Patent Description:
Stress urinary incontinence refers to the leakage of urine because of increased pressure placed on the bladder by for example coughing, sneezing, laughing, exercising or lifting something heavy. It is the most common cause of urinary incontinence in women and significantly impacts the quality of life of women suffering from this problem.

Female overactive bladder refers to a frequent and urgent need to urinate, which can come on quite suddenly. The signal that the bladder needs emptying may occur even if the bladder is only partially full.

Incomplete bladder emptying refers to a condition where after voiding as much as possible, the bladder retains some urine. It may be caused by the position of the bladder relative to the urethra due to prolapse.

Pelvic organ prolapse is the descent of one or more of the pelvic structures (bladder, uterus, vagina, colon, rectum) from the normal anatomic location toward or through the vaginal opening. Pelvic organ prolapse may occur when the pelvic floor muscles and ligaments stretch and weaken and no longer provide enough support for the pelvic structures. Pelvic organ prolapse may be associated with stress urinary incontinence.

While there are surgical options to treat stress incontinence and pelvic organ prolapse, such as sling procedures and colposuspension, significant risks and complications may arise. Given these risks and complications, non-surgical approaches are often used for the management of stress urinary incontinence and pelvic organ prolapse.

A device, a vaginal pessary, may be inserted into the vagina to aid in controlling stress urinary incontinence and/or support the prolapsed structures. A variety of vaginal pessaries are known in the art and include but are not limited to ring and shelf pessaries.

<CIT> describes an intravaginal device to aid in controlling urinary incontinence by engaging the anterior vaginal wall to support the vaginal wall and the urethra there behind.

<CIT> describes an intra-vaginal incontinence control device formed of elastically deformable or resilient material, the device having a displacement member (<NUM>) including a compression recess (<NUM>) whereby the displacement member can be partly deformed by pressing a portion of the displacement member into the recess, the recess wall including an invertible wall portion being part of the wall of the displacement member, the invertible wall portion including a slit (<NUM>). <CIT> also describes an applicator for an intra-vaginal incontinence control device includes an elongate handle (<NUM>) and a head (<NUM>) including at least two prongs (<NUM>, <NUM>) adapted for engagement with lobe recesses formed in a compressed intra-vaginal incontinence control device.

An object of the present invention is to provide an intravaginal device, according to claim <NUM>.

In accordance with another aspect of the present invention, there is provided a kit according to claim <NUM>.

These and other features of the invention will become more apparent in the following detailed description in which reference is made to the appended drawings.

The present invention provides an intravaginal device to aid in controlling stress urinary incontinence and/or overactive bladder and/or incomplete bladder emptying and/or to support pelvic organ(s) in a subject in need thereof, for example in a subject with or at risk of pelvic organ prolapse.

The intravaginal device <NUM> of the present invention comprises a body <NUM> for engaging and supporting the vaginal walls and a removal strip <NUM>.

The body <NUM> of the intravaginal device is formed from a non-absorbent (optionally hydrophobic) and flexible material. By using non-absorbent (optionally hydrophobic), material, the risk of odors developing, bacterial growth and toxic shock syndrome may be reduced. In certain embodiments, the non-absorbent material is washable and therefore, in such embodiments, the device is reusable. In other embodiments, the device is disposable. Exemplary non-absorbent, flexible materials include but are not limited to thermoplastic elastomers such as thermoplastic vulcanizates. In certain embodiments, the body of the intravaginal device is made of a non-hygroscopic thermoplastic vulcanizate. In specific embodiments, the body is made of Santoprene™. Exemplary grades of Santoprene™ which may be used for the manufacture of the body include Santoprene™ <NUM>-55MED.

The body <NUM> of the intravaginal device is shaped to engage the anterior vaginal wall and thereby support and elevate the anterior wall and urethra without closing the urethra and impeding urination. The body <NUM> further engages the posterior vaginal wall. In one embodiment, the device applies pressure to a weak vaginal wall where, in the absence of the device, a pelvic organ pushes into the vaginal cavity and creates a bulge. In one embodiment, the orientation of the device in the vagina is appropriate to support an anterior or posterior vaginal wall that is weak.

