Method for controlling flow of urine in a patient's urethra, ureter, renal pelvis or bladder

• US 20090247817A1
• Filed: 10/14/2008
• Published: 10/01/2009
• Est. Priority Date: 10/11/2007
• Status: Active Grant

• Current Assignee: Kirk Promotion Ltd.
• Original Assignee: Milux Holding SA
• Inventors: Forsell, Peter
• Granted Patent: US 10,307,597 B2
• Time in Patent Office: Days
• US Class Current: 600/31
• CPC Class Codes: A61F 2/0036 implantable A61F2/0018 takes precedence
• CPC Class Codes: A61F 2/004 inflatable
• CPC Class Codes: A61F 2250/0013 for adjusting fluid pressure
• CPC Class Codes: A61M 2205/33 Controlling, regulating or measuring
• CPC Class Codes: A61M 2205/3303 Using a biosensor
• CPC Class Codes: A61M 2205/8243 by induction
• CPC Class Codes: A61M 60/148 in line with a blood vessel using resection or like techniques, e.g. permanent endovascular heart assist devices
• CPC Class Codes: A61N 1/3605 Implantable neurostimulators for stimulating central or peripheral nerve system
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/403 for thermotherapy, e.g. hyperthermia

Abstract

There is provided a method for controlling a flow of urine in the urinary passageway of a patient'"'"'s urethra, ureter, renal pelvis or bladder. The method comprises gently constricting (i.e., without substantially hampering the blood circulation in the urinary tissue wall) at least one portion of the urinary tissue wall to influence the flow in the urinary passageway, and stimulating the constricted wall portion to cause contraction of the wall portion to further influence the flow in the urinary passageway. The method can be used for restricting or stopping the flow in the urinary passageway of a urinary incontinent patient, or for actively moving the urine in the urinary passageway, with a low risk of injuring the urethra, ureter, renal pelvis or bladder.

Claims

1. A method for controlling a flow of urine in the urinary passageway of a patient'"'"'s urethra, ureter, renal pelvis or bladder, the method comprising:

a) gently constricting at least one portion of the tissue wall of the patient'"'"'s urethra, ureter, renal pelvis or bladder to influence the flow of urine in the urinary passageway, and

b) stimulating the constricted wall portion to cause contraction of the wall portion to further influence the flow in the urinary passageway.

2. The method according to claim 1, wherein the wall portion is constricted, so that the flow in the urinary passageway is at least is restricted and the constricted wall portion is stimulated to at least further restrict the flow in the urinary passageway.

3. The method according to claim 2, wherein the wall portion is constricted to a constricted state, in which the blood circulation in the constricted wall portion is substantially unrestricted and the flow in the urinary passageway is at least restricted, and the constricted wall portion is stimulated when it is in the constricted state to at least further restrict the flow in the urinary passageway.

4. The method according to claim 1, wherein the wall portion is stimulated while the constriction of the wall portion is changed.

5. The method according to claim 1, wherein the constriction of the wall portion is calibrated by stimulating the wall portion while adjusting the constriction of the wall portion until the desired restriction of the flow in the urinary passageway is obtained.

6. The method according to claim 1, wherein step (b) is not performed while step (a) is performed.

7. The method according to claim 2, wherein step (a) is performed by constricting the wall portion, so that the flow in the urinary passageway is restricted but not stopped, and step (b) is performed by stimulating the constricted wall portion to cause contraction thereof, so that the flow in the urinary passageway is further restricted but not stopped.

8. The method according to claim 7, further comprising sensing a physical parameter of the patient and adjusting the intensity of the stimulation of the wall portion in response to the sensed parameter.

9. The method according to claim 7, further comprising (c) ceaseing stimulating the wall portion to increase the flow in the urinary passageway, and (d) releasing the wall portion to restore the flow in the urinary Passageway.

11. The method according to claim 2, wherein step (a) is performed by constricting the wall portion, so that the flow in the urinary passageway is restricted but not stopped, and step (b) is performed by stimulating the constricted wall portion to cause contraction thereof, so that the flow in the urinary passageway is stopped.

12. The method according to claim 11, further comprising (c) ceaseing stimulating the wall portion to allow flow in the urinary passageway, and (d) releasing the wall portion to restore the flow in the urinary passageway.

14. The method according to claim 11, further comprising sensing a physical parameter of the patient and adjusting the intensity of the stimulation of the wall portion in response to the sensed parameter, wherein the intensity of the stimulation of the wall portion is increased so that the flow in the urinary passageway remains stopped when a pressure increase occurs in the urinary Passageway, wherein the Physical Parameter relates to the pressure in the urinary passageway and the stimulation of the wall portion is controlled in response to the sensed parameter, and wherein the Physical parameter is a pressure in the patient'"'"'s body.

18. The method according to claim 2, wherein step (a) is performed by constricting the wall portion, so that the flow in the urinary passageway is substantially stopped, and step (b) is performed by stimulating the constricted wall portion to cause contraction thereof, so that the flow in the urinary passageway is completely stopped.

19. The method according to claim 18, further comprising (c) ceaseing stimulating the wall portion to allow flow in the urinary passageway, and (d) releasing the wall portion to restore the flow in the urinary Passageway.

