U.S. patent application number 17/738089 was filed with the patent office on 2022-08-25 for negative pressure therapy system.
The applicant listed for this patent is Roivios Limited. Invention is credited to Lance Michael Black, John R. Erbey, II, Michael Alan Fisher, David E. Orr, Patrick William Strane, Jacob L. Upperco.
Application Number | 20220265914 17/738089 |
Document ID | / |
Family ID | |
Filed Date | 2022-08-25 |
United States Patent
Application |
20220265914 |
Kind Code |
A1 |
Erbey, II; John R. ; et
al. |
August 25, 2022 |
Negative Pressure Therapy System
Abstract
A negative pressure therapy system is provided for inducing
negative pressure in a portion of a urinary tract, the system
including: (a) at least one ureteral catheter configured to be
positioned within a ureter and/or kidney; (b) one or more sensor(s)
configured to determine information about at least one of blood
composition, blood flow, respiration, heart rate, glucose, protein,
or creatinine; and (c) a controller configured to increase urine
production by adjusting one or more operating parameters of a
negative pressure source for inducing negative pressure through the
at least one ureteral catheter into the urinary tract, based at
least in part upon the information determined by the one or more
sensor(s).
Inventors: |
Erbey, II; John R.; (Milton,
GA) ; Upperco; Jacob L.; (Atlanta, GA) ;
Fisher; Michael Alan; (Lawrenceville, GA) ; Strane;
Patrick William; (Atlanta, GA) ; Black; Lance
Michael; (Pearland, TX) ; Orr; David E.;
(Piedmont, SC) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Roivios Limited |
Nassau, N.P. |
|
BS |
|
|
Appl. No.: |
17/738089 |
Filed: |
May 6, 2022 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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16670249 |
Oct 31, 2019 |
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17738089 |
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15411884 |
Jan 20, 2017 |
10512713 |
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16670249 |
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15214955 |
Jul 20, 2016 |
10307564 |
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15411884 |
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62300025 |
Feb 25, 2016 |
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62278721 |
Jan 14, 2016 |
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62260966 |
Nov 30, 2015 |
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62194585 |
Jul 20, 2015 |
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International
Class: |
A61M 1/00 20060101
A61M001/00; A61M 25/00 20060101 A61M025/00; A61M 25/04 20060101
A61M025/04; A61M 25/10 20060101 A61M025/10; A61M 39/12 20060101
A61M039/12 |
Claims
1. A negative pressure therapy system for inducing negative
pressure in a portion of a urinary tract, the system comprising:
(a) at least one ureteral catheter configured to be positioned
within a ureter and/or kidney; (b) one or more sensor(s) configured
to determine information about at least one of blood composition,
blood flow, respiration, heart rate, glucose, protein, or
creatinine; and (c) a controller configured to increase urine
production by adjusting one or more operating parameters of a
negative pressure source for inducing negative pressure through the
at least one ureteral catheter into the urinary tract, based at
least in part upon the information determined by the one or more
sensor(s).
2. The negative pressure therapy system according to claim 1,
wherein the information about blood composition comprises
hematocrit.
3. The negative pressure therapy system according to claim 1,
wherein the information about blood composition comprises
protein(s).
4. The negative pressure therapy system according to claim 1,
wherein the information about blood composition comprises
creatinine.
5. The negative pressure therapy system according to claim 1,
wherein the information about blood composition comprises
hemoglobin.
6. The negative pressure therapy system according to claim 1,
wherein the information about blood composition comprises
oxygen.
7. The negative pressure therapy system according to claim 6,
wherein the sensor comprises a pulse oximetry sensor.
8. The negative pressure therapy system according to claim 1,
wherein the information about blood flow comprises blood
pressure.
9. The negative pressure therapy system according to claim 1,
wherein the information about blood flow comprises blood flow
velocity.
10. The negative pressure therapy system according to claim 1,
wherein the information about respiration comprises carbon
dioxide.
11. The negative pressure therapy system according to claim 10,
wherein the sensor comprises a capnography sensor.
12. The negative pressure therapy system according to claim 1,
wherein the information comprises heart rate.
13. The negative pressure therapy system according to claim 1,
wherein the information comprises glucose.
14. The negative pressure therapy system according to claim 1,
wherein the information comprises protein(s) in urine.
15. The negative pressure therapy system according to claim 1,
wherein the information comprises urine output volume.
16. The negative pressure therapy system according to claim 1,
wherein the sensor(s) are configured to measure information of
blood passing through an extracorporeal blood system or
circuit.
17. The negative pressure therapy system according to claim 16,
wherein the sensor is a capacitance sensor.
18. The negative pressure therapy system according to claim 16,
wherein the sensor is an optical spectroscopy sensor.
19. The negative pressure therapy system according to claim 1,
wherein the sensor is embedded in a wall of the at least one
ureteral catheter.
20. The negative pressure therapy system according to claim 1,
wherein the sensor is in fluid communication with a drainage lumen
of the at least one ureteral catheter.
21. The negative pressure therapy system according to claim 1,
wherein the sensor is positioned in a fluid collection
container.
22. The negative pressure therapy system according to claim 1,
further comprising a negative pressure source for inducing negative
pressure through the at least one ureteral catheter into the
urinary tract.
23. The negative pressure therapy system according to claim 22,
wherein the sensor(s) is positioned in internal circuitry of the
negative pressure source.
24. The negative pressure therapy system according to claim 1,
wherein the at least one ureteral catheter comprises a distal
portion comprising a retention portion, wherein when negative
pressure is applied through the ureteral catheter, fluid is drawn
into the ureteral catheter through one or more drainage ports of
the retention portion while mucosal tissue is prevented from
appreciably occluding the one or more drainage ports by contact
with an outwardly facing portion of the retention portion.
25. The negative pressure therapy system according to claim 24,
wherein the outwardly facing portion is essentially free of
drainage ports.
26. The negative pressure therapy system according to claim 1,
wherein the at least one ureteral catheter comprises a distal
portion comprising a retention portion, in which a diameter of the
retention portion is greater than a diameter of the drainage lumen
portion, and wherein the retention portion comprises at least one
drainage port to permit fluid flow into the drainage lumen.
27. The negative pressure therapy system according to claim 1,
wherein a distal portion of the ureteral catheter comprises a
retention portion comprising at least one coil.
28. The negative pressure therapy system according to claim 1,
wherein a proximal portion of the ureteral catheter is configured
to be connected to a negative pressure source for application of
negative pressure through the ureteral catheter.
29. The negative pressure therapy system according to claim 1,
wherein a proximal portion of the ureteral catheter is configured
to be positioned in a bladder.
30. The negative pressure therapy system according to claim 29,
wherein a proximal portion of the ureteral catheter is configured
to be in fluid communication with a bladder catheter, and wherein
the bladder catheter is configured to be connected to a negative
pressure source for application of negative pressure through both
the bladder catheter and the ureteral catheter.
31. The negative pressure therapy system according to claim 1,
wherein the ureteral catheter is configured to be deployed in a
urinary tract of a patient.
32. The negative pressure therapy system according to claim 31,
wherein the patient is a human.
33. The negative pressure therapy system according to claim 31,
wherein the patient is an animal.
34. The negative pressure therapy system according to claim 1,
wherein the negative pressure source alters interstitial pressure
within the kidney.
35. The negative pressure therapy system according to claim 1,
wherein the controller adjusts the negative pressure to
therapeutically appropriate levels.
36. The negative pressure therapy system according to claim 1,
wherein the controller adjusts the frequency with which the
negative pressure source induces negative pressure.
37. The negative pressure therapy system according to claim 1,
wherein the controller induces negative pressure at two or more
different pressure levels.
38. The negative pressure therapy system according to claim 1,
wherein the controller induces pulses of negative pressure followed
by periods in which no negative pressure is provided.
39. The negative pressure therapy system according to claim 1,
wherein the controller induces alternating negative pressure and
positive pressure to produce an alternating flush and pump
effect.
40. The negative pressure therapy system according to claim 1,
wherein the controller induces a negative pressure ranging from
about 0.1 mmHg to about 50 mmHg.
41. The negative pressure therapy system according to claim 40,
wherein the controller induces a negative pressure of about 15 mm
Hg, or about 20 mm Hg, or about 25 mm Hg.
42. The negative pressure therapy system according to claim 1,
wherein the controller induces a positive pressure ranging from
about 0.1 mmHg to 20 mmHg.
43. The negative pressure therapy system according to claim 1,
further comprising a data transmitter in communication with the
controller, the data transmitter being configured to provide the
information from the one or more sensors to an external source.
44. A system for determining information about urine produced
within a urinary tract, the system comprising: (a) at least one
ureteral catheter configured to be positioned within a ureter
and/or kidney; and (b) one or more sensor(s) configured to
determine information about at least one of blood composition,
blood flow, respiration, heart rate, glucose, protein, or
creatinine.
45. A method for inducing negative pressure in a portion of a
urinary tract, comprising: (a) positioning a distal end of a
ureteral catheter at a fluid collection position within a ureter
and/or kidney; (b) determining information from measurement(s)
conducted by one or more sensor(s) configured to determine
information about at least one of blood composition, blood flow,
respiration, heart rate, glucose, protein, or creatinine; and (c)
inducing negative pressure in a portion of a urinary tract by
adjusting one or more operating parameters of a negative pressure
source, based at least in part upon the information determined by
the one or more sensors.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 16/670,249 filed Oct. 31, 2019, which is a
divisional of U.S. patent application Ser. No. 15/411,884, filed
Jan. 20, 2017, now issued as U.S. Pat. No. 10,512,713, which is a
continuation-in-part of U.S. patent application Ser. No. 15/214,955
filed Jul. 20, 2016, now issued as U.S. Pat. No. 10,307,564, which
claims the benefit of U.S. Provisional Application No. 62/300,025
filed Feb. 25, 2016, U.S. Provisional Application No. 62/278,721,
filed Jan. 14, 2016, U.S. Provisional Application No. 62/260,966
filed Nov. 30, 2015, and U.S. Provisional Application No.
62/194,585, filed Jul. 20, 2015, each of which is incorporated
herein by reference in its entirety.
BACKGROUND
Technical Field
[0002] The present disclosure relates to methods and devices for
treating impaired renal function across a variety of disease states
and, in particular, to catheter devices, assemblies, and methods
for collection of urine and/or inducement of negative pressure in
the ureters and/or kidneys.
Background
[0003] The renal or urinary system includes a pair of kidneys, each
kidney being connected by a ureter to the bladder, and a urethra
for draining urine produced by the kidneys from the bladder. The
kidneys perform several vital functions for the human body
including, for example, filtering the blood to eliminate waste in
the form of urine. The kidneys also regulate electrolytes (e.g.,
sodium, potassium and calcium) and metabolites, blood volume, blood
pressure, blood pH, fluid volume, production of red blood cells,
and bone metabolism. Adequate understanding of the anatomy and
physiology of the kidneys is useful for understanding the impact
that altered hemodynamics other fluid overload conditions have on
their function.
[0004] In normal anatomy, the two kidneys are located
retroperitoneally in the abdominal cavity. The kidneys are
bean-shaped encapsulated organs. Urine is formed by nephrons, the
functional unit of the kidney, and then flows through a system of
converging tubules called collecting ducts. The collecting ducts
join together to form minor calyces, then major calyces, which
ultimately join near the concave portion of the kidney (renal
pelvis). A major function of the renal pelvis is to direct urine
flow to the ureter. Urine flows from the renal pelvis into the
ureter, a tube-like structure that carries the urine from the
kidneys into the bladder. The outer layer of the kidney is called
the cortex, and is a rigid fibrous encapsulation. The interior of
the kidney is called the medulla. The medulla structures are
arranged in pyramids.
[0005] Each kidney is made up of approximately one million
nephrons. Each nephron includes the glomerulus, Bowman's capsule,
and tubules. The tubules include the proximal convoluted tubule,
the loop of Henle, the distal convoluted tubule, and the collecting
duct. The nephrons contained in the cortex layer of the kidney are
distinct from the anatomy of those contained in the medulla. The
principal difference is the length of the loop of Henle. Medullary
nephrons contain a longer loop of Henle, which, under normal
circumstances, allows greater regulation of water and sodium
reabsorption than in the cortex nephrons.
[0006] The glomerulus is the beginning of the nephron, and is
responsible for the initial filtration of blood. Afferent
arterioles pass blood into the glomerular capillaries, where
hydrostatic pressure pushes water and solutes into Bowman's
capsule. Net filtration pressure is expressed as the hydrostatic
pressure in the afferent arteriole minus the hydrostatic pressure
in Bowman's space minus the osmotic pressure in the efferent
arteriole.
Net Filtration Pressure=Hydrostatic Pressure(Afferent
Arteriole)-Hydrostatic Pressure(Bowman's Space)-Osmotic
Pressure(Efferent Arteriole) (Equation 1)
[0007] The magnitude of this net filtration pressure defined by
Equation 1 determines how much ultra-filtrate is formed in Bowman's
space and delivered to the tubules. The remaining blood exits the
glomerulus via the efferent arteriole. Normal glomerular
filtration, or delivery of ultra-filtrate into the tubules, is
about 90 ml/min/1.73 m.sup.2.
[0008] The glomerulus has a three-layer filtration structure, which
includes the vascular endothelium, a glomerular basement membrane,
and podocytes. Normally, large proteins such as albumin and red
blood cells, are not filtered into Bowman's space. However,
elevated glomerular pressures and mesangial expansion create
surface area changes on the basement membrane and larger
fenestrations between the podocytes allowing larger proteins to
pass into Bowman's space.
[0009] Ultra-filtrate collected in Bowman's space is delivered
first to the proximal convoluted tubule. Re-absorption and
secretion of water and solutes in the tubules is performed by a mix
of active transport channels and passive pressure gradients. The
proximal convoluted tubules normally reabsorb a majority of the
sodium chloride and water, and nearly all glucose and amino acids
that were filtered by the glomerulus. The loop of Henle has two
components that are designed to concentrate wastes in the urine.
The descending limb is highly water permeable and reabsorbs most of
the remaining water. The ascending limb reabsorbs 25% of the
remaining sodium chloride, creating a concentrated urine, for
example, in terms of urea and creatinine. The distal convoluted
tubule normally reabsorbs a small proportion of sodium chloride,
and the osmotic gradient creates conditions for the water to
follow.
[0010] Under normal conditions, there is a net filtration of
approximately 14 mmHg. The impact of venous congestion can be a
significant decrease in net filtration, down to approximately 4
mmHg. See Jessup M., The cardiorenal syndrome: Do we need a change
of strategy or a change of tactics?, JACC 53(7):597-600, 2009
(hereinafter "Jessup"). The second filtration stage occurs at the
proximal tubules. Most of the secretion and absorption from urine
occurs in tubules in the medullary nephrons. Active transport of
sodium from the tubule into the interstitial space initiates this
process. However, the hydrostatic forces dominate the net exchange
of solutes and water. Under normal circumstances, it is believed
that 75% of the sodium is reabsorbed back into lymphatic or venous
circulation. However, because the kidney is encapsulated, it is
sensitive to changes in hydrostatic pressures from both venous and
lymphatic congestion. During venous congestion the retention of
sodium and water can exceed 85%, further perpetuating the renal
congestion. See Verbrugge et al., The kidney in congestive heart
failure: Are natriuresis, sodium, and diruetucs really the good,
the bad and the ugly? European Journal of Heart Failure 2014:16,
133-42 (hereinafter "Verbrugge").
[0011] Venous congestion can lead to a prerenal form of acute
kidney injury (AKI). Prerenal AKI is due to a loss of perfusion (or
loss of blood flow) through the kidney. Many clinicians focus on
the lack of flow into the kidney due to shock. However, there is
also evidence that a lack of blood flow out of the organ due to
venous congestion can be a clinically important sustaining injury.
See Damman K, Importance of venous congestion for worsening renal
function in advanced decompensated heart failure, JACC 17:589-96,
2009 (hereinafter "Damman").
[0012] Prerenal AKI occurs across a wide variety of diagnoses
requiring critical care admissions. The most prominent admissions
are for sepsis and Acute Decompensated Heart Failure (ADHF).
Additional admissions include cardiovascular surgery, general
surgery, cirrhosis, trauma, burns, and pancreatitis. While there is
wide clinical variability in the presentation of these disease
states, a common denominator is an elevated central venous
pressure. In the case of ADHF, the elevated central venous pressure
caused by heart failure leads to pulmonary edema, and,
subsequently, dyspnea in turn precipitating the admission. In the
case of sepsis, the elevated central venous pressure is largely a
result of aggressive fluid resuscitation. Whether the primary
insult was low perfusion due to hypovolemia or sodium and fluid
retention, the sustaining injury is the venous congestion resulting
in inadequate perfusion.
[0013] Hypertension is another widely recognized state that creates
perturbations within the active and passive transport systems of
the kidney(s). Hypertension directly impacts afferent arteriole
pressure and results in a proportional increase in net filtration
pressure within the glomerulus. The increased filtration fraction
also elevates the peritubular capillary pressure, which stimulates
sodium and water re-absorption. See Verbrugge.
[0014] Because the kidney is an encapsulated organ, it is sensitive
to pressure changes in the medullary pyramids. The elevated renal
venous pressure creates congestion that leads to a rise in the
interstitial pressures. The elevated interstitial pressures exert
forces upon both the glomerulus and tubules. See Verburgge. In the
glomerulus, the elevated interstitial pressures directly oppose
filtration. The increased pressures increase the interstitial
fluid, thereby increasing the hydrostatic pressures in the
interstitial fluid and peritubular capillaries in the medulla of
the kidney. In both instances, hypoxia can ensue leading to
cellular injury and further loss of perfusion. The net result is a
further exacerbation of the sodium and water re-absorption creating
a negative feedback. See Verbrugge, 133-42. Fluid overload,
particularly in the abdominal cavity is associated with many
diseases and conditions, including elevated intra-abdominal
pressure, abdominal compartment syndrome, and acute renal failure.