In certain embodiments, the body <NUM> is a hollow open-ended cylindrical body (ring) in which the posterior wall is extended in the first end to form a substantially lingulate-shaped extension. The lingulate-shape extension prevents the device from rotating and becoming displaced when inserted. In certain embodiments, the second end of the body has a slight inclination towards the posterior of the body portion. In certain embodiments, the inclination is between <NUM>-<NUM>°. In specific embodiments, the inclination is <NUM>°.

In certain embodiments, the body <NUM> includes one or more means to engage the removal strip. Non-limiting examples of means to engage the removal strip (<NUM>) include but are not limited to one or more notches (<NUM>), cut outs, openings (<NUM>) and combinations thereof. In specific embodiments, the body comprises a first notch in the first end in the anterior wall and second notch in the second end in the anterior wall; the first notch and the second notch being positioned in line and substantially at the midline of the anterior wall and forming a track for the removal portion; and the posterior wall further comprising an opening (<NUM>) adapted to receive therethrough the removal strip and the opening positioned substantially across from the first notch.

In certain embodiments, the intravaginal device includes one or more areas, flex points (<NUM>), to enhance the flexibility of the device. The areas which enhance flexibility may include for example areas of decreased thickness in the wall of the intravaginal device including but not limited to grooves, holes, cutouts or cuts in the wall of the intravaginal device. The one or more flex points may assist with preventing excess pressure being exerted against the urethra by the intravaginal device, thus preventing the possibility of urination being obstructed. The one or more areas may assist with the collapse or folding of the intravaginal device during insertion and removal of the device from the vagina. In specific embodiments, the device comprises a flex point on the interior anterior wall of the intravaginal device. In more specific embodiments, the flex point comprises a shallow cut located (see <FIG> and <FIG>) on the interior anterior wall of the intravaginal device. In specific embodiments, the depth of the cut on the anterior inside bridge ranges from about <NUM> to about <NUM>. In particular embodiments, the depth of the cut is dependent on device size. For example, depth of <NUM> for small, <NUM> for medium and <NUM> large devices. In specific embodiments, the length of the cut is about <NUM>.

The intravaginal device further comprises a removal strip which may be used to assist with removal of the intravaginal device. See <FIG> as well as <FIG>. The removal strip <NUM> may include for example one or more ribbons, strings and/or strips. In certain embodiments, the removal strip is constructed from non-absorbent material. In specific embodiments, the removal strip is a removal ribbon formed from a non-absorbent, flexible material. Exemplary materials include but are not limited to silicon.

In certain embodiments, pulling of the removal strip <NUM> decreases the cross-sectional area of the intravaginal device. In specific embodiments, the cross-sectional area is decreased by collapsing the anterior wall into the posterior wall or vice versa. In certain embodiments, the removal strip <NUM> is attached to the device body <NUM>. In other embodiments, the removal strip <NUM> is associated but not anchored to the body <NUM>. For example, the removal strip <NUM> may be looped around/through the body <NUM>. In certain embodiments, the removal strip passes through one or more notches <NUM> and/or openings <NUM> in the body <NUM>, wherein the one or more notches <NUM> and/or openings <NUM> are configured such that when force is applied the cross-sectional area of the body is reduced. In specific embodiments, at least one end of the removal strip comprises a stopper to prevent it from passing through one or more opening in the body. In specific embodiments one end of the removal strip <NUM> is inserted through an opening <NUM> in the second end of the removal strip thereby forming a loop which can be tightened when downward force is applied to the first end and thereby reducing the cross-sectional area of the body. In one embodiment both ends of the removal strip <NUM> have an opening <NUM>. The opening in each end may be the same or different sizes and/or shapes. For example, the opening in the first end may be configured to allow insertion of a tool to aid in the removal of the device and the opening in second end may be configured to allow the first end of the removal strip to be inserted through the opening in the second and thereby form a loop. When the device is desired to be removed, the first end of the removal strip, which extends out of the vagina, can be pulled manually or by using a hook such as the hook end of an assistive wand. Once force is applied to the removal strip, the cross-sectional area of the body of the device is reduced to aid with removal. Or, removed by inserting an index finger through the anterior bridge of the device and pulling downward.

