fig1 shows the frame 50 of one embodiment of a device 60 that can be used to inhibit or prevent stress urinary incontinence in a human female . frame 50 consists of an outer tube 1 , an inner tube 2 , a spider 3 ( with the number of vanes equal to the number of elastic chambers or balloons 5 ) and a retaining ring 4 all connected to form a semi - rigid structure and possibly manufactured as a single piece . fig1 a is a view of frame 50 perpendicular to its long axis and viewed from its distal end when inserted in the urethra of a woman . fig1 b is a side view of frame 50 . the retaining ring 4 maintains the location of the device along the long axis of the female urethra . fig2 shows the complete device 60 . frame 50 surrounds two or more flexible balloons or chambers 5 ( three in this case ) which are filled with a fluid 6 that is preferably a biocompatible fluid with low viscosity , such as isotonic saline solution . any air or other gas has been removed from the balloons and filling fluid so as to render the fluid incompressible . this embodiment includes three balloons , but the apparatus and method herein contemplates the use of one or more balloons or chambers . the distal end ( nearest the vulva when the device is inside the female urethra ) of each balloon in this embodiment is generally wedge shaped ( more specifically , generally shaped as a circular segment ), such that the distal ends of the balloons as a whole occupy a generally circular cylindrical volume . the outer diameter of this cylinder is approximately equal to the inner diameter of the outer tube 1 of frame 50 . the rounded part of the distal portion of each balloon 5 ( corresponding to the cylinder &# 39 ; s circumference ) is attached to the inner surface of the outer tube 1 along part or all of their meeting surfaces . the proximal end ( nearest the urinary bladder when the device is inside the female urethra ) of each balloon is generally shaped like a sector of an annulus , with the inside diameter of such annulus approximately equal to the outer diameter of the inner tube 2 of frame 50 and attached along all or part of their meeting surfaces . chambers 5 thus are inhibited from moving longitudinally or rotationally relative to frame 50 . the spiders 3 that connect the frame &# 39 ; s inner and outer tubes pass between the balloons . the outer diameter of the proximal part of each balloon is almost equal to the inner diameter of the frame &# 39 ; s outer tube . the outer diameter of the frame &# 39 ; s outer tube is approximately equal to the inside diameter of the human adult female urethra . the volume of fluid inside each balloon is determined by placing a solid cylindrical rod , whose diameter is slightly less than that of the frame &# 39 ; s inner tube and whose length exceeds that of the device , inside the frame &# 39 ; s inner tube with one end at the device &# 39 ; s proximal end and placing a hollow tube of circular cross - section , whose inner diameter is slightly larger than the outside diameter of the frame &# 39 ; s outer tube , with one end at the device &# 39 ; s proximal end , then filling the multiple balloons with equal amounts of incompressible fluid until all the balloons are full . once this fill volume is measured and recorded , it will be used to fill each balloon before the balloon is sealed . when device 60 is placed in the mid - urethra of a woman , and her intra - abdominal pressure , abbreviated tap , is low , the balloons will have an arbitrary shape . when the woman initiates the micturition reflex , her bladder &# 39 ; s detrusor muscles contract . this causes urine to flow from her bladder through her urethra and through the lumen 14 that is located along the longitudinal axis ( not shown in the drawing ) of device 60 , and exit outside her body . tube 2 maintains a central entrance opening to the device , into which urine flows from the bladder . the fluid pressure of her urine against the balloons in the location within tube 1 pushes the inner portions of the balloons ( corresponding to the points of each balloon &# 39 ; s circular segment shaped distal end ) away from the device &# 39 ; s axis . this creates a full - length lumen or passageway 14 for urine flow . this also displaces the fluid inside each balloon from its distal end toward its proximal end , as shown in fig2 a . when the woman is not micturating , but raises her iap by coughing , laughing , sneezing , jogging , lifting or other means , the raised tap presses her urethra against the proximal outer surfaces of the balloons above tube 2 ( indicated by the arrows in fig2 b ). this displaces the fluid within the balloons from their proximal ends toward their distal ends . the movement of fluid causes the distal ends of the balloons to each assume a circular segment shape as shown in fig2 b , thereby occluding the device lumen 14 a where it passes through outer frame 1 , thus