Fluid overload can be addressed through renal replacement therapy.
See Peters, C. D., Short and Long-Term Effects of the Angiotensin
II Receptor Blocker Irbesartanon Intradialytic Central
Hemodynamics: A Randomized Double-Blind Placebo-Controlled One-Year
Intervention Trial (the SAFIR Study), PLoS ONE (2015) 10(6):
e0126882. doi:10.1371/journal.pone.0126882 (hereinafter "Peters").
However, such a clinical strategy provides no improvement in renal
function for patients with the cardiorenal syndrome. See Bart B,
Ultrafiltration in decompensated heart failure with cardiorenal
syndrome, NEJM 2012; 367:2296-2304 (hereinafter "Bart").
[0015] In view of such problematic effects of fluid retention,
devices and methods for improving removal of urine from the urinary
tract and, specifically for increasing quantity and quality of
urine output from the kidneys, are needed.
[0016] Summary
[0017] In some examples, a method for removing excess fluid from a
patient with hemodilution is provided. The method includes:
deploying a urinary tract catheter into the patient such that flow
of urine from the ureter and/or kidney is transported within a
drainage lumen of the catheter; applying negative pressure to the
ureter and/or kidney through the drainage lumen of the catheter to
extract urine from the patient; periodically measuring a hematocrit
value of the patient; and if the measured hematocrit value is
greater than a predetermined threshold value, ceasing the
application of the negative pressure to the ureter and/or
kidney.
[0018] In other examples, a method for removing excess fluid from a
patient with hemodilution includes: deploying a urinary tract
catheter into the patient such that flow of urine from the ureter
and/or kidney is transported within a drainage lumen of the
catheter; applying negative pressure to the ureter and/or kidney
through the drainage lumen of the catheter to extract urine from
the patient; periodically measuring the patient's weight; and if
the measured weight is less than a predetermined threshold value,
ceasing the application of the negative pressure to the urinary
tract.
[0019] In some examples, a system for removing excess fluid from a
patient with hemodilution is provided. The system includes a
urinary tract catheter and a pump. The urinary track catheter
includes a drainage lumen portion having a proximal end, a distal
end configured to be positioned in a patient's urinary tract, and a
sidewall extending therebetween; and a retention portion extending
radially outward from a portion of the distal end of the drainage
lumen portion, and being configured to be extended into a deployed
position in which a diameter of the retention portion is greater
than a diameter of the drainage lumen portion. At least one of the
drainage lumen portion or the retention portion has at least one
drainage port to permit fluid flow into the drainage lumen. The
pump is in fluid communication with a drainage lumen defined by the
drainage lumen portion of the ureteral catheter. The pump includes
a controller configured to: actuate the pump to cause the pump to
induce a negative pressure in a ureter and/or kidney of the patient
to draw urine through the drainage lumen of the urinary tract
catheter, periodically receive information representative of a
hematocrit value of the patient; and if the received hematocrit
value exceeds a predetermined minimum threshold value, ceasing the
application of the negative pressure to the ureter and/or
kidney.
[0020] In some examples, ureteral catheters are provided
comprising: a drainage lumen comprising a proximal portion
configured to be positioned in at least a portion of a patient's
urethra and a distal portion configured to be positioned in a
patient's ureter and/or kidney, the distal portion comprising a
coiled retention portion, wherein the retention portion comprises
at least a first coil having a first diameter and a second coil
having a second diameter, the first diameter being less than the
second diameter.
[0021] In some examples, a urine collection assembly is provided
comprising: at least one ureteral catheter comprising: a drainage
lumen comprising a proximal portion configured to be positioned in
at least a portion of a patient's urethra and a distal portion
configured to be positioned in a patient's ureter and/or kidney,
the distal portion comprising a coiled retention portion, wherein
the retention portion comprises at least a first coil having a
first diameter and a second coil having a second diameter, the
first diameter being less than the second diameter; and a bladder
catheter for deployment within the patient's bladder, the bladder
catheter comprising: a drainage lumen portion defining a drainage
lumen and comprising a proximal end, a distal end configured to be
positioned in the patient's bladder, and a sidewall extending
therebetween; and a deployable anchor portion comprising a seal
configured to contact a proximal portion of the bladder wall to
essentially or fully seal the urethral opening of the bladder,
wherein the drainage lumen portion or the anchor portion comprises
at least one drainage port for permitting fluid flow into the
drainage lumen.
[0022] In some examples, a ureteral catheter is provided
comprising: a drainage lumen portion comprising a proximal end, a
distal end configured to be positioned in a patient's ureter and/or
kidney, and a sidewall extending therebetween; and a retention
portion extending radially outwardly from a portion of the distal
end of the drainage lumen portion, the retention portion comprising
a proximal end having a first diameter, a distal end having a
second diameter, and a wall and/or surface extending therebetween,
the retention portion being configured to be extended into a
deployed position in which the second diameter is greater than the
first diameter.
[0023] In some examples, a urine collection assembly is provided
comprising: at least one ureteral catheter comprising: a drainage
lumen portion comprising a proximal end, a distal end configured to
be positioned in a patient's ureter and/or kidney, and a sidewall
extending therebetween; and a retention portion extending radially
outwardly from a portion of the distal end of the drainage lumen
portion, the retention portion comprising a proximal end having a
first diameter, a distal end having a second diameter, and a wall
and/or surface extending therebetween, the retention portion being
configured to be extended into a deployed position in which the
second diameter is greater than the first diameter; and a bladder
catheter for deployment within the patient's bladder, the bladder
catheter comprising: a drainage lumen portion defining a drainage
lumen and comprising a proximal end, a distal end configured to be
positioned in the patient's bladder, and a sidewall extending
therebetween; and a deployable anchor portion comprising a seal
configured to contact a proximal portion of the bladder wall to
seal the urethral opening of the bladder, wherein the drainage
lumen portion or the anchor portion comprises at least one drainage
port for permitting fluid flow into the drainage lumen.
[0024] In some examples, a ureteral catheter is provided
comprising: a drainage lumen portion comprising a proximal end, a
distal end configured to be positioned in a patient's ureter and/or
kidney, and a sidewall extending therebetween, the drainage lumen
portion defining a drainage lumen; and a retention portion which,
in a deployed position, extends radially outwardly from a portion
of the distal end of the drainage lumen portion, the retention
portion comprising a plurality of tubes extending between a
proximal end of the retention portion and a distal end of the
retention portion, wherein each tube defines a lumen in fluid
communication with the drainage lumen defined by the drainage lumen
portion and wherein each tube comprises a plurality of drainage
ports for allowing fluid to enter the lumen.
[0025] In some examples, a urine collection assembly is provided
comprising: at least one ureteral catheter comprising: a drainage
lumen portion comprising a proximal end, a distal end configured to
be positioned in a patient's ureter and/or kidney, and a sidewall
extending therebetween, the drainage lumen portion defining a
drainage lumen; and a retention portion which, in a deployed
position, extends radially outward from a portion of the distal end
of the drainage lumen portion, the retention portion comprising a
plurality of tubes extending between a proximal end of the
retention portion and a distal end of the retention portion,
wherein each tube defines a lumen in fluid communication with the
drainage lumen defined by the drainage lumen portion and wherein
each tube comprises a plurality of drainage ports for allowing
fluid to enter the lumen; and a bladder catheter for deployment
within the patient's bladder, the bladder catheter comprising: a
drainage lumen portion defining a drainage lumen and comprising a
proximal end, a distal end configured to be positioned in the
patient's bladder, and a sidewall extending therebetween; and a
deployable anchor portion comprising a seal configured to contact a
proximal portion of the bladder wall to seal the urethral opening
of the bladder, wherein the drainage lumen portion or the anchor
portion comprises at least one drainage port for permitting fluid
flow into the drainage lumen.
[0026] In some examples, a connector is provided for connecting
ureteral catheters configured to be positioned at a patient's
ureter and/or kidney to a vacuum source for inducing negative
pressure in the ureter and/or kidney and for connecting a bladder
catheter to a fluid collection container for fluid collection of
urine from the bladder by gravity drainage, the connector
comprising: a connector body; first and second ureteral catheter
inflow ports extending from the connector body, the inflow ports
each being configured to be connected to a ureteral catheter
positioned in a patient's ureter and/or kidney; a ureteral catheter
outflow port in fluid communication with each inflow port and being
configured to be connected to a pump for inducing negative pressure
in the respective ureteral catheters; a gravity drainage inflow
port configured to be connected to a bladder catheter; and a
gravity drainage outflow port in fluid communication with the
bladder catheter inflow port and being configured to be connected
to a fluid collection container.
[0027] In some examples, a urine collection assembly is provided
comprising: a first ureteral catheter configured to be positioned
in a patient's ureter and/or kidney and a second ureteral catheter
configured to be positioned in the patient's other ureter and/or
kidney, the ureteral catheters each comprising: a drainage lumen
portion defining a drainage lumen and comprising a proximal end, a
distal end configured to be positioned in a patient's ureter and/or
kidney, and a sidewall extending therebetween; and a retention
portion extending radially outward from a portion of the distal end
of the drainage lumen portion, and being configured to be extended
into a deployed position in which a diameter of the retention
portion is greater than a diameter of the drainage lumen portion,
wherein at least one of the drainage lumen portion or the retention
portion comprises at least one drainage port to permit fluid flow
into the drainage lumen; and a bladder catheter for deployment
within the patient's bladder, the bladder catheter comprising: a
drainage lumen portion defining a drainage lumen and comprising a
proximal end, a distal end configured to be positioned in the
patient's bladder, and a sidewall extending therebetween; and a
deployable anchor portion comprising a seal configured to contact a
proximal portion of the bladder wall to seal the urethral opening,
wherein at least one of the drainage lumen portion or the anchor
portion comprises at least one drainage port for permitting fluid
flow into the drainage lumen.
[0028] In some examples, a bladder catheter is provided for
deployment within the patient's bladder for collecting excess urine
not collected by deployed ureteral catheters positioned in the
patient's ureter and/or kidney, the bladder catheter comprising: a
drainage lumen portion defining a drainage lumen and comprising a
proximal end portion, a distal end portion configured to be
positioned in the patient's bladder, and a sidewall extending
therebetween; and a deployable anchor portion configured to contact
a proximal portion of the bladder wall to seal the urethral
opening, wherein at least one of the drainage lumen portion or the
anchor portion comprises at least one drainage port for permitting
fluid flow into the drainage lumen for expelling urine from the
bladder.
[0029] In some examples, a system is provided for inducing negative
pressure in a portion of a urinary tract of a patient, the system
comprising: a ureteral catheter comprising: a drainage lumen
portion comprising a proximal end, a distal end configured to be
positioned in a patient's ureter and/or kidney, and a sidewall
extending therebetween; and a retention portion extending radially
outward from a portion of the distal end of the drainage lumen
portion, and being configured to be extended into a deployed
position in which a diameter of the retention portion is greater
than a diameter of the drainage lumen portion, wherein at least one
of the drainage lumen portion or the retention portion comprises at
least one drainage port to permit fluid flow into the drainage
lumen; and a pump in fluid communication with a drainage lumen
defined by the drainage lumen portion of the ureteral catheter, the
pump being configured for inducing a negative pressure in a portion
of the urinary tract of the patient to draw fluid through the
drainage lumen of the ureteral catheter.
[0030] Methods of using the above catheters and assemblies also are
provided.
[0031] In some examples, a method is provided for extracting urine
from a ureter and/or kidney of a patient for effecting interstitial
pressure in the kidney, the method comprising: positioning a distal
end of a catheter at a fluid collection position within a patient's
ureter and/or kidney, the catheter comprising a tube defining a
drainage lumen and comprising a helical retention portion and a
plurality of drainage ports; inducing a negative pressure within a
drainage lumen of the catheter; and extracting urine by drawing
urine through the drainage ports into the drainage lumen, thereby
altering interstitial pressure within the patient's kidney.
[0032] In some examples, a method is provided for inhibiting kidney
damage by application of negative pressure to decrease interstitial
pressure within tubules of the medullar region to facilitate urine
output and to prevent venous congestion-induced nephron hypoxia in
the medulla of the kidney, the method comprising: deploying a
ureteral catheter in the ureter and/or kidney of a patient such
that flow of urine from the ureter and/or kidney is not prevented
by occlusion of the ureter and/or kidney by the deployed catheter;
and applying negative pressure to the ureter and/or kidney through
the catheter for a predetermined period of time to facilitate urine
output from the kidney.
[0033] In some examples, a method is provided for treatment of
acute kidney injury due to venous congestion, the method
comprising: deploying a ureteral catheter at a fluid collection
position in the ureter and/or kidney of a patient such that the
ureter and/or kidney is not occluded by the deployed catheter; and
applying negative pressure to the ureter and/or kidney through the
catheter for a predetermined period of time, thereby reducing
venous congestion in the kidney to treat acute kidney injury.
[0034] In some examples, a method is provided for treatment of New
York Heart Association (NYHA) Class III and/or Class IV heart
failure through reduction of venous congestion in the kidney(s),
the method comprising: deploying a ureteral catheter in the ureter
and/or kidney of a patient such that flow of urine from the ureter
and/or kidney is not prevented by occlusion of the ureter and/or
kidney; and applying negative pressure to the ureter and/or kidney
through the catheter for a predetermined period of time to treat
volume overload in NYHA Class III and/or Class IV heart
failure.
[0035] In some examples, a method is provided for treatment of
Stage 4 and/or Stage 5 chronic kidney disease through reduction of
venous congestion in the kidney(s), the method comprising:
deploying a ureteral catheter in the ureter and/or kidney of a
patient such that flow of urine from the ureter and/or kidney is
not prevented by occlusion of the ureter and/or kidney; and
applying negative pressure to the ureter and/or kidney through the
catheter for a predetermined period of time to treat Stage 4 and/or
Stage 5 chronic kidney disease.
[0036] Non-limiting examples, aspects or embodiments of the present
invention will now be described in the following numbered
clauses:
[0037] Clause 1: A ureteral catheter comprising: a drainage lumen
comprising a proximal portion configured to be positioned in at
least a portion of a patient's urethra and a distal portion
configured to be positioned in a patient's ureter and/or kidney,
the distal portion comprising a coiled retention portion, wherein
the retention portion comprises at least a first coil having a
first diameter and a second coil having a second diameter, the
first diameter being less than the second diameter.
[0038] Clause 2: The ureteral catheter of clause 1, wherein the
first coil is proximal to the second coil.
[0039] Clause 3: The ureteral catheter of any of clause 1 or clause
2, wherein, prior to insertion into a patient's urinary tract, a
portion of the drainage lumen that is proximal to the retention
portion defines a straight or curvilinear central axis, and wherein
the first coil and the second coil of the retention portion extend
about an axis that is at least partially coextensive with the
straight or curvilinear central axis of the portion of the drainage
lumen.
[0040] Clause 4: The ureteral catheter of clause 1 or clause 2,
wherein, prior to insertion to the patient's urinary tract, a
portion of the drainage lumen that is proximal to the retention
portion defines a straight or curvilinear central axis, and wherein
the first coil and the second coil of the retention portion extend
about an axis that is essentially coextensive with the straight or
curvilinear central axis of the portion of the drainage lumen.
[0041] Clause 5: The ureteral catheter of clause 3 or clause 4,
wherein the axis of the retention portion is curved relative to the
central axis of the drainage lumen.
[0042] Clause 6: The ureteral catheter of any of clauses 1 to 5,
wherein a portion of the drainage lumen that is proximal to the
retention portion defines a straight or curvilinear central axis,
and wherein the first coil and the second coil of the retention
portion extend about an axis of the retention portion, the axis of
the retention portion being positioned at an angle from the central
axis ranging from about 15 degrees to about 75 degrees.
[0043] Clause 7: The ureteral catheter of any of clauses 1 to 6,
wherein the catheter is transitionable between a contracted
configuration for insertion into the patient's ureter and a
deployed configuration for deployment within the ureter.
[0044] Clause 8: The ureteral catheter of any of clauses 1 to 7,
wherein the retention portion further comprises a third coil, the
third coil having a diameter greater than or equal to either the
first diameter or the second diameter.
[0045] Clause 9: The ureteral catheter of any of clauses 1 to 8,
wherein the retention portion comprises a tube comprising
perforations for permitting fluid to be received within the lumen
of the tube.
[0046] Clause 10: The ureteral catheter of clause 9, wherein, in
the retention portion, the tube comprises a radially inwardly
facing side and a radially outwardly facing side, and wherein a
total surface area for perforations on the radially inwardly facing
side is greater than a total surface area of perforations on the
radially outwardly facing side.
[0047] Clause 11: The ureteral catheter of clause 9, wherein, in
the retention portion, the tube comprises a radially inwardly
facing side and a radially outwardly facing side, and wherein the
perforations are disposed on the radially inwardly facing side, and
wherein the radially outwardly facing side of the tube is
essentially free of perforations.
[0048] Clause 12: The ureteral catheter of clause 11, wherein the
radially outwardly facing side of the tube is free of
perforations.
[0049] Clause 13: The ureteral catheter of any of clauses 1 to 12,
wherein the tube is formed, at least in part, from one or more of
copper, silver, gold, nickel-titanium alloy, stainless steel,
titanium, polyurethane, polyvinyl chloride, polytetrafluoroethylene
(PTFE), latex, and silicone.
[0050] Clause 14: A urine collection assembly comprising: at least
one ureteral catheter comprising: a drainage lumen comprising a
proximal portion configured to be positioned in at least a portion
of a patient's urethra and a distal portion configured to be
positioned in a patient's ureter and/or kidney, the distal portion
comprising a coiled retention portion, wherein the retention
portion comprises at least a first coil having a first diameter and
a second coil having a second diameter, the first diameter being
less than the second diameter; and a bladder catheter for
deployment within the patient's bladder, the bladder catheter
comprising: a drainage lumen portion defining a drainage lumen and
comprising a proximal end, a distal end configured to be positioned
in the patient's bladder, and a sidewall extending therebetween;
and a deployable anchor portion comprising a seal configured to
contact a proximal portion of the bladder wall to essentially or
fully seal the urethral opening of the bladder, wherein the
drainage lumen portion or the anchor portion comprises at least one
drainage port for permitting fluid flow into the drainage
lumen.