21. The method according to claim 18, further comprising sensing a physical parameter of the patient and adjusting the intensity of the stimulation of the wall portion in response to the sensed parameter, wherein the intensity of the stimulation of the wall portion is increased so that the flow in the urinary passageway remains stopped when a pressure increase occurs in the urinary passageway, wherein the Physical parameter relates to the pressure in the urinary passageway and the stimulation of the wall portion is controlled in response to the sensed parameter, and wherein the Physical Parameter is a pressure in the patient'"'"'s body.

25. The method according to claim 1, wherein step (a) is performed by constricting the wall portion, so that the flow in the urinary passageway is stopped.

26. The method according to claim 25, further comprising (d) releasing the wall portion to restore the flow in the urinary passageway.

27. The method according to claim 25, wherein step (b) is performed by stimulating the constricted wall portion to cause contraction thereof, so that the flow in the urinary passageway remains stopped when a pressure increase occurs in the urinary passageway, further comprising sensing a physical parameter of the patient'"'"'s that relates to the pressure in the urinary passageway, and controlling the stimulation of the wall portion in response to the sensed parameter, wherein the physical parameter is a pressure in the patient'"'"'s body.

30. The method according to claim 1, wherein steps (a) and (b) are co-operated to move the urine in the urinary passageway.

31. The method according to claim 30, wherein step (a) is performed by constricting the wall portion to restrict the flow in the urinary passageway, and step (b) is performed by progressively stimulating the constricted wall portion to cause progressive contraction of the wall portion to move the urine in the urinary passageway, and wherein the constricted wall portion is progressively stimulated in the downstream or upstream direction of the urinary passageway.

33. The method according to claim 30, wherein step (a) is performed by constricting the wall portion to restrict the flow in the urinary passageway, and step (b) is performed by stimulating the constricted wall portion to close the urinary passageway either at an upstream end or a downstream end of the constricted wall portion, further comprising (c) increasing the constriction of the wall portion to move the urine in the urinary passageway.

34. The method according to claim 30, wherein step (a) is performed by varyingly constricting the wall portion to vary the flow in the urinary passageway, and step (b) is performed by progressively stimulating the constricted wall portion to cause progressive contraction of the wall portion to move the urine in the urinary passageway, and wherein the constricted wall portion is progressively stimulated in the downstream or upstream direction of the urinary passageway.

36. The method according to claim 30, wherein step (a) is performed by varyingly constricting different areas of the wall portion to cause progressive constriction of the wall portion in the downstream or upstream direction of the urinary passageway.

37. The method according to claim 36, wherein the constricted wall portion is progressively stimulated to cause progressive contraction thereof in harmony with the progressive constriction of the wall portion.

38. The method according to claim 36, further comprising providing at least one elongated constriction element extending along the wall portion, and controlling the elongated constriction element to progressively constrict the wall portion in the downstream or upstream direction of the urinary passageway, wherein the elongated constriction element comprises contact surfaces dimensioned to contact a length of the wall portion, further comprising providing a plurality of stimulation elements distributed along the contact surfaces, and controlling the stimulation elements to stimulate the different areas of the wall portion along the length of the wall portion.

40. The method according to claim 30, wherein step (a) is performed by constricting any one of a series of wall portions of the tissue wall to at least restrict the flow in the urinary passageway, and step (b) is performed by stimulating the constricted wall portion to close the urinary passageway, further comprising successively constricting the wall portions of the series of wall portions to move the urine in the urinary passageway in a peristaltic manner.

41. The method according to claim 40, further comprising providing at least one constriction element and at least one stimulation element positioned on the constriction element, moving the constriction element along the urethra, ureter, renal pelvis or bladder to successively constrict the wall portions of the series of wall portions, and using the stimulation element to stimulate the wall portion constricted by the constriction element to close the urinary passageway.

43. The method according to claim 40, further comprising providing a plurality of constriction elements and stimulation elements positioned on the constriction elements, moving each constriction element along the urethra, ureter, renal pelvis or bladder to successively constrict the wall portions of the series of wall portions, and using the stimulation elements to stimulate the wall portion constricted by any one of the constriction elements to close the urinary passageway, and further comprising cyclically moving the constriction element along the wall portions of the series of wall portions.

47. The method according to claim 30, wherein step (a) is performed by constricting the wall portion at an upstream or downstream end thereof to close the urinary passageway, further comprising (c) constricting the wall portion between the upstream and downstream ends thereof, to move the fluid or other urine contained in the wall portion between the upstream and downstream ends thereof downstream or upstream in the urinary passageway, further comprising stimulating the wall portion between the upstream and downstream ends thereof, as step (c) is performed, wherein step (a) is performed by constricting the wall portion at the upstream or downstream end thereof to restrict the flow in the urinary Passageway, and step (b) is performed by stimulating the constricted wall portion at the upstream or downstream end to close the urinary passageway, whereby the urine contained in the wall portion between the upstream and downstream ends thereof is moved downstream or upstream in the urinary passageway, as step (c) is performed.

51. The method according to claim 30, wherein step (b) is performed by stimulating the wall portion with electric pulses.

52. The method according to claim 1, further comprising controlling by the patient the constriction and/or stimulation of the wall portion from outside the patient'"'"'s body.