blocking urine flow through the device . once the tap returns to normal , the fluid redistributes within each balloon and allows urine flow during micturition . to prevent the growth of microbes on the surfaces of the device , an antimicrobial substance can be mixed into the materials before they are formed into the balloons and frame . to prevent urine crystals , if any , from adhering to the device all surfaces of the device in contact with urine can be coated with a highly lubricious material . in a second embodiment , as shown in fig3 , the device 70 is fabricated from elastic waterproof material in the shape of a hollow toroid 8 formed from rotating a long rectangle about an axis parallel to and displaced from a long side ; a rigid generally hourglass - shaped frame 7 inside the toroid maintains its length and outer diameter at its extremities , while allowing the outer surface of the elastic toroid to be deformed by the adjacent urethra during periods of increased intra - abdominal pressure . the toroid is filled with an incompressible liquid , which may be distilled water , isotonic saline or a fluid whose density and viscosity is equal to or less than that of distilled water at body temperature , 37 degrees centigrade . when the outer surface of the toroid is pressed inward by the adjacent urethra , the incompressible fluid inside it is displaced and causes the inner surface of the toroid , which normally forms the conduit 24 for urine , to expand into such conduit to narrow the conduit &# 39 ; s diameter , greatly increase the conduit &# 39 ; s flow resistance ( which varies inversely with the fourth power of the conduit diameter ) and inhibit or effectively prevent any urine flow through the conduit . a prototype of this second embodiment consisted of a flexible balloon with an internal channel for urine flow stretched over a rigid plastic frame , as shown in fig3 . the device was placed inside a thin - walled elastic tube which simulated the urethra , and whose inner diameter was equal to the outside diameter of the device . proof of concept testing was performed using a starling resistor , which consisted of a pump , the thin - walled elastic tube in an air - tight chamber , and a flow control circuit equipped with a flow meter . the external pressure of the elastic tube , which is the internal pressure of the airtight chamber , was controlled by a rubber bulb and measured by an attached gauge . the flow through the elastic tube was measured by the flow meter . as the average urine flow rate during micturition for females between 14 and 65 years old is between 0 . 9 and 1 . 08 l / min , a flow rate of about 1 l / min was used to test the device . the flow registered by the flow meter was recorded as the external pressure on the elastic tube was slowly increased until no flow was registered by the flow meter . this procedure was repeated multiple times . a graph of the average flow rate versus external pressure is shown in fig4 . as the external pressure on the elastic tube simulating the female urethra was increased , the flow through the embodiment &# 39 ; s conduit decreased until it reached zero flow at 32 mmhg , which is 43 . 5 cm h 2 o . this is the external pressure that causes occlusion . while this pressure is greater than the specified occlusion pressure of the device , 30 cm h 2 o , this value is likely to change when the final device materials are tested . despite this discrepancy , the results of this test demonstrate that occlusion occurs for physiologic external pressures . the second embodiment ( device 70 ) can be constructed by connecting together , using adhesives or ultrasonic welding , the ends of a tube of flexible material to form a balloon . we have selected biocompatible materials such as pdms , a silicone rubber ( polydimethylsiloxane ), or alternatives like thermoplastic polyurethanes made by bayer , such as texin and desmopan , for the flexible balloon . the more rigid parts of the device can be machined or molded from a biocompatible plastic such as polyetheretherketone ( e . g ., zeniva peek from solvay advanced polymers llc in alpharetta , ga .) with polysulfone , polyphenylsulfone or polyetherimide as alternative biocompatible plastics , ionic silver in a zeolite carrier from agion technologies in wakefield , mass ., or equivalent antimicrobial compounds , can be incorporated into these flexible and more rigid materials to give them antimicrobial properties . once the rigid frame is inserted inside the balloon , the balloon is filled with one of the sterile liquids described above so that air is excluded , and the balloon is sealed . the device looks like that shown in fig3 and has an overall length of about 25 millimeters , and at low intra - abdominal ( iap ) and intravesical ( ivp ) pressures , an outside diameter of about 3 millimeters and a conduit , passageway or lumen 24 whose inside diameter is about 1 . 