Minimally invasive implant and method
View Patent ↗Apparatus and methods are provided for treating urinary incontinence, fecal incontinence, and other pelvic defects or dysfunctions, in both males and females, using one or more lateral implants to reinforce the supportive tissue of the urethra. The implants are configured to engage and pull (e.g., pull up) pelvic tissue to cause the lateral sub-urethral tissue, such as the endopelvic fascia, to tighten and provide slack reduction for improved support. As such, certain embodiments of the implants can be utilized to eliminate the need for mesh or other supportive structures under the urethra that is common with other incontinence slings.
1. A pelvic implant system to tension the lateral urethral support tissue of a patient, comprising:
at least one implant device having:
a leading end portion, a trailing end portion, and an extension portion extending between the leading end and trailing end portions;
a first anchor portion comprising a tissue penetrating tip, the first anchor portion being provided at the leading end portion of the at least one implant device and adapted to penetrate at least a portion of lateral urethral support tissue of the patient on a side of the patient;
a second anchor portion provided at the trailing end portion of the at least one implant device, the second anchor portion comprising a tissue-supporting bulk surface adapted to contact and support lateral urethral support tissue on the same side of the patient,
wherein the extension portion is of a length that allows the first anchor portion to be placed at tissue on the side of the patient while the second anchor portion supports lateral urethral support tissue on the side of the patient such that the lateral urethral support tissue can be supported to generally place the tissue in a correct anatomical position and the at least one implant device does not directly contact or extend below the urethra of the patient; and
an introducer device adapted to engage the first anchor portion to insert and deploy the at least one implant device within the patient.
2. The system of claim 1 , wherein the at least one implant device includes the at least one implant device and a second implant device to provide bilateral urethral support, the second implant device comprising:
a leading end portion, a trailing end portion, and an extension portion extending between the leading end and trailing end portions;
a first anchor portion comprising a tissue penetrating tip, the first anchor being provided at the leading end portion of the at least one implant device and adapted to penetrate at least a portion of lateral urethral support tissue of the patient on a second side of the patient; and
a second anchor portion provided at the trailing end portion of the second implant device, the second anchor portion comprising a tissue-supporting bulk surface adapted to contact and support lateral urethral support tissue on the second side of the patient,
wherein the extension portion of the second implant is of a length that allows the first anchor portion to be placed at tissue on the second side of the patient while the second anchor portion supports lateral urethral support tissue on the second side of the patient such that the lateral urethral support tissue can be supported to generally place the tissue in a correct anatomical position and the at least one implant device does not directly contact or extend below the urethra of the patient.
3. The system of claim 1 , wherein the first anchor portion has one or more extending barbs.
4. The system of claim 1 , wherein the second anchor portion is a adapted to abut against one side of lateral urethral support tissue comprising endopelvic fascia to limit movement of the trailing end and to support the endopelvic fascia.
5. The system of claim 1 , wherein the extension portion is constructed of a porous mesh material.
6. The system of claim 1 , wherein the extension portion is constructed of a non-porous material.
7. The system of claim 1 , wherein the first anchor comprises a penetrating tip adapted to penetrate tissue selected from the group consisting of: the obturator muscle and the rectus fascia.
8. The system of claim 1 , wherein the second anchor portion includes a tubular bulk anchor.
9. A method of tensioning sub-urethral tissue, the sub-urethral tissue having a first laterally extending portion extending from a first side of the urethra and a second laterally extending portion extending from a second side of the urethra generally opposed to the first laterally extending portion, the method comprising:
introducing an implant device into the pelvis of a patient, the implant device including
a leading end, a trailing end, and an extension portion extending between the leading end and the trailing end;
a first anchor portion comprising a tissue penetrating tip, the first anchor portion being provided at the leading end and adapted to penetrate at least a portion of lateral urethral support tissue of the patient on a side of the patient;
a second anchor portion provided at the trailing end, the second anchor portion comprising a tissue-supporting bulk surface adapted to contact and support lateral urethral support tissue on the same side of the patient;
directing the leading end through the first laterally extending portion of the sub-urethral support tissue along a path generally toward an obturator foramen such that the second anchor portion contacts the first laterally extending portion; and
engaging the first anchor portion to tissue a distance from the first laterally extending portion of the sub-urethral support tissue such that the second anchor portion contacts and supports the first laterally extending portion of the sub-urethral support tissue.
10. The method of claim 9 , wherein the first anchor portion is a fixating anchor having one or more extending barbs.
11. The method of claim 10 , wherein the second anchor portion is a bulk anchor adapted to abut against a surface side of the first laterally extending portion opposite the leading end to limit movement of the trailing end.
12. The method of claim 9 , wherein the extension portion is constructed of a porous mesh material.
13. The method of claim 9 , wherein the extension portion is constructed of a non-porous material.
14. The method of claim 9 , comprising directing the leading end through the first laterally extending portion of the sub-urethral support tissue at two or more regions of the support tissue.
15. The method of claim 9 , wherein the first laterally extending portion of the sub-urethral support tissue is endopelvic fascia.
16. The method of claim 9 , wherein introducing the implant device includes introducing the implant transvaginally.
17. A method of providing bilateral tensioning to treat a pelvic disorder, the method comprising:
introducing a first implant device into the pelvis of a patient on a first side of the patient, the first implant device including at least a leading end anchor and an extension portion;
advancing the leading end anchor of the first implant device through lateral urethral support tissue of the patient along a path generally toward a first obturator foramen;
positioning the leading end anchor of the first implant for fixation at endopelvic fascia or at tissue near endopelvic fascia on the first side,
introducing a second implant device into the pelvis of a patient on a second side of the patient, the second implant device including at least a leading end anchor and an extension portion;
advancing the leading end anchor of the second implant device through lateral urethral support tissue of the patient along a path generally toward a second obturator foramen;
positioning the leading end anchor of the second implant for fixation at endopelvic fascia or at tissue near endopelvic fascia on the second side, and
tensioning at least one of the first and second implant devices to generally return the lateral urethral support tissue to its correct anatomical position.
18. The method of claim 17 , wherein the first and second implant devices each include a trailing end anchor comprising a bulk anchor adapted to contact endopelvic fascia, the method comprising
placing the trailing end anchor of the first implant device to contact endopelvic fascia on the first side and using the trailing end anchor to support the endopelvic fascia on the first side;
placing the trailing end anchor of the second implant device to contact endopelvic fascia on the second side and using the trailing end anchor to support the endopelvic fascia on second first side.
19. The method of claim 17 , wherein the leading end anchors of the first and second implants are further positioned through the obturator foramen.
20. The method of claim 17 , wherein the extension portions of the first and second implant devices are constructed of a porous mesh material.
21. The method of claim 17 , wherein the lateral urethral support tissue is endopelvic fascia.
22. The system of claim 1 , wherein the first anchor portion has a length to allow the first anchor portion to be placed at or near obturator internus muscle or an obturator foramen on the side of the patient, with the second anchor portion placed adjacent to endopelvic fascia on the same side of the patient, with the extension portion extending between the first anchor portion and the second anchor portion, and the second anchor portion supporting the endopelvic fascia.
23. The system of claim 1 , wherein the implant device has a length of from 0.5 cm to 6 cm.