54. The method according to claim 1, further comprising sensing a physical parameter of the patient and automatically controlling the constriction and/or stimulation of the wall portion in response to the sensed parameter.

56. The method according to claim 1, further comprising providing a constriction device for performing step (a) and a stimulation device for performing step (b), and forming the constriction and stimulation devices in an operable constriction/stimulation unit.

57. The method according to claim 56, further comprising providing a control device that controls the constriction/stimulation unit, and operating the control device from outside the patient'"'"'s body.

59. The method according to claim 57, wherein the control device comprises a hand-held wireless remote control that is operated by the patient, or a manually operable switch for switching on and off the constriction device and/or stimulation device, the method further comprising subcutaneously implanting the switch in the patient and manually operating the implanted switch from outside the patient'"'"'s body.

61. The method according to claim 57, further comprising using the control device to wirelessly control the constriction device and/or stimulation device in a non-magnetic manner.

63. The method according to claim 1, wherein step (b) is performed by intermittently and individually stimulating different areas of the wall portion so that at least two of the areas are stimulated at different points of time, wherein step (b) is performed by intermittently stimulating each area of the different areas of the wall portion during successive time periods, each time period being short enough to maintain over time satisfactory blood circulation in the area until the laps of the time period, and wherein step (b) is performed by intermittently stimulating the areas of the wall portion so that an area of the wall portion that currently is not stimulated has time to restore substantially normal blood circulation before it is stimulated again.

66. The method according to claim 1, wherein step (b) is performed by stimulating one or more of different areas of the wall portion at a time.

67. The method according to claim 66, wherein step (b) is performed by sequentially stimulating the different areas of the wall portion, or by shifting the stimulation from one area to another over time, or by cyclically propagating the stimulation of the areas along the wall portion in the same or opposite direction of the flow in the patient'"'"'s urinary passageway in accordance with a determined stimulation pattern.

71. The method according to claim 1, wherein step (b) is performed by stimulating the wall portion with cyclically varying stimulation intensity.

73. The method according to claim 1, wherein step (b) is performed by stimulating different areas of the wall portion with pulses.

75. The method according to claim 73, wherein the pulses form pulse trains and at least one of the following steps is performed:

varying the pulse amplitudes of the pulses of the pulse trains;

varying the frequency of the pulses of the pulse trains;

varying the frequency of the pulse trains; and

varying the number of pulses of each pulse train.

76. The method according to claim 75, wherein the pulses form pulse trains and at least one of the following steps is performed:

varying the off time periods between the individual pulses of each pulse train;

varying the off time periods between the pulse trains;

varying the width of each pulse of the pulse trains; and

varying the length of each pulse train.

82. The method according to claim 75, wherein each off time period between the pulse trains is kept long enough to restore substantially normal blood circulation in each area when the area is not stimulated during the off time periods.

86. The method according to claim 1, wherein step (b) is performed by electrically stimulating different areas of the wall portion with electric pulses.

88. The method according to claim 86, wherein the wall portion includes muscle fibers, and step (b) is performed by stimulating the wall portion including the muscle fibers with the electric pulses.

89. The method according to claim 86, further comprising providing at least one electrical element engaging the wall portion.

90. The method according to claim 89, further comprising providing a plurality of electrical elements engaging the wall portion.

91. The method according to claim 90, further comprising placing the electrical elements in a fixed orientation relative to one another and providing a structure holding the electrical elements in the fixed orientation, wherein the electrical elements form an elongate pattern of electrical elements with two opposite short ends, and further comprising applying the structure on the patient'"'"'s urethra, ureter, renal pelvis or bladder so that the elongate pattern of electrical elements extends along the wall portion of the urethra, ureter, renal pelvis or bladder in the direction of the flow in the patient'"'"'s urinary Passageway and the elements abut the respective areas of the wall portion.

115. The method according to claim 1, wherein step (b) is performed by thermally stimulating the wall portion.

117. The method according to claim 115, wherein step (a) is performed to at least restrict the flow in the urinary passageway, and step (b) is performed by cooling the wall portion to cause contraction of the wall portion, so that the flow in the urinary passageway is at least further restricted, or at least further restricted but not stopped, or stopped.

120. The method according to claim 117, further comprising heating the wall portion, when the wall portion is constricted and contracted, to cause expansion of the wall portion.

132. The method according to claim 56, further comprising calibrating the constriction of the wall portion by controlling the stimulation device to stimulate the wall portion while controlling the constriction device to adjust the constriction of the wall portion until the desired restriction of the flow in the urinary passageway is obtained.

133. The method according to claim 56, further comprising implanting at least one sensor and controlling by the control device the constriction device and/or stimulation device in response to signals from the sensor.

134. The method according to claim 133, wherein at least one physical parameter of the patient is directly or indirectly sensed by the sensor, the sensor comprising a pressure sensor that senses a pressure in the patient'"'"'s body, further comprising controlling the constriction device by the control device to change the constriction of the patient'"'"'s wall portion in response to the pressure sensor sensing a predetermined value.

135. The method according to claim 133, further comprising implanting in the patient a medical implant, wherein at least one functional parameter of the medical implant is directly or indirectly sensed by the sensor.

138. The method according to claim 133, wherein the control device comprises an internal control unit, further comprising implanting in the patient the internal control unit and directly controlling by the internal control unit the constriction device and/or stimulation device in response to signals from the sensor.