5 millimeters . the thickness of the balloon and its mechanical properties can be selected so that when the intra - abdominal pressure is below about 20 cm h 2 o , defined as iap 2 above , and the pressure of urine or similar fluid inside the device &# 39 ; s conduit is greater than about 40 cm h 2 o , defined as ivp 1 above , then urine will flow through the device &# 39 ; s conduit 24 and allow the patient &# 39 ; s bladder to empty . when the intra - abdominal pressure is above about 30 cm h 2 o , defined as iap 1 above , and bladder &# 39 ; s detrusor muscles are relaxed , then fluid within the device &# 39 ; s flexible balloon will transmit the intra - abdominal pressure to the walls of the device &# 39 ; s conduit 24 , and cause the conduit diameter to become very small , cause its flow resistance to become very high and effectively obstruct flow through such conduit . this will prevent urine leakage during intra - abdominal pressure spikes due to the patient laughing , coughing , sneezing , lifting , etc . a third embodiment , device 80 , is shown in fig5 a , 5 b and 5 c . as viewed from the urethral meatus ( fig5 c ), the device includes three flexible and elastic chambers 5 constructed of biocompatible elastomer which may contain an antimicrobial substance , such as silver ions ; the device cross section resembles a pie cut into three equal slices as shown in the center of fig5 c . the chambers run parallel to the long axis of the urethra for about 25 mm ; part of the way from the distal to the proximal end of the device , the chamber cross - section changes to surround a hollow conduit 2 whose diameter is about half that of the about 3 millimeter outside diameter of the device established by portion 1 . this proximally located tube connects , via a spider 3 of three vanes passing between the three chambers , to a larger hollow tube 1 that surrounds the outside curved surfaces of the three chambers . each chamber is filled with sterile isotonic saline solution and sealed ; each chamber is filled to a predetermined volume so that , at normal intra - abdominal pressure , a lumen 34 can form between the distal apices of the three chambers to allow the outflow of urine . in fig5 a and 5 b , which are not to scale , the striped lines represent the urethra 9 ; the black lines represent the harder plastic shell comprised of interconnected portions 1 , 2 and 3 , and the elastic chambers 5 are shown as thin black lines with dots inside to represent the fluid fill . while the urethra of women with stress and mixed incontinence may not be subject to the full amplitude of increases in iap , the elevated iap will still exert pressure on the urethral wall , which will be transmitted to the three chambers of the device in the urethral lumen , causing them to move the fluid contained within them from the proximal to the distal end of the device , and to expand that part of the chambers so that they come together to block the device lumen 34 a , as shown in fig5 b . due to its low viscosity and volume , we expect the fluid inside each balloon to respond quickly to elevated iap ( typically in the range of 85 to 95 cm h 2 o ) and occlude the urethra during coughs and sneezes . the device will also respond to contraction of the muscular walls of the urethra , part of which contracts under neural control at the start of a sneeze before elevation of the iap . the elastic chambers &# 39 ; liquid fill volume will be set during the manufacturing process so that the part inside of tube 1 is closed at low iap and low intra - urethral pressure , but opens at elevated intra - urethral pressure during micturition ( typically in the range of 10 to 30 cm h 2 o ). the flexible balloons can be fabricated using the well - known dip molding technique used to make surgical gloves and condoms . the molds can be made of a water soluble material , so that after the silicone material cures , water can be injected into the part to dissolve and wash out the molding material ; the balloon interior can be flushed with a solution that kills bacteria , viruses and fungi , flushed again with sterile water then filled with sterile isotonic saline and sealed . the more rigid parts of the device can be machined or molded from a biocompatible plastic , as described above . ionic silver in a zeolite carrier can be incorporated into these materials to give them antimicrobial properties , also as described above . additional embodiments similar to the second embodiment may be constructed with two , three , four or five ( or , conceivably , more if desired ) flexible balloons , as shown in fig6 - 9 , respectively , in which fig6 a - 9 a show the balloons in their state during micturition , and fig6 b - 9 b show the same balloons in their state during which the lumen is occluded . these figures show only the balloons and not the frame , which typically includes the spider vanes , an