SURGICAL TREATMENT OF STRESS URINARY INCONTINENCE

• US 20020005204A1
• Filed: 03/14/1997
• Published: 01/17/2002
• Est. Priority Date: 12/03/1991
• Status: Active Grant

• Current Assignee: Boston Scientific Scimed, Inc. (Boston Scientific Corporation)
• Original Assignee: Scimed Life Systems Incorporated (Boston Scientific Corporation)
• Inventors: BENDEREV, THEODORE V., NAVES, NEIL H., LEGOME, MARK J.
• Granted Patent: US 6,500,194 B2
• Time in Patent Office: Days
• US Class Current: 128/898
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• CPC Class Codes: A61B 17/06109 Big needles, either gripped by hand or connectable to a handle
• CPC Class Codes: A61B 17/062 Needle manipulators
• CPC Class Codes: A61B 17/0644 penetrating the tissue, deformable to closed position
• CPC Class Codes: A61B 17/10 for applying or removing wound clamps, e.g. containing only one clamp or staple A61B17/076 takes precedence; containing multiple wound clamps A61B17/068; Wound clamp magazines containers, packaging elements or packages specially adapted for particular articles or with special means for dispensing contents B65D83/00, B65D85/00
• CPC Class Codes: A61B 17/1739 specially adapted for particular parts of the body
• CPC Class Codes: A61B 17/1796 for holes for sutures or flexible wires
• CPC Class Codes: A61B 17/42 Gynaecological or obstetrical instruments or methods ligaturing clamps or clips for the umbilical cord A61B17/122; curettage A61B17/320708; dilators A61M29/00
• CPC Class Codes: A61B 2017/00349 Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue A61B17/06066 takes precedence
• CPC Class Codes: A61B 2017/00805 Treatment of female stress urinary incontinence
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening
• CPC Class Codes: A61B 2017/0461 with features cooperating with special features on the suture, e.g. protrusions on the suture
• CPC Class Codes: A61B 2017/0462 One way system, i.e. also tensioning the suture
• CPC Class Codes: A61B 2017/0472 Multiple-needled, e.g. double-needled, instruments
• CPC Class Codes: A61B 2017/0496 for tensioning sutures
• CPC Class Codes: A61B 2090/062 penetration depth
• CPC Class Codes: A61B 46/30 : for surgery through the lower body openings, e.g. urology, gynaecology

Abstract

The surgical treatment of stress urinary incontinence is disclosed. The disclosed methods include: 1) a technique of probe passage to avoid injuring the bladder and to provide a more accurate and reproducible capture of the pubocervical fascia lateral to the bladder neck and urethra, 2) anchor fixation of the suspending sutures to the pubic bone to decrease the risk of suture pull through from above and to decrease post-operative pain and 3) a simple and reproducible technique to set a limited tension of the suspending sutures. A description of these methods and results of procedures with some of these methods are disclosed. Novel drill guides, suture passers, suture tensioners, and various related tools and devices for use in the surgical method are also disclosed.

Claims

1. A method of percutaneously anchoring a suture to a bone while minimizing invasion of the adjacent tissue, comprising the steps of:

percutaneously locating an anchoring site on a bone;

advancing a drill through the tissue and into the bone to provide a recess therein;

advancing a bone anchor through the tissue and into the recess; and

thereafter

securing the anchor within the recess.

2. A method as in claim 1, wherein said locating step comprises advancing at least one bone probe through the tissue and contacting the bone.

3. A method as in claim 2, wherein said locating step comprises advancing two bone probes through the tissue to locate the bone.

4. A method as in claim 1, further comprising the step of selecting an anchor having a suture secured thereto.

5. A method as in claim 1, further comprising the step of fastening a suture to the bone anchor following said securing step.

7. A method of suspending a first tissue mass from a second tissue mass with a preselected tension as in claim 1, wherein said first tissue comprises the facia surrounding a bladder neck.

6. A method of suspending a first tissue mass from a second tissue mass with a preselected tension, comprising the steps of:

positioning a central portion of a suture around the first tissue mass, and the two ends of suture around the second tissue mass;

positioning a suture tensioning structure having a preselected cross sectional area between either of the first or second tissue masses and the suture;

tying the suture around the first and second tissue masses and the suture tensioner; and

thereafter

removing the suture tensioner to produce an amount of slack in the suture corresponding to the cross sectional area of the suture tensioner.

8. A method of suspending a first tissue mass from a second tissue mass with a preselected tension as in claim 6, wherein said second tissue comprises the pubic bone.

9. A method of advancing a suture through tissue, comprising the steps of:

positioning a suture on one side of the tissue;

providing a suture passer of the type having an elongate probe for penetrating tissue and a releasable suture engagement structure on a distal portion thereof;

advancing the suture passer distally through the tissue towards the suture;

grasping the suture within the suture engaging structure; and

thereafter

withdrawing the suture passer proximally to draw the suture through the tissue.

10. A method of advancing a suture through tissue as in claim 9, further comprising the step of advancing the suture passer distally through the tissue to advance the suture distally therethrough.

11. A method of suspending a bladder neck comprising the steps of:

securing a suture to a bone anchor;

positioning said anchor in a bone; and

suspending said bladder neck with said suture.

12. The method of claim 11, wherein said suture is secured to said anchor before said anchor is positioned in the bone.

13. The method of claim 11, wherein said suture is secured to said anchor after said anchor is positioned in the bone.