139. The method according to claim 133, wherein the control device comprises an external control unit outside the patient'"'"'s body, further comprising controlling by the external control unit the constriction device and/or stimulation device in response to signals from the sensor.

140. The method according to claim 133, wherein the control device produces an indication in response to signals from the sensor, the indication comprising a sound signal or displayed information.

142. The method according to claim 1, wherein step (a) is performed by mechanically or hydraulically constricting the wall portion.

143. The method according to claim 142, wherein step (a) is performed by mechanically or hydraulically constricting the wall portion in a non-magnetic and/or non-manual manner.

144. The method according to claim 142, wherein step (a) is performed by constricting the wall portion so that the through-flow area of the urinary passageway assumes a size in the constricted state small enough to cause the flow in the urinary passageway to stop when step (b) is performed.

145. The method according to claim 142, wherein step (a) is performed by bending the urethra, ureter, renal pelvis or bladder or clamping the urethra, ureter, renal pelvis or bladder between at least two elements positioned on different sides of the urethra, ureter, renal pelvis or bladder, or clamping the urethra, ureter, renal pelvis or bladder between an element and the bone or tissue of the patient, or rotating at least two elements positioned on different sides of the urethra, ureter, renal pelvis or bladder, or clamping the urethra, ureter, renal pelvis or bladder between at least two articulated clamping elements positioned on different sides of the urethra, ureter, renal pelvis or bladder.

150. The method according to claim 142, further comprising implanting in the patient a main reservoir containing a predetermined amount of hydraulic fluid and a constriction device engaging the wall portion and having an expandable cavity, wherein step (a) is performed by distributing hydraulic fluid from the main reservoir to increase the volume of the cavity to constrict the wall portion.

151. The method according to claim 150, wherein the main reservoir comprises first and second wall portions, and step (a) is performed by displacing the first and second wall portions towards each other to decrease the volume of the main reservoir, so that fluid is distributed from the main reservoir to the cavity, and wherein at least one of a magnetic device, a hydraulic device or an electric control device displaces the first and second wall portions of the main reservoir toward each other.

153. The method according to claim 150, further comprising implanting a reverse servo that distributes hydraulic fluid from the main reservoir to the cavity.

154. The method according to claim 153, wherein the main reservoir comprises first and second wall portions, and the reverse servo displaces the first and second wall portions towards each other to decrease the volume of the main reservoir, so that fluid is distributed from the main reservoir to the cavity, and wherein the reverse servo comprises an expandable servo reservoir containing servo fluid and having first and second wall portions, which are displaceable relative to each other in response to a change in the volume of the expandable servo reservoir, and the first and second wall portions of the servo reservoir are operatively connected to the first and second wall portions of the main reservoir, so that the volume of the main reservoir is changed when the volume of the servo reservoir is changed.

156. The method according to claim 154, further comprising dimensioning the servo and main reservoirs so that when the volume of the servo reservoir is changed by a relatively small amount of servo fluid, the volume of the main reservoir is changed by a relatively large amount of hydraulic fluid.

157. The method according to claim 154, wherein the first and second wall portions of the servo reservoir are displaced relative to each other by manual manipulation or by a magnetic device, a hydraulic device, or an electric control device.

159. The method according to claim 154, wherein the reverse servo comprises a fluid supply reservoir hydraulically connected to the servo reservoir to form a closed conduit system for the servo fluid.

160. The method according to claim 150, further comprising implanting in the patient a pump that pumps fluid between the main reservoir and the cavity.

161. The method according to claim 160, wherein the pump comprises a first activation member that activates the pump to pump fluid from the main reservoir to the cavity and a second activation member that activates the pump to pump fluid from the cavity to the main reservoir.

163. The method according to claim 161 wherein at least one of the activation members operates when subjected to an external predetermined pressure.

164. The method according to claim 161, wherein at least one of the first and second activating members are operated by a magnetic device, a hydraulic device, or an electric control device.

165. The method according to claim 160, further comprising implanting a fluid conduit between the pump and the cavity, the main reservoir forming part of the conduit and the conduit and pump being devoid of any non-return valve, wherein the main reservoir forms a fluid chamber with a variable volume, step (a) is performed by reducing the volume of the chamber so that fluid is pumped from the chamber to the cavity and the pump comprises a movable wall of the main reservoir for changing the volume of the chamber, the method further comprising implanting a motor for driving the pump.

171. The method according to claim 56, further comprising transmitting wireless energy from outside the patient'"'"'s body to inside the patient'"'"'s body and using the transmitted wireless energy in connection with the operation of the constriction/stimulation unit.

172. The method according to claim 171, further comprising directly using the wireless energy in connection with the operation of the constriction/stimulation unit as the wireless energy is being transmitted wherein the wireless energy comprises an electric, an electromagnetic or a magnetic field, or a combination thereof, or electromagnetic waves, and further comprising implanting in the patient an electric motor or pump operatively connected to the constriction device and directly powering the motor or Pump by wireless energy in the form of a magnetic or an electromagnetic field.

175. The method according to claim 171, wherein the wireless energy comprises energy of a first form, further comprising transmitting the energy of the first form into energy of a second form and operating the constriction/stimulation unit with the energy of the second form.

