causes a greater pain sensation, relative to other regions of the ureter wall and kidneys, and therefore may be a source, in some cases a significant source, of patient discomfort when this region of the ureter contacts indwelling ureteral stents.
Ureteral stents, particularly the portion positioned in the ureter and proximal to the bladder, may produce adverse effects including hemorrhage, a continual urge to urinate, flank pain accompanying reflux of urine back up the ureter due to retrograde pressure when voiding, and/or trigone irritation resulting from chronic irritation due to the bladder-anchoring features of the stent or resulting from intraoperative trauma inflicted from passage of the device in the ureter. Ureteral stents may also cause encrustations, e.g., precipitation of salts from the urine along the device that may irritate tissue, foster bacterial growth, and/or hinder stent removal. In summary, stents may cause or contribute to patient discomfort and/or significant medical problems.
Embodiments of the present disclosure relate to a medical device that may be used within a body tract such as a duct or lumen.
In at least one embodiment, the medical device comprises: an elongate member configured to be implanted within a patient's body, the elongate member including an outermost diameter and a plurality support members disposed within a biodegradable material; wherein degradation of the biodegradable material results in a reduction of the outermost diameter; and wherein at least two of the support members are arranged non-concentrically.
Embodiments of the medical device may include one or more of the following features: the elongate member may define a lumen therethrough; the lumen may be disposed centrally or offset of a longitudinal axis of the elongate member; the elongate member may not include a lumen therethrough; the at least two non-concentric support members may be arranged opposite each other across a central axis; the plurality of support members may include at least four support members disposed around a central axis; the plurality of support members may include at least six support members disposed around the central axis; the plurality of support members together may form a cylindrical shape; the plurality of support members may be connected at a proximal end of the support members, a distal end of the support members, or both the proximal end and the distal end of the support members; a first end of the elongate member may include a first anchoring mechanism and a second end of the elongate member may include a second anchoring mechanism, wherein at least one of the first and second anchoring mechanisms includes the biodegradable material; the biodegradable material may form the outermost diameter of the elongate member; a cross-section of the elongate member may have a non-circular shape; a cross-section of at least one of the support members may have a non-circular shape such as oval, triangular, square, rectangular, or star-shaped; the elongate member may include a therapeutic agent; the biodegradable material may include the therapeutic agent; or the medical device may have sufficient column strength for removal from the patient's body after degradation of the biodegradable material.
Embodiments of the present disclosure also include a medical device, comprising: an elongate member including at least four support members disposed around a central axis and a biodegradable material surrounding at least a portion of each of the support members; wherein at least two of the support members are arranged non-concentrically; and wherein the medical device is configured to be implanted within a ureter. Embodiments of the medical device may include one or more of the following features: the biodegradable material may completely surround an outer diameter of each of the support members; or the elongate member may include at least eight support members.
Embodiments of the present disclosure also include a medical device, comprising: an elongate member configured to be implanted within a patient's body, the elongate member including a plurality support members disposed within a biodegradable material and at least one therapeutic agent; wherein at least two of the support members are arranged non-concentrically. Embodiments of the medical device may include one or more of the following features: the biodegradable material may include the at least one therapeutic agent; the plurality of support members may include the at least one therapeutic agent; or the medical device may be configured to release at least 50% of the therapeutic agent within about 12 hours after implantation in the patient's body.
Embodiments of the present invention are described with reference to the following drawings for exemplary purposes only. In the drawings, like reference numerals refer to like parts throughout the various figures unless otherwise specified.
For a better understanding of the presently disclosed subject matter, reference will be made to the following Detailed Description, which is to be read in association with the accompanying drawings, wherein:
Embodiments of the present disclosure include medical devices, such as implantable medical devices, and methods of use thereof.
In some embodiments, the medical device comprises a ureteral stent, e.g., an implantable ureteral stent. The medical device may be configured to be implanted within a patient's body, and may include an elongate member configured to be implanted within a patient's body.
The elongate member 104 may define a lumen therethrough, e.g., along a longitudinal axis, such as a central axis of the elongate member 104. In some embodiments, the outermost diameter of the elongate member 104 may range from about 4-8 Fr, such as about 6 Fr, with a lumen diameter ranging from about 2-4 Fr, such as about 3 Fr. However, the elongate member 104 may have any other dimensions, regular or irregular, that are beneficial or otherwise useful according to the needs and preferences of a physician and/or patient.