In certain embodiments, in which both ends of the removal strip <NUM> have openings, the hook can be inserted into the opening <NUM> in the first end of the removal strip which extends out of the vagina.

In certain embodiments, the removal strip <NUM> is a removal ribbon which is attached through the posterior hole or opening <NUM> and wrapped over the anterior bridge within the notches <NUM>.

In certain embodiments, a kit is provided that comprises the intravaginal device of the present invention, a removal strip, an assistive wand, and instructions. In certain embodiments, the instructions are provided through a website or digital material. Illustrative embodiments of the assistive wand <NUM> are show in <FIG>. In certain embodiments, the assistive wand is an elongate member having a hook <NUM> end and a bowl <NUM> end. The hook end may be used to facilitate the removal of the intravaginal device. In particular, the hook may be used to grab the device by the removal strip <NUM> or by the body <NUM> of the device. In certain embodiments, the bowl <NUM> end of the assistive wand is able to hold the body of the intravaginal device in a collapsed position. It is easier to insert the device when it is in its collapsed position. Accordingly, in certain embodiments, the assistive wand may be used to facilitate insertion of the intravaginal device. In some embodiments, the assistive wand includes a rod <NUM> that maintains the intravaginal device in its collapsed position while it is located in the bowl <NUM> end of the assistive wand <NUM>.

The normal anatomy of the urinary system of a female patient is shown in <FIG>. In normal anatomy, the bladder <NUM> is located such that the bladder neck <NUM> is positioned above the pelvic floor <NUM>. The upper portion <NUM> of the urethra <NUM> lies within the abdominal cavity <NUM>, and the lower portion <NUM> of the urethra lies within the vaginal cavity <NUM>. As a consequence of the upper portion <NUM> of the urethra <NUM> lying within the abdominal cavity <NUM>, when dynamic abdominal pressure is exerted, such as by exercise or by coughing, the abdominal pressure is exerted not only on the bladder <NUM> but also on the upper portion <NUM> of the urethra <NUM>. This transient pressure on the upper portion <NUM> of the urethra <NUM> balances the pressure exerted on the bladder <NUM> and thus helps prevent the leakage of urine despite transient increased bladder pressure.

The anatomy of the urinary system of an incontinent female patient is illustrated in <FIG>. In such patients, the bladder neck is in a descended position such that it is at a location at or below the pelvic floor <NUM>. The entire urethra <NUM> lies within the vaginal cavity <NUM>. In this condition, when dynamic abdominal pressure is exerted, because the upper portion <NUM> of the urethra <NUM> no longer lies within the abdominal cavity <NUM>, there is no increased pressure exerted on the urethra <NUM> to offset the transient increased bladder pressure. Consequently, urine will leak when dynamic abdominal pressure is exerted, a condition known as stress urinary incontinence.

When installed in the vagina (see <FIG>), the device corrects improper position of the urethra. In particular, the posterior wall of the body rests on the posterior vaginal wall and the anterior wall displaces the anterior vaginal wall forward and upward to support the urethra. This support stabilises a hypermobile urethra such that the upper portion of the urethra is retained within the abdominal cavity. Consequently, when a dynamic abdominal pressure is exerted, a portion of the abdominal pressure is applied against the upper portion of the urethra, which provides an additional force to offset transient bladder pressure increases.

Accordingly, there is disclosed a method of controlling stress urinary incontinence, the method comprising inserting the device of the present invention into the vagina of a subject in need thereof.

The intravaginal device of the present invention provides support for pelvic organ(s). Accordingly, in certain embodiments, may be used to support pelvic organ(s) in a subject in need thereof, for example in a subject with or at risk of pelvic organ prolapse. In certain embodiments, the intravaginal device of the present invention helps prevent, manage and slow the progression of prolapse. In certain embodiments, use of the intravaginal device alleviates one or more symptoms of pelvic organ prolapse.