176. The method according to claim 175, wherein the energy of the second form is different than the energy of the first form, the energy of the second form comprises electric energy and the constriction/stimulation unit is directly operated with the energy of the second form in a non-magnetic, non-thermal or non-mechanical manner.

180. The method according to claim 175, wherein the energy of the first form is directly or indirectly transformed into the energy of the second form, further comprising providing a motor for operating the constriction device and powering the motor with the energy of the second form.

181. The method according to claim 180, wherein the constriction device is operable to perform at least one reversible function, further comprising reversing the function by using the motor.

182. The method according to claim 180, further comprising shifting polarity of the energy of the second form to reverse the motor.

183. The method according to claim 180, further comprising directly powering the motor with the transformed energy of the second form, as the energy of the second form is being transformed from the energy of the first form.

184. The method according to claim 175, wherein the wireless energy of the first form comprises sound waves and the energy of the second form comprises electric energy.

185. The method according to claim 175, further comprising implanting in the patient a source of energy for storing the energy of the second form and supplying energy from the source of energy in connection with the operation of the constriction/stimulation unit, wherein the source of energy comprises an accumulator, and wherein the accumulator comprises at least one capacitor or at least one rechargeable battery, or a combination of at least one capacitor and at least one rechargeable battery.

188. The method according to claim 175, further comprising implanting in the patient a source of energy for supplying energy for the operation of the constriction/stimulation unit and a switch for switching the energy supplied by the source of energy, and using the energy of the second form to operate the switch to switch from an “

off”

mode, in which the source of energy is not in use, to an “

on”

mode, in which the source of energy supplies energy for the operation of the constriction/stimulation unit.

190. The method according to claim 175, further comprising implanting in the patient a stabilizer for stabilizing the energy of the second form, wherein the energy of the second form comprises electric current and the stabilizer comprises at least one capacitor.

192. The method according to claim 171, wherein the wireless energy is transmitted in at least one wireless signal.

193. The method according to claim 192, wherein the signal comprises a wave signal in the form of a sound or ultrasound wave signal, or in the form of an electromagnetic wave signal including one of an infrared light signal, a visible light signal, an ultra violet light signal, a laser signal, a micro wave signal, a radio wave signal, an x-ray radiation signal, and a gamma radiation signal.

196. The method according to claim 192, wherein the signal comprises a digital or analogue signal, or a combination of a digital and analogue signal.

197. The method according to claim 175, wherein the energy of the first form comprises an electric, an electromagnetic or a magnetic field, or a combination thereof.

198. The method according to claim 171, wherein the wireless energy comprises an electric, an electromagnetic or a magnetic field, or a combination thereof, further comprising transmitting the wireless energy in pulses or digital pulses, or a combination of pulses and digital pulses.

199. The method according to claim 175, wherein the energy of the first form is transformed into a direct current or pulsating direct current, or a combination of a direct current and pulsating direct current, or transformed into an alternating current or a combination of a direct and alternating current.

201. The method according to claim 175, wherein one of the energy of the first form and the energy of the second form comprises magnetic energy, kinetic energy, sound energy, chemical energy, radiant energy, electromagnetic energy, photo energy, nuclear energy or thermal energy.

202. The method according to claim 175, wherein one of the energy of the first form and the energy of the second form is non-magnetic, non-kinetic, non-chemical, non-sonic, non-nuclear or non-thermal.

207. The method according to claim 57, wherein the control device comprises a wireless remote control that controls the constriction/stimulation unit from outside the patient'"'"'s body, wherein the wireless remote control transmits at least one wireless control signal for controlling the constriction/stimulation unit.

210. The method according to claim 207, wherein the control signal comprises a frequency, amplitude, phase modulated signal or a combination thereof, and an analogue or a digital signal, or a combination of an analogue and digital signal.

212. The method according to claim 207, wherein the wireless remote control transmits a carrier signal that carries the control signal, the carrier signal comprising digital, analogue or a combination of digital and analogue wave signals.

215. The method according to claim 207, wherein the control signal comprises an electric or magnetic field or a combined electric and magnetic field, or a wave signal comprising one of a sound wave signal, an ultrasound wave signal, an electromagnetic wave signal, an infrared light signal, a visible light signal, an ultra violet light signal, a laser light signal, a micro wave signal, a radio wave signal, an x-ray radiation signal and a gamma radiation signal.

217. The method according to claim 210, wherein the wireless remote control transmits an electromagnetic carrier wave signal that carries the digital or analogue control signal.

218. The method according to claim 56, further comprising implanting in the patient an operation device and operating the constriction/stimulation unit with the operation device.

219. The method according to claim 218, further comprising providing a magnet and activating the operation device with the magnet, wherein the magnet activates the operation device from outside the patient'"'"'s body.

221. The method according to claim 218, wherein the operation device comprises a motor, further comprising providing a source of energy and powering the motor with energy released from the source of energy.

223. The method according to claim 56, further comprising implanting a source of energy, releasing energy from the source of energy and using the released energy in connection with the operation of the constriction/stimulation unit wherein the source of energy comprises a battery.