[0051] Clause 15: The assembly of clause 14, wherein the drainage
lumen portion of the at least one ureteral catheter is removably
received through the drainage port of the bladder catheter, such
that the proximal end of the at least one ureteral catheter is
disposed within the drainage lumen of the bladder catheter.
[0052] Clause 16: The assembly of any of clauses 14 or 15, wherein
the deployable anchor portion of the bladder catheter comprises an
inflatable element or balloon in fluid communication with an
inflation lumen defined by the drainage lumen portion of the
bladder catheter.
[0053] Clause 17: The assembly of any of clauses 14 to 16, wherein
the at least one drainage port is disposed on a sidewall of the
bladder catheter at a position proximal to the deployable anchor
portion.
[0054] Clause 18: The assembly of any of clauses 14 to 17, wherein
the deployable anchor portion comprises an expandable cage
comprising a plurality of flexible members extending radially and
longitudinally from the drainage lumen portion of the bladder
catheter.
[0055] Clause 19: The assembly of any of clauses 14 to 18, wherein
the deployable anchor portion comprises a plurality of
longitudinally extending members that, in a deployed position,
extend radially and longitudinally outwardly from a portion of the
distal end of the bladder catheter, thereby forming a cage.
[0056] Clause 20: The assembly of clause 18, wherein the deployable
anchor further comprises a flexible cover extending about an upper
portion of the cage.
[0057] Clause 21: The assembly of clause 20, wherein the cover
extends over at least about the upper half, or at about least the
upper 2/3, of the cage.
[0058] Clause 22: The assembly of any of clauses 14 to 21, wherein
the drainage lumen of the at least one ureteral catheter is
separate from the drainage lumen of the bladder along an entire
length of the catheters.
[0059] Clause 23: A ureteral catheter comprising: a drainage lumen
portion comprising a proximal end, a distal end configured to be
positioned in a patient's ureter and/or kidney, and a sidewall
extending therebetween; and a retention portion extending radially
outwardly from a portion of the distal end of the drainage lumen
portion, the retention portion comprising a proximal end having a
first diameter, a distal end having a second diameter, and a wall
and/or surface extending therebetween, the retention portion being
configured to be extended into a deployed position in which the
second diameter is greater than the first diameter.
[0060] Clause 24: The ureteral catheter of clause 23, wherein the
retention portion comprises an expandable element or balloon in
fluid communication with an inflation lumen extending along the
drainage lumen portion.
[0061] Clause 25: The ureteral catheter of clause 23 or clause 24,
wherein the retention portion comprises a coiled tube extending
from the distal end of the drainage lumen portion, the tube
defining a lumen in fluid communication with the drainage lumen
defined by the drainage lumen portion.
[0062] Clause 26: The ureteral catheter of any of clauses 23 to 25,
wherein the coiled tube comprises perforations extending through a
sidewall of the tube for permitting fluid to be received within the
lumen.
[0063] Clause 27: The ureteral catheter of clause 26, wherein the
perforations are disposed on a radially inwardly facing portion of
the tube, and wherein an opposing radially outwardly facing portion
of the tube is essentially free of perforations.
[0064] Clause 28: The ureteral catheter of clause 27, wherein the
opposing radially outwardly facing portion of the tube is free of
perforations.
[0065] Clause 29: The ureteral catheter of any of clauses 23 to 28,
wherein the drainage lumen portion and the retention portion are
formed, at least in part, from one or more of copper, silver, gold,
nickel-titanium alloy, stainless steel, titanium, polyurethane,
polyvinyl chloride, polytetrafluoroethylene (PTFE), latex, and
silicone.
[0066] Clause 30: The ureteral catheter of clause 23, wherein the
retention portion comprises a wedge or funnel-shaped extension
formed from a compressible and/or porous material.
[0067] Clause 31: The ureteral catheter of any of clauses 23 to 30,
wherein the retention portion is integrally formed with the
drainage lumen portion.
[0068] Clause 32: The ureteral catheter of any of clauses 23 to 31,
wherein the retention portion further comprises a tapered inner
surface configured to direct fluid towards the drainage lumen
defined by the drainage lumen portion.
[0069] Clause 33: The ureteral catheter of any of clauses 23 to 32,
wherein the drainage lumen of the catheter is configured to be
pressurized to a negative pressure for fluid collection from the
ureter and/or kidney.
[0070] Clause 34: A urine collection assembly comprising: at least
one ureteral catheter comprising: a drainage lumen portion
comprising a proximal end, a distal end configured to be positioned
in a patient's ureter and/or kidney, and a sidewall extending
therebetween; and a retention portion extending radially outwardly
from a portion of the distal end of the drainage lumen portion, the
retention portion comprising a proximal end having a first
diameter, a distal end having a second diameter, and a wall and/or
surface extending therebetween, the retention portion being
configured to be extended into a deployed position in which the
second diameter is greater than the first diameter; and a bladder
catheter for deployment within the patient's bladder, the bladder
catheter comprising: a drainage lumen portion defining a drainage
lumen and comprising a proximal end, a distal end configured to be
positioned in the patient's bladder, and a sidewall extending
therebetween; and a deployable anchor portion comprising a seal
configured to contact a proximal portion of the bladder wall to
seal the urethral opening of the bladder, wherein the drainage
lumen portion or the anchor portion comprises at least one drainage
port for permitting fluid flow into the drainage lumen.
[0071] Clause 35: The assembly of clause 34, wherein the drainage
lumen portion of the at least one ureteral catheter is removably
received through the drainage port of the bladder catheter, such
that the proximal end of the at least one ureteral catheter is
disposed within the drainage lumen of the bladder catheter.
[0072] Clause 36: The assembly of clause 34 or clause 35, wherein
the deployable anchor portion of the bladder catheter comprises an
inflatable element or balloon in fluid communication with an
inflation lumen defined by the drainage lumen portion of the
bladder catheter.
[0073] Clause 37: The assembly of any of clauses 34 to 36, wherein
the at least one drainage port is disposed on a sidewall of the
bladder catheter at a position proximal to the deployable anchor
portion.
[0074] Clause 38: The assembly of clause 34, wherein the deployable
anchor portion comprises an expandable cage comprising a plurality
of flexible members extending radially and longitudinally from the
drainage lumen portion of the bladder catheter.
[0075] Clause 39: The assembly of clause 34, wherein the deployable
anchor portion comprises a plurality of longitudinally extending
members that, in a deployed position, extend radially and
longitudinally outward from a portion of the distal end of the
bladder catheter, thereby forming a cage.
[0076] Clause 40: The assembly of clause 38 or clause 39, wherein
the deployable anchor further comprises a flexible cover extending
about an upper portion of the cage.
[0077] Clause 41: The assembly of clause 40, wherein the cover
extends over at least about the upper half, or at least about the
upper 2/3, of the cage.
[0078] Clause 42: A ureteral catheter comprising: a drainage lumen
portion comprising a proximal end, a distal end configured to be
positioned in a patient's ureter and/or kidney, and a sidewall
extending therebetween, the drainage lumen portion defining a
drainage lumen; and a retention portion which, in a deployed
position, extends radially outwardly from a portion of the distal
end of the drainage lumen portion, the retention portion comprising
a plurality of tubes extending between a proximal end of the
retention portion and a distal end of the retention portion,
wherein each tube defines a lumen in fluid communication with the
drainage lumen defined by the drainage lumen portion and wherein
each tube comprises a plurality of drainage ports for allowing
fluid to enter the lumen.
[0079] Clause 43: The ureteral catheter of clause 42, wherein each
tube comprises a radially inwardly facing side and a radially
outwardly facing side, and wherein the drainage ports are disposed
on the radially inwardly facing side of each tube.
[0080] Clause 44: The ureteral catheter of clause 43, wherein the
radially outwardly facing side of each tube is essentially free of
drainage ports.
[0081] Clause 45: The ureteral catheter of clause 43, wherein the
radially outwardly facing side of each tube is free of drainage
ports.
[0082] Clause 46: The ureteral catheter of any of clauses 42 to 45,
wherein the retention portion is transitionable from a contracted
position, in which each of the plurality of tubes is substantially
parallel to a longitudinal axis of the drainage lumen portion and
the deployed position in which portions of the tubes extend
radially outwardly from the drainage lumen portion.
[0083] Clause 47: The ureteral catheter of any of clauses 42 to 46,
wherein in the deployed position the tubes define a spherical or
ellipsoidal cavity, and wherein the drainage lumen portion extends
at least partially into the cavity.
[0084] Clause 48: The ureteral catheter of any of clauses 42 to 47,
wherein the drainage lumen portion and the retention portion are
formed, at least in part, from one or more of copper, silver, gold,
nickel-titanium alloy, stainless steel, titanium, polyurethane,
polyvinyl chloride, polytetrafluoroethylene (PTFE), latex, and
silicone.
[0085] Clause 49: The ureteral catheter of any of clauses 42 to 48,
wherein the retention portion is integrally formed with the
drainage lumen portion.
[0086] Clause 50: The ureteral catheter of any of clauses 42 to 49,
wherein the drainage lumen of the catheter is configured to be
pressurized to a negative pressure for fluid collection from the
ureter and/or kidney.
[0087] Clause 51: A urine collection assembly comprising: at least
one ureteral catheter comprising: a drainage lumen portion
comprising a proximal end, a distal end configured to be positioned
in a patient's ureter and/or kidney, and a sidewall extending
therebetween, the drainage lumen portion defining a drainage lumen;
and a retention portion which, in a deployed position, extends
radially outward from a portion of the distal end of the drainage
lumen portion, the retention portion comprising a plurality of
tubes extending between a proximal end of the retention portion and
a distal end of the retention portion, wherein each tube defines a
lumen in fluid communication with the drainage lumen defined by the
drainage lumen portion and wherein each tube comprises a plurality
of drainage ports for allowing fluid to enter the lumen; and a
bladder catheter for deployment within the patient's bladder, the
bladder catheter comprising: a drainage lumen portion defining a
drainage lumen and comprising a proximal end, a distal end
configured to be positioned in the patient's bladder, and a
sidewall extending therebetween; and a deployable anchor portion
comprising a seal configured to contact a proximal portion of the
bladder wall to seal the urethral opening of the bladder, wherein
the drainage lumen portion or the anchor portion comprises at least
one drainage port for permitting fluid flow into the drainage
lumen.
[0088] Clause 52: The assembly of clause 51, wherein the drainage
lumen portion of the at least one ureteral catheter is removably
received through the drainage port of the bladder catheter, such
that the proximal end of the at least one ureteral catheter is
disposed within the drainage lumen of the bladder catheter.
[0089] Clause 53: The assembly of clause 51 or clause 52, wherein
the deployable anchor portion of the bladder catheter comprises an
inflatable element or balloon in fluid communication with an
inflation lumen defined by the drainage lumen portion of the
bladder catheter.
[0090] Clause 54: The assembly of any of clauses 51 to 53, wherein
the at least one drainage port is disposed on a sidewall of the
bladder catheter at a position proximal to the deployable anchor
portion.
[0091] Clause 55: The assembly of clause 51 or clause 52, wherein
the deployable anchor portion comprises an expandable cage
comprising a plurality of flexible members extending radially and
longitudinally from the drainage lumen portion of the bladder
catheter.
[0092] Clause 56: The assembly of clause 51 or clause 52, wherein
the deployable anchor portion comprises a plurality of
longitudinally extending members that, in a deployed position,
extend radially and longitudinally outward from a portion of the
distal end of the bladder catheter, thereby forming a cage.
[0093] Clause 57: The assembly of clause 55 or clause 56, wherein
the deployable anchor further comprises a flexible cover extending
about an upper portion of the cage.
[0094] Clause 58: The assembly of clause 57, wherein the cover
extends over at least about the upper half, or about the upper 2/3,
of the cage.
[0095] Clause 59: A connector for connecting ureteral catheters
configured to be positioned at a patient's ureter and/or kidney to
a vacuum source for inducing negative pressure in the ureter and/or
kidney and for connecting a bladder catheter to a fluid collection
container for fluid collection of urine from the bladder by gravity
drainage, the connector comprising: a connector body; first and
second ureteral catheter inflow ports extending from the connector
body, the inflow ports each being configured to be connected to a
ureteral catheter positioned in a patient's ureter and/or kidney; a
ureteral catheter outflow port in fluid communication with each
inflow port and being configured to be connected to a pump for
inducing negative pressure in the respective ureteral catheters; a
gravity drainage inflow port configured to be connected to the
bladder catheter; and a gravity drainage outflow port in fluid
communication with the bladder catheter inflow port and being
configured to be connected to a fluid collection container.
[0096] Clause 60: The connector of clause 59, wherein the connector
body defines a fluid conduit extending from the at least two
ureteral catheter inflow ports to the single ureteral catheter
outflow port.
[0097] Clause 61: The connector of clause 59 or clause 60, wherein
the inflow ports are configured to removably receive ends of the
respective catheters.
[0098] Clause 62: The connector of any of clauses 59 to 61, wherein
the vacuum outflow port and the gravity drainage outflow port are
positioned for connection to a single socket for establishing fluid
connection with the pump and fluid connection container.
[0099] Clause 63: A urine collection assembly comprising: a first
ureteral catheter configured to be positioned in a patient's ureter
and/or kidney and a second ureteral catheter configured to be
positioned in the patient's other ureter and/or kidney, the
ureteral catheters each comprising: a drainage lumen portion
defining a drainage lumen and comprising a proximal end, a distal
end configured to be positioned in a patient's ureter and/or
kidney, and a sidewall extending therebetween; and a retention
portion extending radially outward from a portion of the distal end
of the drainage lumen portion, and being configured to be extended
into a deployed position in which a diameter of the retention
portion is greater than a diameter of the drainage lumen portion,
wherein at least one of the drainage lumen portion or the retention
portion comprises at least one drainage port to permit fluid flow
into the drainage lumen; and a bladder catheter for deployment
within the patient's bladder, the bladder catheter comprising: a
drainage lumen portion defining a drainage lumen and comprising a
proximal end, a distal end configured to be positioned in the
patient's bladder, and a sidewall extending therebetween; and a
deployable anchor portion comprising a seal configured to contact a
proximal portion of the bladder wall to seal the urethral opening,
wherein at least one of the drainage lumen portion or the anchor
portion comprises at least one drainage port for permitting fluid
flow into the drainage lumen.
[0100] Clause 64: The assembly of clause 63, further comprising a
connector for connecting proximal ends of the ureteral catheters to
a vacuum source and for connecting the proximal end of the bladder
catheter to a fluid collection container for fluid collection by
gravity drainage.
[0101] Clause 65: The assembly of clause 64, wherein the connector
comprises: at least two ureteral catheter inflow ports for
connection to the respective proximal ends of the first ureteral
catheter and the second ureteral catheter; a ureteral catheter
outflow port in fluid communication with each inflow port and being
configured to be connected to a pump for inducing negative pressure
in the respective ureteral catheters; a gravity drainage inflow
port configured to be connected to the proximal end of the bladder
catheter; and an outflow port in fluid communication with the
bladder catheter inflow port and being configured to be connected
to a fluid collection container.
[0102] Clause 66: The assembly of clause 65, wherein the connector
further comprises conduit extending from the at least two ureteral
catheter inflow ports to the single ureteral catheter outflow
port.
[0103] Clause 67: The assembly of clause 65 or clause 66, wherein
the proximal ends of the respective catheters are removably
connected to their respective inflow ports.
[0104] Clause 68: The assembly of any clauses 63 to 67, wherein the
deployable anchor portion of the bladder catheter comprises an
inflatable element or balloon in fluid communication with an
inflation lumen defined by the drainage lumen portion of the
bladder catheter.
[0105] Clause 69: The assembly of clause 63, wherein the deployable
anchor portion comprises an expandable cage comprising a plurality
of flexible members extending radially and longitudinally from the
drainage lumen portion of the bladder catheter and a cover
enclosing at least a portion of the cage.
[0106] Clause 70: The assembly of clause 68 or clause 69, wherein
the deployable anchor further comprises a flexible cover extending
about an upper portion of the cage.
[0107] Clause 71: The assembly of clause 70, wherein the cover
extends over at least about the upper half, or at least about the
upper 2/3, of the cage.
[0108] Clause 72: A bladder catheter for deployment within the
patient's bladder for collecting excess urine not collected by
deployed ureteral catheters positioned in the patient's ureter
and/or kidney, the bladder catheter comprising: a drainage lumen
portion defining a drainage lumen and comprising a proximal end
portion, a distal end portion configured to be positioned in the
patient's bladder, and a sidewall extending therebetween; and a
deployable anchor portion configured to contact a proximal portion
of the bladder wall to seal the urethral opening, wherein at least
one of the drainage lumen portion or the anchor portion comprises
at least one drainage port for permitting fluid flow into the
drainage lumen for expelling urine from the bladder.
[0109] Clause 73: The bladder catheter of clause 72, wherein the
deployable anchor portion comprises an inflatable element or
balloon in fluid communication with an inflation lumen defined by
the drainage lumen portion of the bladder catheter.
[0110] Clause 74: The bladder catheter of clause 73, wherein the
inflatable element or balloon comprises an upper portion configured
to be positioned in the patient's bladder and a lower portion
configured to be positioned in the patient's urethra.
[0111] Clause 75: The bladder catheter of any of clauses 62 to 74,
wherein the at least one drainage port is disposed on a sidewall of
the bladder catheter at a position proximal to the anchor
portion.