The ureteral stent 102 as shown in
After implantation, the first end 106 of the ureteral stent 102 may rest in a portion of the kidney 114, e.g., the renal kidney, as shown in
In some embodiments, the ureteral stent 102 may be configured to facilitate removal from the body. For example, the ureteral stent 102 may include at least one thread 122 at the second end 110 (e.g., bladder end) to assist in removal of the stent 102 by pulling the thread 122. For example, single or multiple threads 122 may be attached to the ureteral stent 102 at the second end 110. While
Referring generally to
One or more characteristics of the support members 204 (e.g., number, material(s), length, cross-sectional shape, volume, or other dimensions) may be chosen to correlate with, complement, conform to, or contrast with one or more characteristics of the matrix 206 (e.g., number of matrix regions, material(s), length, cross-sectional shape, volume, or other dimensions). Further, in some embodiments, characteristic(s) of the support members 204 and of the matrix 206 may be independently chosen. Thus, the support members 204 may, but need not be entirely disposed within the matrix 206, and the matrix 206 may, but need not surround one or more support members 204 at any given region or cross-sectional area of the stent 102. Thus, the area represented by matrix 206 in
For example,
In another embodiment shown in
While
In some embodiments, the matrix 206 may be arranged in portions or layers around some or all of the plurality of support members 204, e.g., forming a non-continuous layer. For example,
As shown in
The examples shown in
The support members 204 and matrix 206 may comprise different materials. For example, in some embodiments, at least one support member 204 may include a non-biodegradable material and the matrix 206 may include a biodegradable material. In other embodiments, at least one support member 204 may include a biodegradable material and the matrix 206 may include a non-biodegradable material. Further, one or more support members 204 of the plurality of support members may comprise a material different from the other support members.
In some embodiments, the matrix 206 may include a biodegradable material. The biodegradable material may be resorbable and dissolve over time. Thus, in some embodiments, the medical device may have sufficient column strength for implantation, e.g., before dissolution of any biodegradable material of the matrix 206, and may become smaller, softer, and/or significantly more flexible and thus more comfortable over time. In some embodiments, dissolution of the biodegradable material of the matrix 206 provides an erodible surface that may resist protein deposition, bacterial adhesion, and/or mineralization.
As discussed above, each of the elongate members 200A-200E in
Further, the support members 204 and/or matrix 206 may include a material responsive to one or more stimuli such as pH, temperature (e.g., heat or cold), humidity (e.g., presence or absence of water or other solution), light, pressure, or composition. The stimuli may be, e.g., physical or chemical, and may act as a triggering agent to initiate or terminate dissolution or degradation of the material. In some embodiments, materials may interact with each other and/or with the body or a body material. For example, a material of a support member or matrix may interact with another material within the same or a different support member or matrix. Interactions between materials may result in physical and/or chemical change(s), and may result in a new mixture or composition. In some embodiments, a material or combination of materials within the stent 102 (e.g., a support member 204 and/or matrix 206 material) may be configured to interact with the body or a body material, such as to change or otherwise affect the composition, color, or fluidity of urine. Further, materials of the stent 102 may be configured to interact with each other and/or with the body or a body material at certain times after implantation of the stent 102 within the body, e.g., during degradation of a matrix 206 material and/or support member 204 material.
For example, in some embodiments, the matrix 206 may include one or more of PVA, alginate, PLA, PDO, or other material(s), and the support members 204 may include one or more of EVA, PU, silicone, PIB-PUR, SIBS, or other material(s). In other embodiments, the matrix 206 may include one or more of EVA, PU, silicone, PIB-PUR, SIBS, or other material(s), and the support members 204 may include one or more of PVA, alginate, PLA, PDO, or other material(s). The embodiments illustrated in
In some embodiments, the matrix 206 and/or one or more support members 204 may include at least one active pharmaceutical ingredient (API) or therapeutic agent, such as, e.g., an antibiotic, analgesic, anesthetic, estrogen, muscle relaxant, etc. Any suitable API and/or therapeutic agent may be included in the medical devices disclosed herein. In some embodiments, the support members 204 themselves may at least partially be formed of resorbable or biodegradable material and may include at least one API or therapeutic agent. Release of the therapeutic agent may be affected by one or more stimuli such as pH, temperature (e.g., heat or cold), humidity (e.g., presence or absence of water or other solution), light, pressure, or composition of the stent 102 such as composition of the support members 204 and/or matrix 206. The stimuli affecting the release of the therapeutic agent may be, e.g., physical or chemical, and may initiate, accelerate, inhibit, or terminate release of the therapeutic agent.