240. The method according to claim 1, further comprising providing a constriction device that constricts the wall portion for performing step (a), a stimulation device that stimulates the constricted wall portion for performing step (b) and an external source of energy outside the patient'"'"'s body, controlling the external source of energy from outside the patient'"'"'s body to release wireless energy, and using the released wireless energy for operating the constriction device and/or stimulation device.

241. The method according to claim 240, further comprising transforming the wireless energy into electrical energy inside the patient'"'"'s body by an implanted energy-transforming device and using the electrical energy in connection with the operation of the constriction device and/or stimulation device.

242. The method according to claim 241, further comprising directly using the electrical energy in connection with the operation of the constriction device and/or stimulation device, as the transforming device transforms the wireless energy into the electrical energy.

243. The method according to claim 240, further comprising controlling the external source of energy from outside the patient'"'"'s body to release non-magnetic wireless energy, and using the released non-magnetic wireless energy for operating the constriction device and/or stimulation device.

244. The method according to claim 240, further comprising controlling the external source of energy from outside the patient'"'"'s body to release electromagnetic wireless energy, and using the released electromagnetic wireless energy for operating the constriction device and/or stimulation device.

245. The method according to claim 1, wherein step (a) is performed by constricting any wall portions of a series of wall portions of the urethra, ureter, renal pelvis or bladder.

246. The method according to claim 245, wherein the wall portions of the series of wall portions are constricted in random or in accordance with a predetermined sequence, further comprising constricting the wall portions of the series of wall portions at least two at a time at positions spaced apart on the urethra, ureter, renal pelvis or bladder.

248. The method according to claim 245, wherein the wall portions of the series of wall portions are successively constricted along the urethra, ureter, renal pelvis or bladder to move the urine in the urinary passageway of the patient'"'"'s urethra, ureter, renal pelvis or bladder or to prevent the urine to move in the urinary passageway of the patient'"'"'s urethra, ureter, renal pelvis or bladder.

249. The method according to claim 245, wherein step (b) is performed by stimulating any constricted wall portions of the series of wall portions.

250. The method according to claim 249, wherein the wall portions of the series of wall portions are constricted in random or in accordance with a predetermined sequence, further comprising constricting the wall portions of the series of wall portions at least two at a time at positions spaced apart on the urethra, ureter, renal pelvis or bladder.

252. The method according to claim 249, wherein the wall portions of the series of wall portions are successively constricted along the urethra, ureter, renal pelvis or bladder to move the urine in the urinary passageway of the patient'"'"'s urethra, ureter, renal pelvis or bladder or to prevent the urine to move in the urinary passageway of the patient'"'"'s urethra, ureter, renal pelvis or bladder.

253. The method according to claim 245, wherein the wall portions of the series of wall portions are constricted without completely closing the urinary passageway, and step (b) is performed by stimulating the constricted wall portions one after the other, so that the wall portions of the series of wall portions are successively contracted along the urethra, ureter, renal pelvis or bladder to move the urine in the urinary passageway of the patient'"'"'s urethra, ureter, renal pelvis or bladder.

254. The method according to claim 253, wherein the wall portions of the series of wall portions are constricted in random or in accordance with a predetermined sequence, further comprising constricting the wall portions of the series of wall portions at least two at a time at positions spaced apart on the urethra, ureter, renal pelvis or bladder.

256. The method according to claim 253, wherein the wall portions of the series of wall portions are successively constricted along the urethra, ureter, renal pelvis or bladder to move the urine in the urinary passageway of the patient'"'"'s urethra, ureter, renal pelvis or bladder or to prevent the urine to move in the urinary passageway of the patient'"'"'s urethra, ureter, renal pelvis or bladder, further comprising constricting the wall portions of the series of wall portions at least two at a time at positions spaced apart on the urethra, ureter, renal pelvis or bladder to move the urine in the urinary passageway of the patient'"'"'s urethra, ureter, renal pelvis or bladder or to prevent the urine to move in the urinary passageway of the patient'"'"'s urethra, ureter, renal pelvis or bladder.

258. The method according to claim 245, wherein step (a) is performed by constricting all of the wall portions of the series of wall portions, and step (b) is performed by stimulating any constricted wall portions in random or in accordance with a predetermined sequence to close the urinary passageway.

259. The method according to claim 258, wherein the wall portions of the series of wall portions are further constricted by the stimulation device in random or in accordance with a predetermined sequence, further comprising constricting the wall portions of the series of wall portions at least two at a time at positions spaced apart on the urethra, ureter, renal pelvis or bladder.

261. The method according to claim 258, wherein the wall portions of the series of wall portions are successively further constricted by the stimulation device along the urethra, ureter, renal pelvis or bladder to move the urine in the urinary passageway of the patient'"'"'s urethra, ureter, renal pelvis or bladder or to prevent the urine to move in the urinary passageway of the patient'"'"'s urethra, ureter, renal pelvis or bladder.

262. The method according to claim 1, wherein step (a) and step (b) are performed simultaneously or independently of each other.

264. The method according to claim 240, further comprising providing an internal energy source, transmitting said wireless energy from the external energy source located outside the patient, and receiving the wireless energy transmitted by the internal energy source located inside the patient, the internal energy source being connected to at least one of the constriction and stimulation devices for directly or indirectly supplying received energy thereto, the method further comprising the steps of:

determining an energy balance between the energy received by the internal energy source and the energy used for at least one of the constriction and stimulation devices device, and

controlling the transmission of wireless energy from the external energy source, based on the determined energy balance.