[0112] Clause 76: The bladder catheter of clause 72, wherein the
deployable anchor portion comprises an expandable cage comprising a
plurality of flexible members extending radially and longitudinally
from the drainage lumen portion of the bladder catheter and a cover
enclosing at least a portion of the cage.
[0113] Clause 77: The bladder catheter of clause 76, wherein the
deployable anchor portion further comprises a flexible cover
extending about an upper portion of the cage.
[0114] Clause 78: The bladder catheter of clause 77, wherein the
cover extends over at least about the upper half, or at least about
the upper 2/3, of the cage.
[0115] Clause 79: A system for inducing negative pressure in a
portion of a urinary tract of a patient, the system comprising: a
ureteral catheter comprising: a drainage lumen portion comprising a
proximal end, a distal end configured to be positioned in a
patient's ureter and/or kidney, and a sidewall extending
therebetween; and a retention portion extending radially outward
from a portion of the distal end of the drainage lumen portion, and
being configured to be extended into a deployed position in which a
diameter of the retention portion is greater than a diameter of the
drainage lumen portion, wherein at least one of the drainage lumen
portion or the retention portion comprises at least one drainage
port to permit fluid flow into the drainage lumen; and a pump in
fluid communication with a drainage lumen defined by the drainage
lumen portion of the ureteral catheter, the pump being configured
for inducing a negative pressure in a portion of the urinary tract
of the patient to draw fluid through the drainage lumen of the
ureteral catheter.
[0116] Clause 80: The system of clause 79, further comprising: a
bladder catheter for deployment within the patient's bladder, the
bladder catheter comprising: a drainage lumen portion defining a
drainage lumen and comprising a proximal end, a distal end
configured to be positioned in the patient's bladder, and a
sidewall extending therebetween; and a deployable anchor portion
comprising a seal configured to contact a proximal portion of the
bladder wall to seal the urethral opening, wherein at least one of
the drainage lumen portion or the anchor portion comprises at least
one drainage port for permitting fluid flow into the drainage lumen
for expelling urine from the bladder.
[0117] Clause 81: The system of clause 80, further comprising an
external fluid collection container in fluid communication with the
drainage lumen of the bladder catheter for gravity drainage of
fluid through the bladder catheter.
[0118] Clause 82: The system of any of clauses 79 to 81, further
comprising one or more sensors in fluid communication with the
drainage lumen, the one or more sensors being configured to
determine information comprising at least one of capacitance,
analyte concentration, and temperature of urine within the
respective drainage lumen; and a processor comprising computer
readable memory including programming instructions that, when
executed, cause the processor to: receive the information from the
one or more sensors and adjust an operating parameter of the pump
based, at least in part, on the information received from the one
or more sensors to increase or decrease vacuum pressure in the
drainage lumen of the at least one ureteral catheter to adjust flow
of urine through the drainage lumen.
[0119] Clause 83: The system of clause 82, further comprising a
data transmitter in communication with the processor, the data
transmitter being configured to provide the information from the
one or more sensors to an external source.
[0120] Clause 84: The system of any of clauses 80 to 83, wherein
the pump provides a sensitivity of 10 mmHg or less.
[0121] Clause 85: The system of any of clauses 80 to 84, wherein
the pump is capable of continuous operation for a time period
ranging from about 8 to about 24 hours per day.
[0122] Clause 86: They system of any of clauses 80 to 85, wherein
the pump is configured to provide intermittent negative
pressure.
[0123] Clause 87: The system of any of clauses 80 to 86, wherein
the pump is configured to apply negative pressure independently to
each catheter such that the pressure in each catheter can be the
same or different from the other catheter(s).
[0124] Clause 88: The system of any of clauses 80 to 86, wherein
the pump is configured to alternate between providing negative
pressure and providing positive pressure.
[0125] Clause 89: The system of any of clauses 80 to 86, wherein
the pump is configured to alternate between providing negative
pressure and equalizing pressure to atmosphere.
[0126] Clause 90: The system of clause 88, wherein the negative
pressure is provided within a range of 5 mmHg to 50 mmHg, and/or
wherein the positive pressure is provided within a range of 5 mmHg
to 20 mmHg.
[0127] Clause 91: The system of any of clauses 80 to 90, wherein
the pump is configured to alternate between two or more different
pressure levels.
[0128] Clause 92: The system of clause 91, wherein the pump is
configured to adjust the pressure levels at a regular or irregular
frequency based, at least in part, on a predetermined
algorithm.
[0129] Clause 93: The system of clause 92, wherein the
predetermined algorithm is based in part on demographic data and/or
patient-specific variables.
[0130] Clause 94: The system of clause 93, wherein the demographic
data and/or patient-specific variables comprise one or more of
anatomical, genetic, physiological, and pathophysiological
factors.
[0131] Clause 95: The system of clause 92, wherein the
predetermined algorithm is based, in part, on continuously or
non-continuously changing patient values, the patient values
comprising one or more of urine output rate, peristaltic activity
of renal and/or urological system, heart rate, cardiac output,
blood pressure, respiration rate, renal blood flow, renal plasma
flow, and biomarkers.
[0132] Clause 96: A method for extracting urine from a ureter
and/or kidney of a patient for effecting interstitial pressure in
the kidney, the method comprising: positioning a distal end of a
catheter at a fluid collection position within a patient's ureter
and/or kidney, the catheter comprising a tube defining a drainage
lumen and comprising a helical retention portion and a plurality of
drainage ports; inducing a negative pressure within a drainage
lumen of the catheter; and extracting urine by drawing urine
through the drainage ports into the drainage lumen, thereby
altering interstitial pressure within the patient's kidney.
[0133] Clause 97: The method of clause 96, wherein positioning the
catheter comprises deploying the catheter by expanding the helical
retention portion at the fluid collection position.
[0134] Clause 98: The method of clause 96 or clause 97, further
comprising positioning a distal end of the bladder catheter in the
patient's bladder and deploying an anchor within the bladder, such
that the anchor essentially or fully seals the urethral sphincter
of the bladder.
[0135] Clause 99: The method of clause 98, wherein positioning the
bladder catheter in the bladder comprises advancing the bladder
catheter over a guidewire used for positioning of the ureteral
catheter.
[0136] Clause 100: A method of inhibiting kidney damage by
application of negative pressure to decrease interstitial pressure
within tubules of the medullar region to facilitate urine output
and to prevent venous congestion-induced nephron hypoxia in the
medulla of the kidney, the method comprising: deploying a ureteral
catheter in the ureter and/or kidney of a patient such that flow of
urine from the ureter and/or kidney is not prevented by occlusion
of the ureter and/or kidney by the deployed catheter; and applying
negative pressure to the ureter and/or kidney through the catheter
for a period of time sufficient to facilitate urine output from the
kidney.
[0137] Clause 101: The method of clause 100, further comprising
positioning a bladder catheter in the patient's bladder, such that
an anchor of the bladder catheter essentially or fully seals the
urethral sphincter of the bladder.
[0138] Clause 102: The method of clause 101, further comprising
causing drainage of urine from the bladder through the bladder
catheter for a period of time.
[0139] Clause 103: The method of clause 100, wherein deploying the
catheter comprises accessing the ureter and/or kidney through an
incision or orifice other than the urethral orifice.
[0140] Clause 104: A method for treatment of acute kidney injury
due to venous congestion, the method comprising: deploying a
ureteral catheter in the ureter and/or kidney of a patient such
that flow of urine from the ureter and/or kidney is not prevented
by occlusion of the ureter and/or kidney; and applying negative
pressure to the ureter and/or kidney through the catheter for a
period of time sufficient to treat acute kidney injury due to
venous congestion.
[0141] Clause 105: A method for treatment of NYHA Class III and/or
Class IV heart failure through reduction of venous congestion in
the kidney(s), the method comprising: deploying a ureteral catheter
in the ureter and/or kidney of a patient such that flow of urine
from the ureter and/or kidney is not prevented by occlusion of the
ureter and/or kidney; and applying negative pressure to the ureter
and/or kidney through the catheter for a period of time sufficient
to treat NYHA Class III and/or Class IV heart failure.
[0142] Clause 106: A method for treatment of NYHA Class II, Class
III, and/or Class IV heart failure through reduction of venous
congestion in the kidney(s), the method comprising: deploying a
catheter in a bladder of a patient such that flow of urine into the
bladder from a ureter and/or kidney is not prevented by occlusion;
and applying negative pressure to the bladder through the catheter
for a period of time sufficient to treat NYHA Class II, Class III,
and/or Class IV heart failure.
[0143] Clause 107: A method for treatment of Stage 4 and/or Stage 5
chronic kidney disease through reduction of venous congestion in
the kidney(s), the method comprising: deploying a ureteral catheter
in a ureter and/or kidney of a patient such that flow of urine from
the ureter and/or kidney is not prevented by occlusion of the
ureter and/or kidney; and applying negative pressure to the ureter
and/or kidney through the catheter for a period of time sufficient
to treat Stage 4 and/or Stage 5 chronic kidney disease.
[0144] Clause 108: A method for treatment of Stage 3, Stage 4,
and/or Stage 5 chronic kidney disease through reduction of venous
congestion in the kidney(s), the method comprising: deploying a
catheter in a bladder of a patient such that flow of urine from a
ureter and/or kidney is not prevented by occlusion; and applying
negative pressure to the bladder through the catheter for a period
of time sufficient to treat Stage 3, Stage 4, and/or Stage 5
chronic kidney disease.
[0145] Clause 109: A ureteral catheter, comprising: a drainage
lumen comprising a proximal portion configured to be positioned in
at least a portion of a patient's urethra and a distal portion
configured to be positioned in a patient's ureter and/or kidney,
the distal portion comprising a coiled retention portion, the
coiled retention portion comprising: at least a first coil having a
first diameter; at least a second coil having a second diameter,
the first diameter being less than the second diameter; and one or
more perforations on a sidewall of the drainage lumen for
permitting fluid flow into the drainage lumen, wherein, prior to
insertion into a patient's urinary tract, a portion of the drainage
lumen that is proximal to the retention portion defines a straight
or curvilinear central axis, and wherein, when deployed, the first
coil and the second coil of the retention portion extend about an
axis of the retention portion that is at least partially
coextensive with the straight or curvilinear central axis of the
portion of the drainage lumen.
[0146] Clause 110: The ureteral catheter of clause 109, wherein the
axis of the retention portion is curved relative to the central
axis of the drainage lumen.
[0147] Clause 111: The ureteral catheter of clause 109 or clause
110, wherein at least a portion of the axis of the retention
portion extends at an angle from the central axis ranging from
about 15 degrees to about 75 degrees.
[0148] Clauses 112: The ureteral catheter of any of clauses 109 to
111, wherein the catheter is transitionable between a contracted
configuration for insertion into the patient's ureter and a
deployed configuration for deployment within the ureter.
[0149] Clause 113: The ureteral catheter of any of clauses 109 to
112, wherein the retention portion further comprises a third coil
extending about the axis of the retention portion, the third coil
having a diameter greater than or equal to either the first
diameter or the second diameter.
[0150] Clause 114: The ureteral catheter of any of clauses 109 to
113, wherein, the retention portion of the drainage lumen comprises
a sidewall comprising a radially inwardly facing side and a
radially outwardly facing side, and wherein a total surface area of
perforations on the radially inwardly facing side is greater than a
total surface area of perforations on the radially outwardly facing
side.
[0151] Clause 115: The ureteral catheter of any of clauses 109 to
114, wherein, the retention portion of the drainage lumen comprises
a sidewall comprising a radially inwardly facing side and a
radially outwardly facing side, and wherein the one or more
perforations are disposed on the radially inwardly facing side, and
wherein the radially outwardly facing side is essentially free of
perforations.
[0152] Cause 116: The ureteral catheter of clause any of clauses
109 to 116, wherein the drainage lumen is formed, at least in part,
from one or more of copper, silver, gold, nickel-titanium alloy,
stainless steel, titanium, polyurethane, polyvinyl chloride,
polytetrafluoroethylene (PTFE), latex, and silicone.
[0153] Clause 117: The ureteral catheter of any of clauses 109 to
116, wherein the retention portion of the drainage lumen further
comprises an open distal end for permitting fluid flow into the
drainage lumen.
[0154] Clause 118: The ureteral catheter of any of clauses 109 to
117, wherein each of the one or more perforations has a diameter of
about 0.7 to 0.9 mm.
[0155] Clause 119: The ureteral catheter of any of clauses 109 to
118, wherein the first diameter is about 8 mm to 10 mm and the
second dimeter is about 16 mm to 20 mm.
[0156] Clause 120: A system for inducing negative pressure in a
portion of a urinary tract of a patient, the system comprising: at
least one urine collection catheter comprising a drainage lumen
comprising a proximal portion configured to be positioned in at
least a portion of a patient's urethra and a distal portion
configured to be positioned in a patient's ureter and/or kidney,
the distal portion comprising a coiled retention portion, the
coiled retention portion comprising: at least a first coil having a
first diameter; at least a second coil having a second diameter,
the first diameter being less than the second diameter; and one or
more perforations on a sidewall of the drainage lumen for
permitting fluid flow into the drainage lumen, wherein, prior to
insertion into a patient's urinary tract, a portion of the drainage
lumen that is proximal to the retention portion defines a straight
or curvilinear central axis, and wherein, when deployed, the first
coil and the second coil of the retention portion extend about an
axis of the retention portion that is at least partially
coextensive with the straight or curvilinear central axis of the
portion of the drainage lumen; and a pump in fluid communication
with the drainage lumen of the at least one ureteral catheter, the
pump being configured for inducing a negative pressure in a portion
of the urinary tract of the patient to draw fluid through the
drainage lumen of the ureteral catheter.
[0157] Clause 121: The system of clause 120, further comprising:
one or more sensors in fluid communication with the drainage lumen,
the one or more sensors being configured to determine information
comprising at least one of capacitance, analyte concentration, and
temperature of urine within the respective drainage lumen; and a
controller comprising computer readable memory including
programming instructions that, when executed, cause the controller
to: receive the information from the one or more sensors and adjust
an operating parameter of the pump based, at least in part, on the
information received from the one or more sensors to increase or
decrease vacuum pressure in the drainage lumen of the at least one
ureteral catheter to adjust flow of urine through the drainage
lumen.
[0158] Clause 122: The system of clause 120 or clause 121, further
comprising a data transmitter in communication with the controller,
the data transmitter being configured to provide the information
from the one or more sensors to an external source.
[0159] Clause 123: The system of any of clauses 120 to 122, wherein
the pump provides a sensitivity of 10 mmHg or less.
[0160] Clause 124: The system of any of clauses 120 to 122, wherein
the pump is configured to alternate between providing negative
pressure and providing positive pressure.
[0161] Clause 125: The system of clause 124, wherein the negative
pressure is provided within a range of 5 mmHg to 50 mmHg, and
wherein the positive pressure is provided within a range of 5 mmHg
to 20 mmHg.
[0162] Clause 126: A method of inhibiting kidney damage by
application of negative pressure to decrease interstitial pressure
within tubules of the medullar region to facilitate urine output
and to prevent venous congestion-induced nephron hypoxia in the
medulla of the kidney, the method comprising: deploying a ureteral
catheter in the ureter and/or kidney of a patient such that flow of
urine from the ureter and/or kidney is not prevented by occlusion
of the ureter and/or kidney by the deployed catheter; and applying
negative pressure to the ureter and/or kidney through the catheter
for a period of time sufficient to facilitate urine output from the
kidney, wherein the ureteral catheter comprises a drainage lumen
comprising a proximal portion configured to be positioned in at
least a portion of a patient's urethra and a distal portion
configured to be positioned in a patient's ureter and/or kidney,
the distal portion comprising a coiled retention portion, the
coiled retention portion comprising: at least a first coil having a
first diameter; at least a second coil having a second diameter,
the first diameter being less than the second diameter; and one or
more perforations on a sidewall of the drainage lumen for
permitting fluid flow into the drainage lumen, wherein, prior to
deployment, a portion of the drainage lumen that is proximal to the
retention portion defines a straight or curvilinear central axis,
and wherein, upon deployment, the first coil and the second coil of
the retention portion extend about an axis of the retention portion
that is at least partially coextensive with the straight or
curvilinear central axis of the portion of the drainage lumen.
[0163] Clause 127: The method of clause 126, further comprising,
upon application of negative pressure to the ureter and/or kidney,
extracting urine by drawing urine through the one or more
perforations into the drainage lumen, thereby altering interstitial
pressure within the patient's kidney.
[0164] Clause 128: The method of clause 126 or clause 127, wherein
application of negative pressure to the ureter and/or kidney
through the catheter is provided for a period of time sufficient to
treat acute kidney injury due to venous congestion.
[0165] Clause 129: A method for removing excess fluid from a
patient with hemodilution, the method comprising: deploying a
urinary tract catheter into the patient such that flow of urine
from the ureter and/or kidney is transported within a drainage
lumen of the catheter; applying negative pressure to the ureter
and/or kidney through the drainage lumen of the catheter to extract
urine from the patient; periodically measuring a hematocrit value
of the patient; and if the measured hematocrit value exceeds a
predetermined minimum threshold value, ceasing the application of
the negative pressure to the ureter and/or kidney.
[0166] Clause 130: The method of clause 129, wherein the urinary
tract catheter comprises a ureteral catheter comprising a tube
defining a drainage lumen and comprising a helical retention
portion comprising a helical arrangement with multiple coils when
deployed and a plurality of drainage ports.
[0167] Clause 131: The method of clause 130, wherein deploying the
ureteral catheter comprises expanding the helical retention portion
at a fluid collection position in the renal pelvis of the patient's
kidney.
[0168] Clause 132: The method of clause 130 or clause 131, further
comprising deploying a bladder catheter in the patient's bladder
for receiving urine which passes through the ureter and enters the
bladder.
[0169] Clause 133: The method of clause 132, wherein a proximal
portion of the ureteral catheter is positioned within a drainage
lumen of the bladder catheter.