A worker skilled in the art would readily appreciate that the use of an intravaginal device to support pelvic organ(s) in a subject having pelvic organ prolapse may be dependent on the severity of the pelvic organ prolapse. In certain embodiments, the pelvic organ prolapse is stage <NUM> pelvic organ prolapse. In certain embodiments, the pelvic organ prolapse is stage <NUM> pelvic organ prolapse.

A worker skilled in the art would further appreciate that the use of an intravaginal device to support pelvic organ(s) in a subject having pelvic organ prolapse may be dependent on that the type of pelvic organ prolapse. Types of pelvic organ prolapse include: cystocele (i.e. prolapse of the bladder into the vagina), urethrocele (i.e. prolapse of the urethra), uterine prolapse, vaginal vault prolapse, enterocele (i.e. a small intestine prolapse) and rectocele (i.e. prolapse of the posterior vaginal wall between the vagina and the rectum).

In certain embodiments, the pelvic organ prolapse is selected from one or more of the following cystocele, urethrocele, uterine prolapse, vaginal vault prolapse, enterocele and rectocele.

In certain embodiments, the pelvic organ prolapse is cystocele.

In certain embodiments, the pelvic organ prolapse is urethrocele.

In certain embodiments, the pelvic organ prolapse is rectocele. When in place in the vagina, the posterior wall of the intravaginal device rests against the posterior wall of the vagina and helps to support the weakened or thin wall of tissue that separates the vagina and rectum. That is, the intravaginal device of the present invention applies pressure to the posterior vaginal wall (as well as applying pressure to the anterior wall between the urethra and the vagina). This posterior pressure is helpful in keeping the colon aligned so that stool can exit the colon via the rectum, and may prevent stool from getting trapped in a prolapsed pocket. In certain embodiments, there is disclosed a method of supporting pelvic organ(s) in a subject with pelvic organ prolapse, the method comprising inserting the device of the present invention into the vagina of a subject in need thereof. The pelvic organ prolapse may be stage <NUM> pelvic organ prolapse. Alternatively, the pelvic organ prolapse may be stage <NUM> pelvic organ prolapse.

In certain embodiments, the intravaginal device of the present invention may be used in conjunction with pelvic floor therapy for treatment of pelvic organ prolapse and/or may help strengthen the pelvic floor muscles with regular use. Pelvic floor therapy includes but is not limited to pelvic floor exercises.

Overactive bladder and incomplete bladder emptying may be due to pelvic organ prolapse. Accordingly, in certain embodiments, the intravaginal device of the present invention may be used in a method of controlling female overactive bladder and/or controlling female incomplete bladder emptying.

An exemplary non-limiting method for the insertion of the device manually is detailed below.

An exemplary non-limiting method for the insertion of the device using the assistive wand is detailed below.

An exemplary non-limiting method for manual removal of the device is detailed below.

An exemplary non-limiting method for removal of the device using the assistive wand is detailed below.

Claim 1:
An intravaginal device (<NUM>) comprising a hollow open-ended cylindrical body (<NUM>) and a removal strip (<NUM>);
the body (<NUM>) having a first end and a second end, an anterior wall and a posterior wall;
the body (<NUM>) having a first notch (<NUM>) in the first end of the anterior wall, and a second notch (<NUM>) in the second end of the anterior wall wherein the first notch (<NUM>) and the second notch (<NUM>) are positioned in line and substantially at the midline of the anterior wall and forming a track for the removal strip (<NUM>);
the posterior wall comprising a lingulate-shaped extension, and characterised in that the intravaginal device further comprises an opening (<NUM>) positioned substantially across from the first notch wherein the opening (<NUM>) is adapted to receive therethrough the removal strip (<NUM>);
wherein the removal strip (<NUM>) passes through the first notch (<NUM>), second notch (<NUM>) and opening (<NUM>) and, when force is applied to the removal strip (<NUM>), the anterior wall and the posterior wall are compressed together.