265. The method according to claim 264, wherein the wireless energy is transmitted inductively from a primary coil in the external energy source to a secondary coil in the internal energy source.

266. The method according to claim 264, wherein a change in said energy balance is detected, and the transmission of wireless energy is controlled based on said detected energy balance change.

267. The method according to claim 264, wherein a difference is detected between energy received by said internal energy source and energy used for the constriction device and/or stimulation device, and the transmission of wireless energy is controlled based on said detected energy difference, and wherein the amount of transmitted wireless energy is decreased if the detected energy difference implies that the received energy is greater than the used energy, or vice versa, wherein the decrease/increase of energy transmission corresponds to the magnitude of the detected energy difference.

268. The method according to claim 266, wherein the amount of transmitted wireless energy is decreased if the detected energy balance change implies that the energy balance is increasing, or vice versa, wherein the decrease/increase of energy transmission corresponds to a detected change rate.

272. The method according to claim 266, wherein the energy used for at least one of the constriction and stimulation devices is stored in at least one energy storage device of the device.

273. The method according to claim 266, wherein substantially all the energy used for at least one of the constriction and stimulation devices is consumed to operate the device, wherein the energy is consumed after being stabilized in at least one energy stabilizing unit of the device.

275. The method according to claim 267, wherein the energy used for at least one of the constriction and stimulation devices is stored in at least one energy storage device of the device.

276. The method according to claim 267, wherein substantially all the energy used for at least one of the constriction and stimulation devices is consumed to operate the device, wherein the energy is consumed after being stabilized in at least one energy stabilizing unit of the device.

278. The method according to claim 240, further comprising providing an internal energy source located inside the patient connected to at least one of the constriction and stimulation devices for directly or indirectly supplying received energy thereto, determining an energy balance between the energy sent by the external energy source and the energy received by the internal energy source, and controlling the transmission of wireless energy from the external energy source, based on the determined energy balance.

279. The method according to claim 278, wherein the wireless energy is transmitted inductively from a primary coil in the external energy source to a secondary coil in the internal energy source.

280. The method according to claim 278, wherein a change in said energy balance is detected, and the transmission of wireless energy is controlled based on said detected energy balance change.

281. The method according to claim 278, wherein a difference is detected between the energy sent by the external energy source and the energy received by said internal energy source, and the transmission of wireless energy is controlled based on said detected energy difference.

282. The method according to claim 280, wherein the amount of transmitted wireless energy is decreased if the detected energy balance change implies that the energy balance is increasing, or vice versa, wherein the decrease/increase of energy transmission corresponds to a detected change rate.

284. The method according to claim 281, wherein the amount of transmitted wireless energy is decreased if the detected energy difference implies that the received energy is greater than the used energy, or vice versa, wherein the decrease/increase of energy transmission corresponds to the magnitude of the detected energy difference.

286. The method according to claim 278, wherein said wireless energy is transmitted by means of a primary coil in the external energy source and received inductively by means of a secondary coil in an internal energy source, the internal energy source is connected to a device for directly or indirectly supplying received energy thereto, and wherein feedback control information is transferred from the secondary coil to the primary coil by switching the secondary coil on and off to induce a detectable impedance load variation in the primary coil encoding the feedback control information, and wherein the feedback control information relates to the energy received by the internal energy source and is used for controlling the transmission of wireless energy from the external energy source.

287. The method according to claim 286, wherein the external energy source further comprises an electronic circuit for comparing the feedback information with the amount of energy transmitted by the external energy source, wherein the electronic circuit comprises an analyzer, further comprising analyzing by the analyzer the amount of energy being transmitted and the received feedback information related to the amount of energy received in the receiver, and determining the energy balance by comparing the amount of transmitted energy and the feedback information related to the amount of received energy, further comprising using the feedback information to adjust the level of the energy transmitted from the external energy source.

290. The method according to claim 264, wherein said wireless energy is transmitted by means of a primary coil in the external energy source and received inductively by means of a secondary coil in the internal energy source, wherein feedback control information is transferred from the secondary coil to the primary coil by switching the secondary coil on and off to induce a detectable impedance load variation in the primary coil encoding the feedback control information, where the feedback control information relates to said energy balance.

291. The method according to claim 240, further comprising the steps of;

transmitting wireless energy from a coil of the external energy source placed externally to the human body,

placing an energy receiver internally in the human body,

providing an electric circuit connected to the external coil,

supplying by the external coil electrical pulses to transmit the wireless energy, the electrical pulses having leading and trailing edges,

varying by the electric circuit first time intervals between successive leading and trailing edges and/or second time intervals between successive trailing and leading edges of the electrical pulses, thus varying the power of the transmitted wireless energy, and

receiving by the energy receiver the transmitted wireless energy having a varied power.

292. The method according to claim 291, further comprising delivering by the electric circuit the electrical pulses to remain unchanged except varying the first and/or second time intervals.

293. The method according to claim 291, wherein the electric circuit has a time constant, further comprising

varying the first and second time intervals only in the range of the first time constant, so that the lengths of the first and/or second time intervals are varied, and

varying the transmitted power over the coil.