[0170] Clause 134: The method of clause 132 or clause 133, wherein
the bladder catheter comprises a seal for sealing an opening to the
urethra for preventing passage of urine from the bladder to the
urethra outside of the drainage lumen of the bladder catheter.
[0171] Clause 135: The method of any of clause 129 to 134, wherein
the urinary tract catheter is introduced to one or the patient's
bladder, ureter, and kidney through the urethra of the patient.
[0172] Clause 136: The method of any of clauses 129 to 135, further
comprising collecting fluid extracted from the patient through the
urinary tract catheter to determine a total volume of extracted
fluid.
[0173] Clause 137: The method of clause 136, further comprising
ceasing application of negative pressure when the determined total
volume of extracted fluid exceeds a predetermined fluid volume.
[0174] Clause 138: The method of clause 137, wherein the
predetermined value is based on an amount of fluid provided to a
patient during a fluid resuscitation procedure.
[0175] Clause 139: The method of any of clauses 129 to 138, wherein
the excess fluid is provided to the patient during a fluid
resuscitation procedure performed for the patient.
[0176] Clause 140: The method of clause 139 wherein removing excess
fluid from the patient is provided as one of a treatment for
systemic fluid volume management associated with acute heart
failure and as a treatment is provided to the patient during a
coronary graft bypass procedure.
[0177] Clause 141: The method of any of clauses 129 to 140, wherein
the predetermined hematocrit value is between 25% and 45%.
[0178] Clause 142: A method for removing excess fluid from a
patient with hemodilution, the method comprising: deploying a
urinary tract catheter into the patient such that flow of urine
from the ureter and/or kidney is transported within a drainage
lumen of the catheter; applying negative pressure to the ureter
and/or kidney through the drainage lumen of the catheter to extract
urine from the patient; periodically measuring the patient's
weight; and if the measured weight is less than a predetermined
threshold value, ceasing the application of the negative pressure
to the urinary tract.
[0179] Clause 143: The method of clause 142, wherein the urinary
tract catheter comprises a ureteral catheter comprising a tube
defining a drainage lumen and comprising a helical retention
portion and a plurality of drainage ports.
[0180] Clause 144: The method of clause 143, wherein deploying the
ureteral catheter comprises expanding the helical retention portion
at a fluid collection position within the patient's ureter and/or
kidney.
[0181] Clause 144: The method of clause 143, wherein the ureteral
catheter is introduced to the patient's ureter and/or kidney
through the urethra and bladder of the patient.
[0182] Clause 145: The method of clause 143, wherein the
predetermined threshold value is a dry weight of the patient.
[0183] Clause 146: The method of clause 145, wherein removing
excess fluid from the patient is provided as a treatment for acute
kidney injury.
[0184] Clause 147: The method of clause 145, wherein the patient's
dry weight is directly measured prior to a fluid resuscitation
procedure.
[0185] Clause 148: A system for removing excess fluid from a
patient with hemodilution, comprising: a urinary tract catheter
comprising: a drainage lumen portion comprising a proximal end, a
distal end configured to be positioned in a patient's urinary
tract, and a sidewall extending therebetween; and a retention
portion extending radially outward from a portion of the distal end
of the drainage lumen portion, and being configured to be extended
into a deployed position in which a diameter of the retention
portion is greater than a diameter of the drainage lumen portion,
wherein at least one of the drainage lumen portion or the retention
portion comprises at least one drainage port to permit fluid flow
into the drainage lumen; and a pump in fluid communication with a
drainage lumen defined by the drainage lumen portion of the
ureteral catheter, the pump comprising a controller configured to:
actuate the pump to cause the pump to induce a negative pressure in
a ureter and/or kidney of the patient to draw urine through the
drainage lumen of the urinary tract catheter, periodically receive
information representative of a hematocrit value of the patient;
and if the received hematocrit value exceeds a predetermined
minimum threshold value, ceasing the application of the negative
pressure to the ureter and/or kidney.
[0186] Clause 149: The system of clause 148, wherein the
predetermined threshold value comprises a hematocrit value for a
healthy patient.
[0187] Clause 150: The system of clause 148, wherein the
predetermined threshold value is between 25% and 40%.
[0188] Clause 151: The system of clause 148, further comprising a
bladder catheter for deployment within the patient's bladder, the
bladder catheter comprising: a drainage lumen portion defining a
drainage lumen and comprising a proximal end, a distal end
configured to be positioned in the patient's bladder, and a
sidewall extending therebetween; and a deployable anchor portion
comprising a seal configured to contact a proximal portion of the
bladder wall to seal the urethral opening, wherein at least one of
the drainage lumen portion or the anchor portion comprises at least
one drainage port for permitting fluid flow into the drainage lumen
for expelling urine from the bladder.
[0189] Clause 152: The system of clause 148, further comprising one
or more physiological sensors associated with the patient, the
physiological sensors being configured to provide the information
representative of the hematocrit value to the controller.
[0190] Clause 153: The system of clause 152, wherein the one or
more physiological sensors comprise an analyte and/or capacitance
sensor associated with an extracorporeal blood system associated
with the patient.
[0191] Clause 154: The system of clause 148, wherein, prior to
ceasing application of the negative pressure, the controller is
further configured to adjust an operating parameter of the pump
based, at least in part, on the measured hematocrit value.
[0192] Clause 155: The system of clause 154, wherein adjusting an
operating parameter of the pump based on the measured hematocrit
value comprises reducing applied negative pressure when a downward
trend in measured hematocrit value is identified.
[0193] Clause 156: The system of clause 148, wherein the pump
provides a sensitivity of 10 mmHg or less.
[0194] Clause 157: The system of clause 148, wherein the controller
is configured to cause the pump to alternate between providing
negative pressure and providing positive pressure.
[0195] Clause 158: The system of clause 157, wherein the negative
pressure is provided within a range of 5 mmHg to 50 mmHg, and
wherein the positive pressure is provided within a range of 5 mmHg
to 20 mmHg.
[0196] Clause 159: The system of clause 148, wherein the excess
fluid is provided to the patient during a fluid resuscitation
procedure.
BRIEF DESCRIPTION OF THE DRAWINGS
[0197] These and other features and characteristics of the present
disclosure, as well as the methods of operation and functions of
the related elements of structures and the combination of parts and
economies of manufacture, will become more apparent upon
consideration of the following description and the appended claims
with reference to the accompanying drawings, all of which form a
part of this specification, wherein like reference numerals
designate corresponding parts in the various figures. It is to be
expressly understood, however, that the drawings are for the
purpose of illustration and description only and are not intended
as a definition of the limit of the invention.
[0198] Further features and other examples and advantages will
become apparent from the following detailed description made with
reference to the drawings in which:
[0199] FIG. 1 is a schematic drawing of an indwelling portion of a
urine collection assembly deployed in a urinary tract of a patient,
according to an example of the present invention;
[0200] FIG. 2A is a perspective view of an exemplary ureteral
catheter according to an example of the disclosure;
[0201] FIG. 2B is a front view of the ureteral catheter of FIG.
2A;
[0202] FIG. 3A is a schematic drawing of an example of a retention
portion for a ureteral catheter according to an example of the
present invention;
[0203] FIG. 3B is a schematic drawing of another example of a
retention portion for a ureteral catheter according to an example
of the present invention;
[0204] FIG. 3C is a schematic drawing of another example of a
retention portion for a ureteral catheter according to an example
of the present invention;
[0205] FIG. 3D is a schematic drawing of another example of a
retention portion for a ureteral catheter according to an example
of the present invention;
[0206] FIG. 3E is a schematic drawing of another example of a
retention portion for a ureteral catheter according to an example
of the present invention;
[0207] FIG. 4A is a schematic drawing of another example of a
retention portion for a ureteral catheter according to an example
of the present invention;
[0208] FIG. 4B is a schematic drawing of a cross-sectional view of
a portion of the retention portion of FIG. 4A, taken along lines
B-B of FIG. 4A;
[0209] FIG. 5A is a schematic drawing of another example of a
retention portion for a ureteral catheter according to an example
of the present invention;
[0210] FIG. 5B is a schematic drawing of a portion of a
cross-sectional view of the retention portion of FIG. 5A, taken
along lines B-B of FIG. 5A;
[0211] FIG. 6 is a schematic drawing of another example of a
retention portion for a ureteral catheter according to an example
of the present invention;
[0212] FIG. 7 is a schematic drawing of a cross section of another
example of a retention portion for a ureteral catheter according to
an example of the present invention;
[0213] FIG. 8 is a schematic drawing of another example of a
retention portion for a ureteral catheter according to an example
of the present invention;
[0214] FIG. 9A is a schematic drawing of another example of a urine
collection assembly according to an example of the present
invention;
[0215] FIG. 9B is a partial schematic drawing taken along section
9B-9B of the bladder anchor portion of the assembly of FIG. 9A;
[0216] FIG. 10A is a schematic drawing of another example of a
urine collection assembly according to an example of the present
invention;
[0217] FIG. 10B is a schematic drawing taken along section 10B-10B
of the bladder anchor portion of the assembly of FIG. 10A;
[0218] FIG. 11A is a schematic drawing of a urine collection
assembly according to an example of the present invention;
[0219] FIG. 11B is a schematic drawing taken along section 11B-11B
of a bladder anchor portion of the assembly of FIG. 11A;
[0220] FIG. 12A is a schematic drawing of another bladder anchor
portion of a urine collection assembly according to an example of
the disclosure;
[0221] FIG. 12B is a schematic drawing of a cross section of a
bladder catheter of a urine collection assembly, taken along line
C-C of FIG. 12A;
[0222] FIG. 12C is a schematic drawing of a cross section of
another example of a bladder catheter of a urine collection
assembly;
[0223] FIG. 13 is a schematic drawing of another example of a
bladder anchor portion of a urine collection assembly according to
an example of the present disclosure;
[0224] FIG. 14 is a schematic drawing of another example of a
bladder anchor portion of a urine collection assembly according to
an example of the present disclosure;
[0225] FIG. 15 is a schematic drawing of another example of a
bladder anchor portion of a urine collection assembly configured to
be deployed in the patient's bladder and urethra according to an
example of the present invention;
[0226] FIG. 16 is a schematic drawing of another example of a
bladder anchor portion of a urine collection assembly according to
an example of the present invention;
[0227] FIG. 17A is an exploded perspective view of a connector for
a urine collection assembly according to an example of the
disclosure;
[0228] FIG. 17B is a cross-sectional view of a portion of the
connector of FIG. 17A;
[0229] FIG. 17C is a schematic drawing of a connector for a urine
collection assembly according to an example of the disclosure;
[0230] FIG. 18A is a flow chart illustrating a process for
insertion and deployment of a ureteral catheter or urine collection
assembly according to an example of the present invention;
[0231] FIG. 18B is a flow chart illustrating a process for applying
negative pressure using a ureteral catheter or urine collection
assembly according to an example of the present invention;
[0232] FIG. 19 is a schematic drawing of a system for inducing
negative pressure to the urinary tract of a patient according to an
example of the present invention;
[0233] FIG. 20A is a plan view of a pump for use with the system of
FIG. 19 according to an example of the present invention;
[0234] FIG. 20B is a side elevation view of the pump of FIG.
20A;
[0235] FIG. 21 is a schematic drawing of an experimental set-up for
evaluating negative pressure therapy in a swine model;
[0236] FIG. 22 is a graph of creatinine clearance rates for tests
conducted using the experimental set-up shown in FIG. 21;
[0237] FIG. 23A is a low magnification photomicrograph of kidney
tissue from a congested kidney treated with negative pressure
therapy;
[0238] FIG. 23B is a high magnification photomicrograph of the
kidney tissue shown in FIG. 23A;
[0239] FIG. 23C is a low magnification photomicrograph of kidney
tissue from a congested and untreated (e.g., control) kidney;
[0240] FIG. 23D is a high magnification photomicrograph of the
kidney tissue shown in FIG. 23C
[0241] FIG. 24 is a flow chart illustrating a process for reducing
creatinine and/or protein levels of a patient according to an
aspect of the disclosure;
[0242] FIG. 25 is a flow chart illustrating a process for treating
a patient undergoing fluid resuscitation according to an aspect of
the disclosure; and
[0243] FIG. 26 is a graph of serum albumin relative to baseline for
tests conduct on swine using the experimental method described
herein.
DETAILED DESCRIPTION OF THE INVENTION
[0244] As used herein, the singular form of "a", "an", and "the"
include plural referents unless the context clearly states
otherwise.
[0245] As used herein, the terms "right", "left", "top", and
derivatives thereof shall relate to the invention as it is oriented
in the drawing figures. The term "proximal" refers to the portion
of the catheter device that is manipulated or contacted by a user
and/or to a portion of an indwelling catheter nearest to the
urinary tract access site. The term "distal" refers to the opposite
end of the catheter device that is configured to be inserted into a
patient and/or to the portion of the device that is inserted
farthest into the patient's urinary tract. However, it is to be
understood that the invention can assume various alternative
orientations and, accordingly, such terms are not to be considered
as limiting. Also, it is to be understood that the invention can
assume various alternative variations and stage sequences, except
where expressly specified to the contrary. It is also to be
understood that the specific devices and processes illustrated in
the attached drawings, and described in the following
specification, are examples. Hence, specific dimensions and other
physical characteristics related to the embodiments disclosed
herein are not to be considered as limiting.
[0246] For the purposes of this specification, unless otherwise
indicated, all numbers expressing quantities of ingredients,
reaction conditions, dimensions, physical characteristics, and so
forth used in the specification and claims are to be understood as
being modified in all instances by the term "about." Unless
indicated to the contrary, the numerical parameters set forth in
the following specification and attached claims are approximations
that can vary depending upon the desired properties sought to be
obtained by the present invention.
[0247] Notwithstanding that the numerical ranges and parameters
setting forth the broad scope of the invention are approximations,
the numerical values set forth in the specific examples are
reported as precisely as possible. Any numerical value, however,
inherently contains certain errors necessarily resulting from the
standard deviation found in their respective testing
measurements.
[0248] Also, it should be understood that any numerical range
recited herein is intended to include all sub-ranges subsumed
therein. For example, a range of "1 to 10" is intended to include
any and all sub-ranges between and including the recited minimum
value of 1 and the recited maximum value of 10, that is, all
subranges beginning with a minimum value equal to or greater than 1
and ending with a maximum value equal to or less than 10, and all
subranges in between, e.g., 1 to 6.3, or 5.5 to 10, or 2.7 to
6.1.
[0249] As used herein, the terms "communication" and "communicate"
refer to the receipt or transfer of one or more signals, messages,
commands, or other type of data. For one unit or component to be in
communication with another unit or component means that the one
unit or component is able to directly or indirectly receive data
from and/or transmit data to the other unit or component. This can
refer to a direct or indirect connection that can be wired and/or
wireless in nature. Additionally, two units or components can be in
communication with each other even though the data transmitted can
be modified, processed, routed, and the like, between the first and
second unit or component. For example, a first unit can be in
communication with a second unit even though the first unit
passively receives data, and does not actively transmit data to the
second unit. As another example, a first unit can be in
communication with a second unit if an intermediary unit processes
data from one unit and transmits processed data to the second unit.
It will be appreciated that numerous other arrangements are
possible.
[0250] Fluid retention and venous congestion are central problems
in the progression to advanced renal disease. Excess sodium
ingestion coupled with relative decreases in excretion leads to
isotonic volume expansion and secondary compartment involvement. In
some examples, the present invention is generally directed to
devices and methods for facilitating drainage of urine or waste
from the bladder, ureter, and/or kidney(s) of a patient. In some
examples, the present invention is generally directed to devices
and methods for inducing a negative pressure in the bladder,
ureter, and/or kidney(s) of a patient. While not intending to be
bound by any theory, it is believed that applying a negative
pressure to the bladder, ureter, and/or kidney(s) can offset the
medullary nephron tubule re-absorption of sodium and water in some
situations. Offsetting re-absorption of sodium and water can
increase urine production, decrease total body sodium, and improve
erythrocyte production. Since the intra-medullary pressures are
driven by sodium and, therefore, volume overload, the targeted
removal of excess sodium enables maintenance of volume loss.
Removal of volume restores medullary hemostasis. Normal urine
production is 1.48-1.96 L/day (or 1-1.4 ml/min).
[0251] Fluid retention and venous congestion are also central
problems in the progression of prerenal Acute Kidney Injury (AKI).
Specifically, AKI can be related to loss of perfusion or blood flow
through the kidney(s). Accordingly, in some examples, the present
invention facilitates improved renal hemodynamics and increases
urine output for the purpose of relieving or reducing venous
congestion. Further, it is anticipated that treatment and/or
inhibition of AKI positively impacts and/or reduces the occurrence
of other conditions, for example, reduction or inhibition of
worsening renal function in patients with NYHA Class III and/or
Class IV heart failure. Classification of different levels of heart
failure are described in The Criteria Committee of the New York
Heart Association, (1994), Nomenclature and Criteria for Diagnosis
of Diseases of the Heart and Great Vessels, (9th ed.), Boston:
Little, Brown & Co. pp. 253-256, the disclosure of which is
incorporated by reference herein in its entirety. Reduction or
inhibition of episodes of AKI and/or chronically decreased
perfusion may also be a treatment for Stage 4 and/or Stage 5
chronic kidney disease. Chronic kidney disease progression is
described in National Kidney Foundation, K/DOQI Clinical Practice
Guidelines for Chronic Kidney Disease: Evaluation, Classification
and Stratification. Am. J. Kidney Dis. 39:S1-S266, 2002 (Suppl. 1),
the disclosure of which is incorporated by reference herein in its
entirety.