inner tube and an outer tube . the number of vanes typically equals the number of balloons . fig6 a shows two balloons 10 a and 10 b that are each generally semi - circular in cross section and can define lumen 44 . fig7 a shows three balloons 11 a - c that each generally define a ⅓ circular segment in cross section and can define lumen 45 . fig8 a shows four balloons 12 a - d that each generally define a ¼ circular segment in cross section and can define lumen 46 . fig9 a shows five balloons 13 a - e that each generally define a ⅕ circular segment in cross section and can define lumen 47 . all embodiments are inserted into the female urethra inside a short catheter , and held in place while the catheter is withdrawn . as shown in fig1 , a retaining ring can hold the device in place . alternatively , the device could be attached to the distal urethral mucous membrane via a bioadhesive so that it is held in place and thus is neither expelled nor moves into the bladder . if the device needs to be removed , a wire or other member with a short l - shaped hook at the far end may be inserted through the device &# 39 ; s inner tube or lumen until it extends beyond the device &# 39 ; s proximal end ; rotated , pressed against one side of the inner tube then withdrawn until the hook is against the proximal end of the inner tube ; a catheter similar to that used to insert the device is inserted into the urethra and advanced until it separates the device from the urethra , then the catheter , device and wire are simultaneously withdrawn . the embodiments describe the use of circular sector - shaped chamber segments that co - act to close the device lumen when the intra - abdominal pressure rises . however , the apparatus could use other means to channel fluid flow caused by a constriction of the urethra due to an iap rise . for example , there could be one or more chambers or balloons used , and the chambers could have more arbitrary shapes , so long as the chamber or the multiple chambers fill or essentially fill one location of the inside of the device tube when fluid inside the chamber ( s ) is moved by the increased iap . as just one example , there could be a single spherical or cylindrical balloon inside the lumen of the larger frame so that when it is full it touches the inside of the frame ( i . e ., fills the frame ) to block flow , but when it is not full , urine can flow around the outside of the balloon between the balloon and the frame around some or all of the balloon &# 39 ; s circumference . a small section of the balloon &# 39 ; s circumference could be attached to the inner surface of the frame to prevent the balloon from getting twisted . this design would retain the rigid frame described above , and have the proximal part of the balloon surround most of the inner tube , but with a single connection between the proximal and distal parts of the balloon . an example is shown in fig1 a , 10 b and 10 c . apparatus 100 includes frame 102 of the type described above , with outer tube 106 longitudinally displaced from inner tube 104 . a single chamber or balloon 110 comprises portion 112 fixed to the outside of tube 104 and portion 114 located within tube 106 and fixed to tube 106 in one location , as shown in the end view of fig1 c . integral connecting portion 113 allows fluid flow between portions 112 and 114 . in the “ open ” position shown in fig1 a and 10 c , lumen 108 is open along the entire length of the apparatus . when portion 112 is squeezed by the urethra it collapses into form 112 a ; this pushes fluid through connecting portion 113 a and into portion 114 , to create enlarged portion 114 a which fills the lumen within tube 106 . this blocks urine flow through apparatus 100 . the volume of fluid to be placed in the single balloon could be determined by placing a crescent shaped object between the balloon 110 and the outer tube 106 in addition to putting the part 106 inside a cylinder whose inside diameter is slightly larger than that of part 106 and whose length is a least as long as the device along its longitudinal axis , and then inflating the balloon to slightly above local atmospheric pressure .
an apparatus for use within a woman &# 39 ; s urethra for inhibiting urine outflow when her intra - abdominal pressure rises . the apparatus includes a generally tubular device having a proximal end and a distal end and defining a longitudinal axis . device comprises structure that is constructed and arranged to define a longitudinal passageway that extends entirely through the device from the proximal end to the distal end . structure is further constructed and arranged to be altered via an increase in intra - abdominal pressure , from a first state in which the passageway is open along its length and able to conduct urine to a second state in which the passageway is more restricted or is closed off , to inhibit the passage of urine .