In some embodiments of the present disclosure, the medical device, e.g., ureteral stent, may be configured to release an amount of the therapeutic agent within a certain period of time. In an embodiment, for example, the medical device may be configured to release at least 25% of the therapeutic agent within about 12 hours after implantation within the patient's body. For example, the API or therapeutic agent may be included in the biodegradable material, and thus gradually release into the body as the biodegradable material dissolves over time. In some embodiments, for example, the medical device may be configured to release at least 25%, at least 50%, at least 60%, at least 75%, or even at least 80% or more of the therapeutic agent within a certain period of time, e.g., within about 1 hour, about 4 hours, about 6 hours, about 8 hours, about 12 hours, about 24 hours, about 36 hours, or about 48 hours after implantation. In some embodiments, the medical device may be configured to release at least 50% of the therapeutic agent with a period of time ranging from about 1 hour to about 48 hours after implantation, e.g., from about 12 hours to about 24 hours after implantation.
Further, release of a therapeutic agent may correspond to the activity of the therapeutic agent and/or correlate with a certain point of treatment after implantation of the stent 102 in the body. For example, the stent 102 may be configured to release a first therapeutic agent at a certain time after implantation and release a second therapeutic agent at a different time. In some embodiments, the stent 102 may be configured to release an analgesic agent within a first period of time after implantation, and then to release an antibiotic agent within a second period of time after implantation, or vice-versa. Release of a therapeutic agent may correlate with a body function, e.g., release of an antibiotic may correlate with stone expulsion. The stent 102 may be configured to indicate the presence, absence, and/or amount of therapeutic agent released. For example, one or more materials of the stent 102 may interact with each other, with the body or a body material, or with the therapeutic agent as an indication of release of the therapeutic agent. In some embodiments, one or more materials of the stent 102 may cause the urine to change in color, composition, fluidity, or affect another characteristic of the urine to indicate initial release or depletion of the therapeutic agent.
The support members 204 of the elongate member 200 may be directly and/or indirectly coupled or connected to one another and may remain disposed in the matrix 206. For example, two or more support members 204 may be coupled at a proximal end and/or a distal end of each support member via any suitable method including, but not limited to, adhesive bonding, tying, etc.
In some embodiments, one or more support members may be integral with a first end 106 and/or second end 110 of the stent 102 with reference to
In some embodiments, the plurality of support members may be connected at a proximal end, e.g., towards the renal kidney 114, and may not be connected at a distal end, e.g., towards the bladder 118. For example, as biodegradable material surrounding the plurality of support members dissolves over time, the distal end of the support members may become free to move relative to one another, thus enhancing patient comfort.
As mentioned above and shown in
Biodegradable material may form the outermost diameter of the elongate member 104 (or 200A-200E shown in
In some embodiments, as mentioned above in connection to
As shown in
While the embodiments described above are generally directed to a ureteral stent, the present disclosure is not so limited and may be applicable to other medical devices.
Moreover, while specific embodiments may have been illustrated and described collectively herein, it should be appreciated that any subsequent arrangement designed to achieve the same or similar purpose may be substituted for the specific embodiments described and shown herein. This disclosure is intended to cover any and all subsequent adaptations or variations of various embodiments. Combinations of the above embodiments, and other embodiments not specifically described herein, will be apparent to those of skill in the art upon reviewing the description.
Other embodiments of the present disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the embodiments disclosed herein. It is intended that the specification and examples be considered as exemplary only, and departure in form and detail may be made without departing from the scope and spirit of the present disclosure as defined by the following claims.
This application claims the benefit of priority from U.S. Provisional Application No. 61/839,999, filed on Jun. 27, 2013, the entirety of which is incorporated by reference herein.
Number | Date | Country | |
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61839999 | Jun 2013 | US |