[0252] With reference to FIG. 1, the urinary tract comprises a
patient's right kidney 2 and left kidney 4. As discussed above, the
kidneys 2, 4 are responsible for blood filtration and clearance of
waste compounds from the body through urine. Urine produced by the
right kidney 2 and the left kidney 4 is drained into a patient's
bladder 10 through tubules, namely a right ureter 6 and a left
ureter 8. For example, urine may be conducted through the ureters
6, 8 by peristalsis of the ureter walls, as well as by gravity. The
ureters 6, 8 enter the bladder 10 through a ureter orifice or
opening 16. The bladder 10 is a flexible and substantially hollow
structure adapted to collect urine until the urine is excreted from
the body. The bladder 10 is transitionable from an empty position
(signified by reference line E) to a full position (signified by
reference line F). Normally, when the bladder 10 reaches a
substantially full state, urine is permitted to drain from the
bladder 10 to a urethra 12 through a urethral sphincter or opening
18 located at a lower portion of the bladder 10. Contraction of the
bladder 10 can be responsive to stresses and pressure exerted on a
trigone region 14 of the bladder 10, which is the triangular region
extending between the ureteral openings 16 and the urethral opening
18. The trigone region 14 is sensitive to stress and pressure, such
that as the bladder 10 begins to fill, pressure on the trigone
region 14 increases. When a threshold pressure on the trigone
region 14 is exceeded, the bladder 10 begins to contract to expel
collected urine through the urethra 12.
Exemplary Ureteral Catheters:
[0253] As shown in FIG. 1, a urine collection assembly 100
including ureteral catheters 112, 114 configured to be positioned
within the urinary tract of a patient is illustrated. For example,
distal ends 120, 121 of the ureteral catheters 112, 114 can be
configured to be deployed in the patient's ureters 2, 4 and, in
particular, in a renal pelvis 20, 21 area of the kidneys 6, 8.
[0254] In some examples, the urine collection assembly 100 can
comprise two separate ureteral catheters, such as a first catheter
112 disposed in or adjacent to the renal pelvis 20 of the right
kidney 2 and a second catheter 114 disposed in or adjacent to the
renal pelvis 21 of the left kidney 4. The catheters 112, 114 can be
separate for their entire lengths, or can be held in proximity to
one another by a clip, ring, clamp, or other type of connection
mechanism (e.g., connector 150) to facilitate placement or removal
of the catheters 112, 114. In some examples, catheters 112, 114 can
merge or be connected together to form a single drainage lumen. In
other examples, the catheters 112, 114 can be inserted through or
enclosed within another catheter, tube, or sheath along portions or
segments thereof to facilitate insertion and retraction of the
catheters 112, 114 from the body. For example, a bladder catheter
116 can be inserted over and/or along the same guidewire as the
ureteral catheters 112, 114, thereby causing the ureteral catheters
112, 114 to extend from the distal end of the bladder catheter
116.
[0255] With reference to FIGS. 1, 2A, and 2B, an exemplary ureteral
catheter 112 can comprise at least one elongated body or tube 122,
the interior of which defines or comprises one or more drainage
channel(s) or lumen(s), such as drainage lumen 124. The tube 122
size can range from about 1 Fr to about 9 Fr (French catheter
scale). In some examples, the tube 122 can have an external
diameter ranging from about 0.33 to about 3 mm, and an internal
diameter ranging from about 0.165 to about 2.39 mm. In one
preferable example, the tube 122 is 6 Fr and has an outer diameter
of 2.0.+-.0.1 mm. The length of the tube 122 can range from about
30 cm to about 120 cm depending on the age (e.g., pediatric or
adult) and gender of the patient.
[0256] The tube 122 can be formed from a flexible and/or deformable
material to facilitate advancing and/or positioning the tube 122 in
the bladder 10 and ureters 6, 8 (shown in FIG. 1). The catheter
material should be flexible and soft enough to avoid or reduce
irritation of the renal pelvis and ureter, but should be rigid
enough that the tube 122 does not collapse when the renal pelvis or
other portions of the urinary tract exert pressure on the exterior
of the tube 122, or when the renal pelvis and/or ureter are drawn
against the tube 122 during inducement of negative pressure. For
example, the tube 122 can be formed from materials including
biocompatible polymers, polyvinyl chloride, polytetrafluoroethylene
(PTFE) such as Teflon.RTM., silicon coated latex, or silicon. In
one preferable example, the tube 122 is formed from a thermoplastic
polyurethane. At least a portion or all of the catheter 112, such
as the tube 122, can be coated with a hydrophilic coating to
facilitate insertion and/or removal, and/or to enhance comfort. In
some examples, the coating is a hydrophobic and/or lubricious
coating. For example, suitable coatings can comprise
ComfortCoat.RTM. hydrophilic coating which is available from
Koninklijke DSM N.V. or hydrophilic coatings comprising
polyelectrolyte(s) such as are disclosed in U.S. Pat. No.
8,512,795, which is incorporated herein by reference.
[0257] In some examples, the tube 122 can comprise: a distal
portion 118 (e.g., a portion of the tube 122 configured to be
positioned in the ureter 6, 8 and renal pelvis 20, 21); a middle
portion 126 (e.g., a portion of the tube 122 configured to extend
from the distal portion through the ureteral openings 16 into the
patient's bladder 10 and urethra 12); and a proximal portion 128
(e.g., a portion of the tube 122 extending from the urethra 12 to
an external fluid collection container and/or pump assembly). In
one preferred example, the combined length of the proximal portion
128 and the middle portion 126 of the tube 122 is about 54.+-.2 cm.
In some examples, the tube 122 terminates in another indwelling
catheter and/or drainage lumen, such as in a drainage lumen of the
bladder catheter 116. In that case, fluid drains from the proximal
end of the ureteral catheter 112, 114 and is directed from the body
through the additional indwelling catheter and/or drainage
lumen.
Exemplary Ureteral Retention Portions:
[0258] With continued reference to FIGS. 1, 2A, and 2B, the distal
portion 118 of the ureteral catheter 112 comprises a retention
portion 130 for maintaining the distal end 120 of the catheter 112
at a desired fluid collection position proximate to or within the
renal pelvis 20, 21 of the kidney 2, 4. In some examples, the
retention portion 130 is configured to be flexible and bendable to
permit positioning of the retention portion 130 in the ureter
and/or renal pelvis. The retention portion 130 is desirably
sufficiently bendable to absorb forces exerted on the catheter 112
and to prevent such forces from being translated to the ureters.
For example, if the retention portion 130 is pulled in the proximal
direction P (shown in FIG. 3A) toward the patient's bladder, the
retention portion 130 can be sufficiently flexible to begin to
unwind or be straightened so that it can be drawn through the
ureter. Similarly, when the retention portion 130 can be reinserted
into the renal pelvis or other suitable region within the ureter,
it can be biased to return to its deployed configuration.
[0259] In some examples, the retention portion 130 is integral with
the tube 122. In that case, the retention portion 130 can be formed
by imparting a bend or curl to the catheter body 122 that is sized
and shaped to retain the catheter at a desired fluid collection
location. Suitable bends or coils can include a pigtail coil,
corkscrew coil, and/or helical coil. For example, the retention
portion 130 can comprise one or more radially and longitudinally
extending helical coils configured to contact and passively retain
the catheter 112 within the ureter 6, 8 proximate to or within the
renal pelvis 20, 21. In other examples, the retention portion 130
is formed from a radially flared or tapered portion of the catheter
body 122. For example, the retention portion 130 can further
comprise a fluid collecting portion, as shown in FIGS. 4A and 4B,
such as a tapered or funnel-shaped inner surface 186. In other
examples, the retention portion 130 can comprise a separate element
connected to and extending from the catheter body or tube 122.
[0260] The retention portion 130 can further comprise one or more
perforated sections, such as drainage holes or ports 132 (shown in
FIGS. 3A-3E). A drainage port can be located, for example, at the
open distal end 120, 121 of the tube 122. In other examples,
perforated sections and/or drainage ports 132 are disposed along
the sidewall of the distal portion 118 of the catheter tube 122.
The drainage ports or holes can be used for assisting in fluid
collection. In other examples, the retention portion 130 is solely
a retention structure and fluid collection and/or imparting
negative pressure is provided by structures at other locations on
the catheter tube 122.
[0261] Referring now to FIGS. 2A, 2B, and 3A-3E, exemplary
retention portions 130 comprising a plurality of helical coils,
such as one or more full coils 184 and one or more half or partial
coils 183, are illustrated. The retention portion 130 is capable of
moving between a contracted position and the deployed position with
the plurality of helical coils. For example, a substantially
straight guidewire can be inserted through the retention portion
130 to maintain the retention portion 130 in a substantially
straight contracted position. When the guidewire is removed, the
retention portion 130 can transition to its coiled configuration.
In some examples, the coils 183, 184 extend radially and
longitudinally from the distal portion 118 of the tube 122. With
specific reference to FIGS. 2A and 2B, in a preferred exemplary
embodiment, the retention portion 130 comprises two full coils 184
and one half coil 183. The outer diameter of the full coils 184,
shown by line D1, can be about 18.+-.2 mm. The half coil 183
diameter D2 can be about 14 mm. The coiled retention portion 130
has a height H of about 16.+-.2 mm. The retention portion 130 can
further comprise the one or more drainage holes 132 (shown in FIGS.
3A-3E) configured to draw fluid into an interior of the catheter
tube 122. In some examples, the retention portion 130 can comprise
six drainage holes, plus an additional hole at the distal tip 120
of the retention portion. The diameter of each of the drainage
holes 132 (shown in FIGS. 3A-3E) can range from about 0.7 mm to 0.9
mm and, preferably, is about 0.83.+-.0.01 mm. The distance between
adjacent drainage holes 132, specifically the linear distance
between drainage holes 132 when the coils are straightened, can be
about 22.5.+-.2.5 mm.
[0262] As shown in FIGS. 3A-3E, in another exemplary embodiment,
the distal portion 118 of the drainage lumen proximal to the
retention portion 130 defines a straight or curvilinear central
axis L. In some examples, at least a half or first coil 183 and a
full or second coil 184 of the retention portion 130 extend about
an axis A of the retention portion 130. The first coil 183
initiates or begins at a point where the tube 122 is bent at an
angle .alpha. ranging from about 15 degrees to about 75 degrees
from the central axis L, as indicated by angle .alpha., and
preferably about 45 degrees. As shown in FIGS. 3A and 3B, prior to
insertion in the body, the axis A can be coextensive with the
longitudinal central axis L. In other examples, as shown in FIGS.
3C-3E, prior to insertion in the body, the axis A extends from and
is curved or angled, for example at angle (3, relative to the
central longitudinal axis L.
[0263] In some examples, multiple coils 184 can have the same inner
and/or outer diameter D and height H2. In that case, the outer
diameter D1 of the coils 184 may range between 10 mm and 30 mm. The
height H2 between coils 184 may be about 3 mm to 10 mm.
[0264] In other examples, the retention portion 130 is configured
to be inserted in the tapered portion of the renal pelvis. For
example, the outer diameter D1 of the coils 184 can increase toward
the distal end 120 of the tube 122, resulting in a helical
structure having a tapered or partially tapered configuration. For
example, the distal or maximum outer diameter D1 of the tapered
helical portion ranges from about 10 mm to about 30 mm, which
corresponds to the dimensions of the renal pelvis. The height H2 of
the retention portion 130 ranges from about 10 mm to about 30
mm.
[0265] In some examples, the outer diameter D1 and/or height H2 of
the coils 184 can vary in a regular or irregular fashion. For
example, the outer diameter D1 of coils or height H2 between coils
can increase or decrease by a regular amount (e.g., about 10% to
about 25% between adjacent coils 184). For example, for a retention
portion 130 having three coils (as shown, for example, in FIGS. 3A
and 3B) an outer diameter D3 of a proximal-most coil or first coil
183 can be about 6 mm to 18 mm, an outer diameter D2 of a middle
coil or second coil 185 can be about 8 mm to about 24 mm, and an
outer diameter D1 of a distal-most or third coil 187 can be between
about 10 mm and about 30 mm.
[0266] The retention portion 130 can further comprise the drainage
ports 132 or holes disposed on or through the sidewall of the
catheter tube 122 on or adjacent to the retention portion 130 to
permit urine waste to flow from the outside of the catheter tube
122 to the inside of the catheter tube 122. The position and size
of the drainage ports 132 can vary depending upon the desired flow
rate and configuration of the retention portion. The diameter of
the drainage ports 132 can range from about 0.005 mm to about 1.0
mm. The spacing between the drainage ports 132 can range from about
1.5 mm to about 5 mm. The drainage ports 132 can be spaced in any
arrangement, for example, linear or offset. In some examples, the
drainage ports 132 can be non-circular, and can have a surface area
of about 0.00002 to 0.79 mm.sup.2.
[0267] In some examples, as shown in FIG. 3A, the drainage ports
132 are located around the entire periphery of the sidewall of the
catheter tube 122 to increase an amount of fluid that can be drawn
into the drainage lumen 124 (shown in FIGS. 1, 2A, and 2B). In
other examples, as shown in FIGS. 3B-3E, the drainage ports 132 can
be disposed essentially only or only on the radially inwardly
facing side of the coils 184 to prevent occlusion or blockage of
the drainage ports 132, and the outwardly facing side of the coils
may be essentially free of drainage ports 132 or free of drainage
ports 132. For example, when negative pressure is induced in the
ureter and/or renal pelvis, mucosal tissue of the ureter and/or
kidney may be drawn against the retention portion 130 and may
occlude some drainage ports 132 on the outer periphery of the
retention portion 130. Drainage ports 132 located on the radially
inward side of the retention structure would not be appreciably
occluded when such tissues contact the outer periphery of the
retention portion 130. Further, risk of injury to the tissues from
pinching or contact with the drainage ports 132 can be reduced or
ameliorated.
[0268] With reference to FIGS. 3C and 3D, other examples of
ureteral catheters 112 having a retention portion 130 comprising a
plurality of coils are illustrated. As shown in FIG. 3C, the
retention portion 130 comprises three coils 184 extending about the
axis A. The axis A is a curved arc extending from the central
longitudinal axis L of the portion of the drainage lumen 181
proximal to the retention portion 130. The curvature imparted to
the retention portion 130 can be selected to correspond to the
curvature of the renal pelvis, which comprises a cornucopia-shaped
cavity.
[0269] As shown in FIG. 3D, in another exemplary embodiment, the
retention portion 130 can comprise two coils 184 extending about an
angled axis A. The angled axis A extends at an angle from a central
longitudinal axis L, and is angled, as shown by angle (3, relative
to an axis generally perpendicular to the central axis L of the
portion of the drainage lumen. The angle (3 can range from about 15
to about 75 degrees (e.g., about 105 to about 165 degrees relative
to the central longitudinal axis L of the drainage lumen portion of
the catheter 112).
[0270] FIG. 3E shows another example of a ureteral catheter 112.
The retention portion comprises three helical coils 184 extending
about an axis A. The axis A is angled, as shown by angle (3,
relative to the horizontal. As in the previously-described
examples, the angle (3 can range from about 15 to about 75 degrees
(e.g., about 105 to about 165 degrees relative to the central
longitudinal axis L of the drainage lumen portion of the catheter
112).
[0271] With reference to FIGS. 4A and 4B, in another example, a
retention portion 130 of a ureteral catheter 112 comprises a
catheter tube 122 having a widened and/or tapered distal end
portion which, in some examples, is configured to be positioned in
the patient's renal pelvis and/or kidney. For example, the
retention portion 130 can be a funnel-shaped structure comprising
an outer surface 185 configured to be positioned against the ureter
and/or kidney wall and comprising an inner surface 186 configured
to direct fluid toward a drainage lumen 124 of the catheter 112.
The retention portion 130 can comprise a proximal end 188 adjacent
to the distal end of the drainage lumen 124 and having a first
diameter D1 and a distal end 190 having a second diameter D2 that
is greater than the first diameter D1 when the retention portion
130 is in its deployed position. In some examples, the retention
portion 130 is transitionable from a collapsed or compressed
position to the deployed position. For example, the retention
portion 130 can be biased radially outward such that when the
retention portion 130 is advanced to its fluid collecting position,
the retention portion 130 (e.g., the funnel portion) expands
radially outward to the deployed state.
[0272] The retention portion 130 of the ureteral catheter 112 can
be made from a variety of suitable materials that are capable of
transitioning from the collapsed state to the deployed state. In
one example, the retention portion 130 comprises a framework of
tines or elongated members formed from a temperature sensitive
shape memory material, such as nitinol. In some examples, the
nitinol frame can be covered with a suitable waterproof material
such as silicon to form a tapered portion or funnel. In that case,
fluid is permitted to flow down the inner surface 186 of the
retention portion 130 and into the drainage lumen 124. In other
examples, the retention portion 130 is formed from various rigid or
partially rigid sheets or materials bended or molded to form a
funnel-shaped retention portion as illustrated in FIGS. 4A and
4B.
[0273] In some examples, the retention portion of the ureteral
catheter 112 can include one or more mechanical stimulation devices
191 for providing stimulation to nerves and muscle fibers in
adjacent tissues of the ureter(s) and renal pelvis. For example,
the mechanical stimulation devices 191 can include linear or
annular actuators embedded in or mounted adjacent to portions of
the sidewall of the catheter tube 122 and configured to emit low
levels of vibration. In some examples, mechanical stimulation can
be provided to portions of the ureters and/or renal pelvis to
supplement or modify therapeutic effects obtained by application of
negative pressure. While not intending to be bound by theory, it is
believed that such stimulation affects adjacent tissues by, for
example, stimulating nerves and/or actuating peristaltic muscles
associated with the ureter(s) and/or renal pelvis. Stimulation of
nerves and activation of muscles may produce changes in pressure
gradients or pressure levels in surrounding tissues and organs
which may contribute to or, in some cases, enhance therapeutic
benefits of negative pressure therapy.
[0274] With reference to FIGS. 5A and 5B, according to another
example, a retention portion 330 of a ureteral catheter 312
comprises a catheter tube 322 having a distal portion 318 formed in
a helical structure 332 and an inflatable element or balloon 350
positioned proximal to the helical structure 332 to provide an
additional degree of retention in the renal pelvis and/or fluid
collection location. A balloon 350 can be inflated to pressure
sufficient to retain the balloon in the renal pelvis or ureter, but
low enough to avoid distending or damaging these structures.