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95. The method according to claim 904, further comprising electrically energizing the electrical elements, wherein each electrical element is cyclically energized with electric pulses.

96. The method according to claim 95, wherein the electrical elements are energized so that a number or groups of the electrical elements are energized at the same time.

97. The method according to claim 95, wherein the electrical elements are energized one at a time in sequence or groups of the electrical elements are sequentially energized, either randomly or in accordance with a predetermined pattern.

98. The method according to claim 95, further comprising applying the electrical elements on the patient'"'"'s urethra, ureter, renal pelvis or bladder so that the electrical elements form an elongate pattern of electrical elements extending along the wall portion of the urethra, ureter, renal pelvis or bladder in the direction of the flow in the patient'"'"'s urinary passageway and the elements abut the respective areas of the wall portion.

99. The method according to claim 98, wherein the electrical elements are successively energized along the elongate pattern of electrical elements.

100. The method according to claim 99, wherein the electrical elements are successively energized along the elongate pattern of electrical elements in the same or opposites direction to that of the flow in the patient'"'"'s urinary passageway.

101. The method according to claim 99, wherein the electrical elements are successively energized along the elongate pattern of electrical elements from a position substantially at the center of the constricted wall portion towards both ends of the elongate pattern of electrical elements.

102. The method according to claim 99, wherein the electrical elements are energized so that electrical elements currently energized form at least one group of adjacent energized electrical elements.

103. The method according to claim 102, wherein the elements in the group of energized electrical elements form a path of energized electrical elements, and wherein the path of energized electrical elements extends at least in part or completely around the patient'"'"'s urethra, ureter, renal pelvis or bladder.

104. The method according to claim 102, wherein the group of adjacent energized electrical elements comprises one or more electrical elements.

105. The method according to claim 104, wherein the group of adjacent energized electrical elements comprises two electrical elements provided mutually on opposite sides of the patient'"'"'s urethra, ureter, renal pelvis or bladder.

106. The method according to claim 102, wherein the electrical elements are applied on the patient'"'"'s intestines in the direction of flow in the patient'"'"'s urethra, ureter, renal pelvis or bladder, and wherein the groups of electrical elements in the series of groups are successively energized in the same or opposite direction of the flow in the patient'"'"'s urethra, ureter, renal pelvis or bladder.

107. The method according to claim 104, wherein the group of adjacent energized electrical elements comprises three electrical elements extending around the patient'"'"'s urethra, ureter, renal pelvis or bladder.

108. The method according to claim 98, wherein the electrical elements are applied on the patient'"'"'s urethra, ureter, renal pelvis or bladder in a series of groups of elements extending along the patient'"'"'s urethra, ureter, renal pelvis or bladder in the direction of flow in the patient'"'"'s urinary passageway.

109. The method according to claim 108, wherein the groups of electrical elements in the series of groups are successively energized in the same or opposites direction to that of the flow in the patient'"'"'s urinary passageway.

111. The method according to claim 108, wherein the electrical elements of each group of electrical elements form a path of elements extending at least in part or completely around the patient'"'"'s urethra, ureter, renal pelvis or bladder.

113. The method according to claim 108, wherein the electrical elements of each group of electrical elements form two paths of elements extending on mutual sides of the patient'"'"'s urethra, ureter, renal pelvis or bladder, and wherein the two paths of electrical elements of each group of elements extend at least substantially transverse to the direction of flow in the patient'"'"'s urinary Passageway.

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205. The method according to claim 204, wherein the control device comprises a manually operable switch for switching on and off the constriction/stimulation unit, further comprising subcutaneously implanting the switch in the patient.

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225. A method for controlling a flow of urine in the passageway of a patient'"'"'s urethra, ureter, renal pelvis or bladder, the method comprising the steps of:

inserting a needle like tube into a cavity of the patients body,

using the needle like tube to fill the cavity with gas thereby expanding the cavity,

placing at least two laparoscopical trocars in the patient'"'"'s body,

inserting a camera through one of the trocars into the cavity,

inserting a dissecting tool through any of the trocar and dissecting an area of at least one portion of the tissue wall of the urethra, ureter, renal pelvis or bladder,

placing a constriction device and a stimulation device in the dissected area in operative engagement with the urethra, ureter, renal pelvis or bladder,

using the constriction device to gently constrict the wall portion of the urethra, ureter, renal pelvis or bladder to influence the flow in the urinary passageway, and

using the stimulation device to stimulate the constricted wall portion to cause contraction of the wall portion to further influence the flow in the urinary passageway.

231. The method according to claim 225, wherein the cavity constitutes an abdominal cavity or a cavity in the pelvic region.

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228. A method for controlling a flow of urine in the passageway of a patient'"'"'s urethra, ureter, renal pelvis or bladder, the method comprising the steps of:

cutting the skin of the patient,

inserting a dissecting tool and dissecting an area of at least one portion of the tissue wall of the urethra, ureter, renal pelvis or bladder,

placing a constriction device and a stimulation device in the dissected area in operative engagement with the urethra, ureter, renal pelvis or bladder,

using the constriction device to gently constrict the wall portion of the urethra, ureter, renal pelvis or bladder to influence the flow in the urinary passageway, and

using the stimulation device to stimulate the constricted wall portion to cause contraction of the wall portion to further influence the flow in the urinary passageway.

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