Suitable inflation pressures are known to those skilled in the art
and are readily discernible by trial and error. As in
previously-described examples, the helical structure 332 can be
imparted by bending the catheter tube 322 to form one or more coils
334. The coils 334 can have a constant or variable diameter and
height as described above. The catheter tube 322 further comprises
a plurality of drainage ports 336 disposed on the sidewall of the
catheter tube 322 to allow urine to be drawn into the drainage
lumen 324 of the catheter tube 322 and to be directed from the body
through the drainage lumen 324, for example on the inwardly facing
and/or outwardly facing sides of the coil 334.
[0275] As shown in FIG. 5B, the inflatable element or balloon 350
can comprise an annular balloon-like structure having, for example,
a generally heart-shaped cross section and comprising a surface or
cover 352 defining a cavity 353. The cavity 353 is in fluid
communication with an inflation lumen 354 extending parallel to the
drainage lumen 324 defined by the catheter tube 322. The balloon
350 can be configured to be inserted in the tapered portion of the
renal pelvis and inflated such that an outer surface 356 thereof
contacts and rests against an inner surface of the ureter and/or
renal pelvis. The inflatable element or balloon 350 can comprise a
tapered inner surface 358 extending longitudinally and radially
inward towards the catheter tube 322. The inner surface 358 can be
configured to direct urine toward the catheter tube 322 to be drawn
into the drainage lumen 324. The inner surface 358 can also be
positioned to prevent fluid from pooling in the ureter, such as
around the periphery of the inflatable element or balloon 350. The
inflatable retention portion or balloon 350 is desirably sized to
fit within the renal pelvis and can have a diameter ranging from
about 10 mm to about 30 mm.
[0276] With reference to FIGS. 6 and 7, in some examples, an
assembly 400 including a ureteral catheter 412 comprising a
retention portion 410 is illustrated. The retention portion 410 is
formed from a porous and/or sponge-like material that is attached
to a distal end 421 of a catheter tube 422. The porous material can
be configured to channel and/or absorb urine and direct the urine
toward a drainage lumen 424 of the catheter tube 422. As shown in
FIG. 7, the retention portion 410 can be a porous wedge
shaped-structure configured for insertion and retention in the
patient's renal pelvis. The porous material comprises a plurality
of holes and/or channels. Fluid can be drawn through the channels
and holes, for example, by gravity or upon inducement of negative
pressure through the catheter 412. For example, fluid can enter the
wedge-shaped retention portion 410 through the holes and/or
channels and is drawn toward a distal opening 420 of the drainage
lumen 424, for example, by capillary action, peristalsis, or as a
result of the inducement of negative pressure in the holes and/or
channels. In other examples, as shown in FIG. 7, the retention
portion 410 comprises a hollow, funnel structure formed from the
porous sponge-like material. As shown by arrow A, fluid is directed
down an inner surface 426 of the funnel structure into the drainage
lumen 424 defined by the catheter tube 422. Also, fluid can enter
the funnel structure of the retention portion 410 through holes and
channels in the porous sponge-like material of a sidewall 428. For
example, suitable porous materials can include open-celled
polyurethane foams, such as polyurethane ether. Suitable porous
materials can also include laminates of woven or non-woven layers
comprising, for example, polyurethane, silicone, polyvinyl alcohol,
cotton, or polyester, with or without antimicrobial additives such
as silver, and with or without additives for modifying material
properties such as hydrogels, hydrocolloids, acrylic, or
silicone.
[0277] With reference to FIG. 8, according to another example, a
retention portion 500 of a ureteral catheter 512 comprises an
expandable cage 530. The expandable cage 530 comprises one or more
longitudinally and radially extending hollow tubes 522. For
example, the tubes 522 can be formed from an elastic, shape memory
material such as nitinol. The cage 530 is configured to transition
from a contracted state, for insertion through the patient's
urinary tract, to a deployed state for positioning in the patient's
ureters and/or kidney. The hollow tubes 522 comprise a plurality of
drainage ports 534 which can be positioned on the tubes, for
example, on radially inward facing sides thereof. The ports 534 are
configured to permit fluid to flow or be drawn through the ports
534 and into the respective tubes 522. The fluid drains through the
hollow tubes 522 into a drainage lumen 524 defined by a catheter
body 526 of the ureteral catheter 512. For example, fluid can flow
along the path indicated by the arrows 532 in FIG. 8. In some
examples, when negative pressure is induced in the renal pelvis,
kidneys, and/or ureters, portions of the ureter wall and/or renal
pelvis may be drawn against the outward facing surfaces of the
hollow tubes 522. The drainage ports 534 are positioned and
configured so as not to be appreciably occluded by ureteral
structures upon application of negative pressure to the ureters
and/or kidney.
Exemplary Urine Collection Assembly:
[0278] Referring now to FIGS. 1, 9A, and 11A, the urine collection
assembly 100 further comprises a bladder catheter 116. The distal
ends 120, 121 of the ureteral catheters 112, 114 can be connected
to the bladder catheter 116 to provide a single drainage lumen for
urine, or the ureteral catheter(s) can drain via separate tube(s)
from the bladder catheter 116.
[0279] Exemplary Bladder Catheter
[0280] The bladder catheter 116 comprises a deployable seal and/or
anchor 136 for anchoring, retaining, and/or providing passive
fixation for indwelling portions of the urine collection assembly
100 and, in some examples, to prevent premature and/or untended
removal of assembly components during use. The anchor 136 is
configured to be located adjacent to the lower wall of the
patient's bladder 10 (shown in FIG. 1) to prevent patient motion
and/or forces applied to indwelling catheters 112, 114, 116 from
translating to the ureters. The bladder catheter 116 comprises an
interior of which defines a drainage lumen 140 configured to
conduct urine from the bladder 10 to an external urine collection
container 712 (shown in FIG. 19). In some examples, the bladder
catheter 116 size can range from about 8 Fr to about 24 Fr. In some
examples, the bladder catheter 116 can have an external diameter
ranging from about 2.7 to about 8 mm. In some examples, the bladder
catheter 116 can have an internal diameter ranging from about 2.16
to about 6.2 mm. The bladder catheter 116 can be available in
different lengths to accommodate anatomical differences for gender
and/or patient size. For example, the average female urethra length
is only a few inches, so the length of a tube 138 can be rather
short. The average urethra length for males is longer due to the
penis and can be variable. It is possible that woman can use
bladder catheters 116 with longer length tubes 138 provided that
the excess tubing does not increase difficulty in manipulating
and/or preventing contamination of sterile portions of the catheter
116. In some examples, a sterile and indwelling portion of the
bladder catheter 116 can range from about 1 inch to 3 inches (for
women) to about 20 inches for men. The total length of the bladder
catheter 116 including sterile and non-sterile portions can be from
one to several feet.
[0281] The catheter tube 138 can comprise one or more drainage
ports 142 configured to be positioned in the bladder 10 for drawing
urine into the drainage lumen 140. For example, excess urine left
in the patient's bladder 10 during placement of the ureteral
catheters 112, 114 is expelled from the bladder 10 through the
ports 142 and drainage lumen 140. In addition, any urine that is
not collected by the ureteral catheters 112, 114 accumulates in the
bladder 10, and can be conducted from the urinary tract through the
drainage lumen 140. The drainage lumen 140 may be pressurized to a
negative pressure to assist in fluid collection or may be
maintained at atmospheric pressure such that fluid is collected by
gravity and/or as a result of partial contraction of the bladder
10. In some examples, the ureteral catheters 112, 114 may extend
from the drainage lumen 140 of the bladder catheter 116 to
facilitate and/or simplify insertion and placement of the ureteral
catheters 112, 114.
[0282] With specific reference to FIG. 1, the deployable seal
and/or anchor 136 is disposed at or adjacent to a distal end 148 of
the bladder catheter 116. The deployable anchor 136 is configured
to transition between a contracted state for insertion into the
bladder 10 through the urethra 12 and urethral opening 18 and a
deployed state. The anchor 136 is configured to be deployed in and
seated adjacent to a lower portion of the bladder 10 and/or against
the urethral opening 18. For example, the anchor 136 can be
positioned adjacent to the urethral opening 18 to enhance suction
of a negative pressure applied to the bladder 10 or, in the absence
of negative pressure, to partially, substantially, or entirely seal
the bladder 10 to ensure that urine in the bladder 10 is directed
through the drainage lumen 140 and to prevent leakage to the
urethra 12. For a bladder catheter 116 including an 8. Fr to 24. Fr
elongated tube 138, the anchor 136 can be about 12 Fr to 32. Fr
(e.g., having a diameter of about 4 mm to about 10.7 mm) in the
deployed state, and preferably between about 24 Fr and 30. Fr. A
24. Fr anchor has a diameter of about 8 mm. It is believed that a
24. Fr anchor 136 would be a single size suitable for all or most
patients. For a catheter 116 with a 24. Fr anchor 136, a suitable
length of the anchor 136 is between about 1.0 cm and 2.3 cm, and
preferably about 1.9 cm (about 0.75 in).
[0283] Exemplary Bladder Anchor Structures:
[0284] With specific reference to FIGS. 1, 12A, and 13, an
exemplary bladder anchor 136 in the form of an expandable balloon
144 is illustrated. The expandable (e.g., inflatable) balloon 144
can be, for example, a spherical balloon of a Foley catheter. The
balloon 144 can be about 1.0 cm to 2.3 cm in diameter, and
preferably about 1.9 cm (0.75 in) in diameter. The balloon 144 is
preferably formed from a flexible material including, for example,
biocompatible polymers, polyvinyl chloride, polytetrafluoroethylene
(PTFE) such as Teflon.RTM., silicon coated latex, or silicon.
[0285] The balloon 144 is in fluid connection with an inflation
lumen 146, and is inflated by introducing fluid into the balloon
144. In a deployed state, the balloon 144 can be a substantially
spherical structure mounted to and extending radially outward from
the catheter tube 138 of the bladder catheter 116 and comprising a
central cavity or channel for the catheter tube 138 to pass
through. In some examples, the catheter tube 138 extends through
the cavity defined by the balloon 144, such that the open distal
end 148 of the catheter tube 138 extends distally beyond the
balloon 144 and toward the center of the bladder 10 (shown in FIG.
1). Excess urine collected in the bladder 10 can be drawn into the
drainage lumen 140 through the distal open end 148 thereof.
[0286] As shown in FIGS. 1 and 12A, in one example, the ureteral
catheters 112, 114 extend from the open distal end 148 of the
drainage lumen 140. In another example, as shown in FIG. 14, the
ureteral catheters 112, 114 extend through ports 172 or openings
disposed on a sidewall of the catheter tube 138 at a position
distal to the balloon 144. The ports 172 can be circular or oval
shaped. The ports 172 are sized to receive the ureteral catheters
112, 114 and, accordingly, can have a diameter ranging from about
0.33 mm to about 3 mm. As shown in FIG. 13, in another example, the
bladder catheter 116 is positioned next to the balloon 144, rather
than extending through a central cavity defined by the balloon 144.
As in other examples, the ureteral catheters 112, 114 extend
through ports 172 in the sidewall of the bladder catheter 116 and
into the bladder 10.
[0287] With reference to FIG. 12B, a cross-sectional view of the
bladder catheter 116 and ureteral catheter(s) 112, 114 is shown. As
shown in FIG. 12B, in one example, the bladder catheter 116
comprises a dual lumen catheter with the drainage lumen 140 at a
central region thereof and a smaller inflation lumen 146 extending
along the periphery of the catheter tube 138. The ureteral
catheters 112, 114 are inserted or enclosed in the central drainage
lumen 140. The ureteral catheters 112, 114 are single-lumen
catheters having a sufficiently narrow cross section to fit within
the drainage lumen 140. In some examples, as discussed above, the
ureteral catheters 112, 114 extend through the entire bladder
catheter 116. In other examples, the ureteral catheters 112, 114
terminate in the drainage lumen 140 of the bladder catheter 116,
either at a position in the patient's ureter 12 or in an external
portion of the drainage lumen 140. As shown in FIG. 12C, in another
example, a bladder catheter 116a is a multi-lumen catheter that
defines at least four lumens, namely a first lumen 112a for
conducting fluid from the first ureteral catheter 112 (shown in
FIG. 1), a second lumen 114a for conducting fluid from the second
ureteral catheter 114 (shown in FIG. 1), a third lumen 140a for
drainage of urine from the bladder 10 (shown in FIG. 1), and the
inflation lumen 146a for conducting fluid to and from the balloon
144 (shown in FIG. 12A) for inflation and retraction thereof.
[0288] As shown in FIG. 15, another example of a catheter balloon
144 for use with a urine collection assembly 100 is illustrated. In
the example of FIG. 15, the balloon 144 is configured to be
positioned partially within the patient's bladder 10 and partially
within the urethra 12 to provide an enhanced bladder seal. A
central portion 145 of the balloon 144 is configured to be radially
contracted by the urethral opening 18, thereby defining a bulbous
upper volume configured to be positioned in the lower portion of
the bladder 10 and a bulbous lower volume configured to be position
at the distal portion of the urethra 12. As in previously-described
examples, the bladder catheter 116 extends through a central cavity
defined by the balloon 144 and toward a central portion of the
bladder 10 and includes drainage ports 142 for conducting urine
from the bladder 10 through a drainage lumen 140 of the catheter
116. The drainage ports 142 can be generally circular or oval
shaped and can have a diameter of about 0.005 mm to about 0.5
mm.
[0289] With reference again to FIGS. 9A and 9B, another example of
a urine collection assembly 100 including a bladder anchor device
134 is illustrated. The bladder anchor device 134 comprises a
bladder catheter 116 defining a drainage lumen 140, an inflation
lumen 146, and an anchor 136, namely, another example of an
expandable balloon 144, configured to be seated in a lower portion
of the bladder 10. Unlike in the previously-described examples, the
ports 142 configured to receive the ureteral catheters 112, 114 are
disposed proximal to and/or below the balloon 144. The ureteral
catheters 112, 114 extend from the ports 142 and, as in
previously-described examples, extend through the ureteral orifices
or openings of the bladder and into the ureters. When the anchor
136 is deployed in the bladder, the ports 142 are disposed in a
lower portion of the bladder adjacent to the urethral opening. The
ureteral catheters 112, 114 extend from the ports 172 and between a
lower portion of the balloon 144 and the bladder wall. In some
examples, the catheters 112, 114 may be positioned to prevent the
balloon 144 and/or bladder wall from occluding the ports 142 so
that excess urine collected in the bladder can be drawn into the
ports 142 to be removed from the body.
[0290] With reference again to FIGS. 10A and 10B, in another
example of a urine collection assembly 200, an expandable cage 210
anchors the assembly 200 in the bladder. The expandable cage 210
comprises a plurality of flexible members 212 or tines extending
longitudinally and radially outward from a catheter body 238 of a
bladder catheter 216 which, in some examples, can be similar to
those discussed above with respect to the retention portion of the
ureteral catheter of FIG. 8. The members 212 can be formed from a
suitable elastic and shape memory material such as nitinol. In a
deployed position, the members 212 or tines are imparted with a
sufficient curvature to define a spherical or ellipsoid central
cavity 242. The cage 210 is attached to an open distal open end 248
of the catheter tube or body 238, to allow access to a drainage
lumen 240 defined by the tube or body 238. The cage 210 is sized
for positioning within the lower portion of the bladder and can
define a diameter and length ranging from 1.0 cm to 2.3 cm, and
preferably about 1.9 cm (0.75 in).
[0291] In some examples, the cage 210 further comprises a shield or
cover 214 over distal portions of the cage 210 to prevent or reduce
the likelihood that tissue, namely, the distal wall of the bladder,
will be caught or pinched as a result of contact with the cage 210
or member 212. More specifically, as the bladder contracts, the
inner distal wall of the bladder comes into contact with the distal
side of the cage 210. The cover 214 prevents the tissue from being
pinched or caught, may reduce patient discomfort, and protect the
device during use. The cover 214 can be formed at least in part
from a porous and/or permeable biocompatible material, such as a
woven polymer mesh. In some examples, the cover 214 encloses all or
substantially all of the cavity 242. In that case, the cover 214
defines openings suitable for receiving the ureteral catheters 112,
114. In some examples, the cover 214 covers only about the distal
2/3, about the distal half, or about the distal third portion or
any amount, of the cage 210. In that case, the ureteral catheters
112, 114 pass through the uncovered portion of the cage 210.
[0292] The cage 210 and cover 214 are transitionable from a
contracted position, in which the members 212 are contracted
tightly together around a central portion and/or around the bladder
catheter 116 to permit insertion through a catheter or sheath to
the deployed position. For example, in the case of a cage 210
constructed from a shape memory material, the cage 210 can be
configured to transition to the deployed position when it is warmed
to a sufficient temperature, such as body temperature (e.g.,
37.degree. C.). In the deployed position, the cage 210 has a
diameter D that is preferably wider than the urethral opening, such
that the cage 210 provides support for the ureteral catheters 112,
114 and prevents patient motion from translating through the
ureteral catheters 112, 114 to the ureters. When the assembly 200
is deployed in the urinary tract, the ureteral catheter(s) 112, 114
extend from the open distal end 248 of the bladder catheter 216,
past the longitudinally extending members 212 of the cage 210, and
into the bladder. Advantageously, the open (e.g., low profile)
arrangement of the members 212 or tines facilitates manipulation of
the ureteral catheters 112, 114 from the bladder catheter 116 and
through the bladder. Particularly, the open arrangement of the
members 212 or tines does not obstruct or occlude the distal
opening 248 and/or drainage ports of the bladder catheter 216,
making manipulation of the catheters 112, 114 easier to
perform.
[0293] With reference to FIG. 16, a portion of another example of a
urine collection assembly 100b is illustrated. The urine collection
assembly 100b comprises a first ureteral catheter 112b and a second
ureteral catheter 114b. The assembly 100b does not comprise a
separate bladder drainage catheter as is provided in the
previously-described examples. Instead, one of the ureteral
catheters 112b comprises a helical portion 127b formed in the
middle portion of the catheter 112b (e.g., the portion of the
catheter configured to be positioned in a lower portion of the
patient's bladder). The helical portion 127b comprises at least one
and preferably two or more coils 176b. The coils 176b can be formed
by bending a catheter tube 138b to impart a desired coil
configuration. A lower coil 178b of the helical portion 127b is
configured to be seated against and/or adjacent to the urethral
opening. Desirably, the helical portion 127b has a diameter D that
is larger than the urethral opening to prevent the helical portion
127b from being drawn into the urethra. In some examples, a port
142b or opening is disposed in the sidewall of the catheter tube
138b for connecting the first ureteral catheter 112b to the second
ureteral catheter 114b. For example, the second catheter 114b can
be inserted in the port 142b to form a fluid connection between the
first ureteral catheter 112b and the second ureteral catheter 114b.
In some examples, the second catheter 114b terminates at a position
just inside a drainage lumen 140b of the first catheter 112b. In
other examples, the second ureteral catheter 114b is threaded
through and/or extends along the length of the drainage lumen 140b
of the first catheter 112b, but is not in fluid communication with
the drainage lumen 140b.
[0294] With reference again to FIGS. 11A and 11B, another exemplary
urine collection assembly 100 comprising a bladder anchor device
134 is illustrated. The assembly 100 includes ureteral catheters
112, 114 and a separate bladder catheter 116. More specifically, as
in previously-described examples, the assembly 100 includes the
ureteral catheters 112, 114, each of which comprise a distal
portion 118 positioned in or adjacent to the right kidney and the
left kidney, respectively. The ureteral catheters 112, 114 comprise
indwelling portions 118, 126, 128 extending through the ureters,
bladder, and urethra. The ureteral catheters 112, 114 further
comprise an external portion 170 extending from the patient's
urethra 12 to a pump assembly for imparting negative pressure to
the renal pelvis and/or kidneys. The assembly 100 also includes a
bladder anchor device 134 comprising a bladder catheter 116 and an
anchor 136 (e.g., a Foley catheter) deployed in the bladder to
prevent or reduce effects of patient motion from being translated
to the ureteral catheters 112, 114 and/or ureters. The bladder
catheter 116 extends from the bladder 10, through the urethra, and
to a fluid collection container for fluid collection by gravity or
negative pressure drainage. In some examples, an external portion
of the tubing extending between a collection vessel 712 and a pump
710 (shown in FIG. 19) can comprise one or more filters for
preventing urine and/or particulates from entering the pump. As in
previously-described examples, the bladder catheter 116 is provided
to drain excess urine left in the patient's bladder during catheter
placement.
[0295] Exemplary connectors and clamps:
[0296] With reference to FIGS. 1, 11A, and 17A-17C, the assembly
100 further comprises a manifold or connector 150 for joining the
two or more of the catheters 112, 114, 116 at a position outside
the patient's body. In some examples, the connector 150 can be a
clamp, manifold, valve, fastener, or other element of a fluid path
set, as is known in the art, for joining a catheter to external
flexible tubing. As shown in FIGS. 17A and 17B, the manifold or
connector 150 comprises a two-piece body comprising an inner
portion 151 mounted inside an outer housing 153. The inner portion
151 defines channels for conducting fluid between inflow ports 154,
155 and an outflow port 158. The inflow port(s) 154, 155 can
comprise threaded sockets 157 configured to receive proximal
portions of the catheters 112, 114. Desirably, the sockets 157 are
a suitable size to securely receive and hold flexible tubing sized
between 1 Fr and 9. Fr. Generally, a user cinches the sockets 157
around the respective catheter tubes 122 by spinning the socket 157
into the ports 154, 155 in the direction of arrow A1 (shown in FIG.
17B).
[0297] Once the catheters 112, 114 are mounted to the connector
150, urine entering the connector 150 through the vacuum inflow
ports 154, 155 is directed through a fluid conduit in the direction
of arrow A2 (shown in FIG. 17B) to the vacuum outflow port 158. The
vacuum outflow port 158 can be connected to the fluid collection
container 712 and/or pump assembly 710 (shown in FIG. 19) by, for
example, flexible tubing 166 defining a fluid flow path.
[0298] With specific reference to FIG. 17C, another exemplary
connector 150 can be configured to connect three or more catheters
112, 114, 116 to outflow ports 158, 162. The connector 150 can
comprise a structure or body having a distal side 152 comprising
two or more vacuum inflow ports 154, 155 configured to be connected
to proximal ends of the ureteral catheters 112, 114, and a separate
gravity drainage port 156 configured to connect to the proximal end
of the bladder catheter 116. The vacuum ports 154, 155 and/or
proximal ends of the ureteral catheters 112, 114 can comprise a
specific configuration to ensure that the ureteral catheters 112,
114 are connected to the vacuum source and not to some other fluid
collection assembly. Similarly, the gravity drainage port 156
and/or proximal end of the bladder catheter 116 can comprise
another connector configuration to ensure that the bladder catheter
116 and not one of the ureteral catheters 112, 114 is permitted to
drain by gravity drainage. In other examples, the ports 154, 155,
156 and/or proximal ends of the catheters 112, 114, 116 can include
visual indicia to assist in correctly setting up the fluid
collection system.
[0299] In some examples, urine received in the vacuum ports 154,
155 can be directed through a Y-shaped conduit to a single vacuum
outflow port 158 located on a proximal side 160 of the connector
150. As in previously-described examples, the vacuum outflow port
158 can be connected to the fluid collection container 712 and/or
pump 710 by suitable flexible tubing or other conduits for drawing
urine from the body and for inducing negative pressure in the
ureters and/or kidneys. In some examples, the outflow port 156
and/or connector 150 can be configured to attach only to vacuum
sources or pumps operating within a predetermined pressure range or
power level to prevent exposing the ureteral catheters 112, 114 to
elevated levels or intensity of negative pressure. The proximal
side 160 of the connector 150 can also comprise a gravity outflow
port 162 in fluid communication with the inflow port 156. The
gravity outflow port 162 can be configured to be connected directly
to the urine collection container 712 for urine collection by
gravity drainage.
[0300] With continued reference to FIG. 17C, in some examples, in
order to facilitate system setup and implementation, the vacuum
outflow port 158 and the gravity outflow port 162 are disposed in
close proximity so that a single socket 164, bracket, or connector
can be coupled to the connector 150 to establish fluid
communication with each port 158, 162. The single socket or
connector can be coupled to a multi-conduit hose or tube (e.g.,
flexible tubing 166) having a first conduit in fluid communication
with the pump 710 and a second conduit in fluid communication with
the collection container 712. Accordingly, a user can easily set up
the external fluid collection system by inserting the single socket
164 in the connector 150 and connecting the respective conduits to
one of the fluid collection container 712 and pump 710 (shown in
FIG. 19). In other examples, a length of flexible tubing 166 is
connected between the urine collection container 712 and the
gravity outflow port 162, and a separate length of flexible tubing
is connected between the pump 710 and the vacuum outflow port
158.
[0301] Exemplary fluid sensors:
[0302] With reference again to FIG. 1, in some examples, the
assembly 100 further comprises sensors 174 for monitoring fluid
characteristics of urine being collected from the ureters 6, 8
and/or bladder 10. As discussed herein in connection with FIG. 19,
information obtained from the sensors 174 can be transmitted to a
central data collection module or processor and used, for example,
to control operation of an external device, such as the pump 710
(shown in FIG. 19). The sensors 174 can be integrally formed with
one or more of the catheters 112, 114, 116 such as, for example,
embedded in a wall of the catheter body or tube and in fluid
communication with drainage lumens 124, 140. In other examples, one
or more of the sensors 174 can be positioned in a fluid collection
container 712 (shown in FIG. 19) or in internal circuitry of an
external device, such as the pump 710.
[0303] Exemplary sensors 174 that can be used with the urine
collection assembly 100 can comprise one or more of the following
sensor types. For example, the catheter assembly 100 can comprise a
conductance sensor or electrode that samples conductivity of urine.
The normal conductance of human urine is about 5-10 mS/m. Urine
having a conductance outside of the expected range can indicate
that the patient is experiencing a physiological problem, which
requires further treatment or analysis. The catheter assembly 100
can also comprise a flow meter for measuring a flow rate of urine
through the catheter(s) 112, 114, 116. Flow rate can be used to
determine a total volume of fluid excreted from the body. The
catheter(s) 112, 114, 116 can also comprise a thermometer for
measuring urine temperature. Urine temperature can be used to
collaborate the conductance sensor. Urine temperature can also be
used for monitoring purposes, as urine temperature outside of a
physiologically normal range can be indicative of certain
physiological conditions. In some examples, the sensors 174 can be
urine analyte sensors configured to measure a concentration of
creatinine and/or proteins in urine. For example, various
conductivity sensors and optical spectrometry sensors may be used
for determining analyte concentration in urine. Sensors based on
color change reagent test strips may also be used for this
purpose.
Method of Insertion of a Urine Collection Assembly:
[0304] Having described the urine collection assembly 100 including
the ureteral catheter retention portions and bladder anchor device
(e.g., a standard or modified Foley-type catheter), methods for
insertion and deployment of the assemblies will now be discussed in
detail.
[0305] With reference to FIG. 18A, steps for positioning a fluid
collection assembly in a patient's body and, optionally, for
inducing negative pressure in a patient's ureter and/or kidneys are
illustrated. As shown at box 610, a medical professional or
caregiver inserts a flexible or rigid cystoscope through the
patient's urethra and into the bladder to obtain visualization of
the ureteral orifices or openings. Once suitable visualization is
obtained, as shown at box 612, a guidewire is advanced through the
urethra, bladder, ureteral opening, ureter, and to a desired fluid
collection position, such as the renal pelvis of the kidney. Once
the guidewire is advanced to the desired fluid collection position,
a ureteral catheter of the present invention (examples of which are
discussed in detail above) is inserted over the guidewire to the
fluid collection position, as shown at box 614. In some examples,
the location of the ureteral catheter can be confirmed by
fluoroscopy, as shown at box 616. Once the position of the distal
end of the catheter is confirmed, as shown at box 618, the
retention portion of the ureteral catheter can be deployed. For
example, the guidewire can be removed from the catheter, thereby
allowing the distal end and/or retention portion to transition to a
deployed position. In some examples, the deployed distal end
portion of the catheter does not entirely occlude the ureter and/or
renal pelvis, such that urine is permitted to pass outside the
catheter and through the ureters into the bladder. Since moving the
catheter can exert forces against urinary tract tissues, avoiding
complete blockage of the ureters avoids application of force to the
ureter sidewalls, which may cause injury.
[0306] After the ureteral catheter is in place and deployed, the
same guidewire can be used to position a second ureteral catheter
in the other ureter and/or kidney using the same insertion and
positioning methods described herein. For example, the cystoscope
can be used to obtain visualization of the other ureteral opening
in the bladder, and the guidewire can be advanced through the
visualized ureteral opening to a fluid collection position in the
other ureter. A catheter can be drawn alongside the guidewire and
deployed in the manner described herein. Alternatively, the
cystoscope and guidewire can be removed from the body. The
cystoscope can be reinserted into the bladder over the first
ureteral catheter. The cystoscope is used, in the manner described
above, to obtain visualization of the ureteral opening and to
assist in advancing a second guidewire to the second ureter and/or
kidney for positioning of the second ureteral catheter. Once the
ureteral catheters are in place, in some examples, the guidewire
and cystoscope are removed. In other examples, the cystoscope
and/or guidewire can remain in the bladder to assist with placement
of the bladder catheter.
[0307] Optionally, a bladder catheter can also be used. Once the
ureteral catheters are in place, as shown at box 620, the medical
professional or caregiver can insert a distal end of a bladder
catheter in a collapsed or contracted state through the urethra of
the patient and into the bladder. The bladder catheter can be a
conventional Foley bladder catheter or a bladder catheter of the
present invention as discussed in detail above. Once inserted in
the bladder, as shown at box 622, an anchor connected to and/or
associated with the bladder catheter is expanded to a deployed
position. For example, when an expandable or inflatable catheter is
used, fluid may be directed through an inflation lumen of the
bladder catheter to expand a balloon structure located in the
patient's bladder. In some examples, the bladder catheter is
inserted through the urethra and into the bladder without using a
guidewire and/or cystoscope. In other examples, the bladder
catheter is inserted over the same guidewire used to position the
ureteral catheters. Accordingly, when inserted in this manner, the
ureteral catheters can be arranged to extend from the distal end of
the bladder catheter and, optionally, proximal ends of the ureteral
catheters can be arranged to terminate in a drainage lumen of the
bladder catheter.
[0308] In some examples, the urine is permitted to drain by gravity
from the urethra. In other examples, a negative pressure is induced
in the ureteral catheter and/or bladder catheter to facilitate
drainage of the urine.
[0309] With reference to FIG. 18B, steps for using the urine
collection assembly for inducement of negative pressure in the
ureter(s) and/or kidney(s) are illustrated. As shown at box 624,
after the indwelling portions of the bladder and/or ureteral
catheters are correctly positioned and anchoring/retention
structures are deployed, the external proximal ends of the
catheter(s) are connected to fluid collection or pump assemblies.
For example, the ureteral catheter(s) can be connected to a pump
for inducing negative pressure at the patient's renal pelvis and/or
kidney. In a similar manner, the bladder catheter can be connected
directly to a urine collection container for gravity drainage of
urine from the bladder or connected to a pump for inducing negative
pressure at the bladder.
[0310] Once the catheter(s) and pump assembly are connected,
negative pressure is applied to the renal pelvis and/or kidney
and/or bladder through the drainage lumens of the ureteral
catheters and/or bladder catheter, as shown at box 626. The
negative pressure is intended to counter congestion mediated
interstitial hydrostatic pressures due to elevated intra-abdominal
pressure and consequential or elevated renal venous pressure or
renal lymphatic pressure. The applied negative pressure is
therefore capable of increasing flow of filtrate through the
medullary tubules and of decreasing water and sodium
re-absorption.
[0311] In some examples, mechanical stimulation can be provided to
portions of the ureters and/or renal pelvis to supplement or modify
therapeutic affects obtained by application of negative pressure.
For example, mechanical stimulation devices, such as linear
actuators and other known devices for providing, for example,
vibration waves, disposed in distal portions of the ureteral
catheter(s) can be actuated. While not intending to be bound by
theory, it is believed that such stimulation effects adjacent
tissues by, for example, stimulating nerves and/or actuating
peristaltic muscles associated with the ureter(s) and/or renal
pelvis. Stimulation of nerves and activation of muscles may produce
changes in pressure gradients or pressure levels in surrounding
tissues and organs which may contribute to or, in some cases,
enhance therapeutic benefits of negative pressure therapy. In some
examples, the mechanical stimulation can comprise pulsating
stimulation. In other examples, low levels of mechanical
stimulation can be provided continuously as negative pressure is
being provided through the ureteral catheter(s). In other examples,
inflatable portions of the ureteral catheter could be inflated and
deflated in a pulsating manner to stimulate adjacent nerve and
muscle tissue, in a similar manner to actuation of the mechanical
stimulation devices described herein.
[0312] As a result of the applied negative pressure, as shown at
box 628, urine is drawn into the catheter at the plurality of
drainage ports at the distal end thereof, through the drainage
lumen of the catheter, and to a fluid collection container for
disposal. As the urine is being drawn to the collection container,
at box 630, sensors disposed in the fluid collection system provide
a number of measurements about the urine that can be used to assess
the volume of urine collected, as well as information about the
physical condition of the patient and composition of the urine
produced. In some examples, the information obtained by the sensors
is processed, as shown at box 632, by a processor associated with
the pump and/or with another patient monitoring device and, at box
634, is displayed to the user via a visual display of an associated
feedback device.
Exemplary fluid collection system:
[0313] Having described an exemplary urine collection assembly and
method of positioning such an assembly in the patient's body, with
reference to FIG. 19, a system 700 for inducing negative pressure
to a patient's ureter(s) and/or kidney(s) will now be described.
The system 700 can comprise the ureteral catheter(s), bladder
catheter or the urine collection assembly 100 described
hereinabove. As shown in FIG. 19, ureteral catheters 112, 114
and/or the bladder catheter 116 of the assembly 100 are connected
to one or more fluid collection containers 712 for collecting urine
drawn from the renal pelvis and/or bladder. In some examples, the
bladder catheter 116 and the ureteral catheters 112, 114 are
connected to different fluid collection containers 712. The fluid
collection container 712 connected to the ureteral catheter(s) 112,
114 can be in fluid communication with an external fluid pump 710
for generating negative pressure in the ureter(s) and kidney(s)
through the ureteral catheter(s) 112, 114. As discussed herein,
such negative pressure can be provided for overcoming interstitial
pressure and forming urine in the kidney or nephron. In some
examples, a connection between the fluid collection container 712
and pump 710 can comprise a fluid lock or fluid barrier to prevent
air from entering the renal pelvis or kidney in case of incidental
therapeutic or non-therapeutic pressure changes. For example,
inflow and outflow ports of the fluid container can be positioned
below a fluid level in the container. Accordingly, air is prevented
from entering medical tubing or the catheter through either the
inflow or outflow ports of the fluid container 712. As discussed
previously, external portions of the tubing extending between the
fluid collection container 712 and the pump 710 can include one or
more filters to prevent urine and/or particulates from entering the
pump 710.
[0314] As shown in FIG. 19, the system 700 further comprises a
controller 714, such as a microprocessor, electronically coupled to
the pump 710 and having or associated with computer readable memory
716. In some examples, the memory 716 comprises instructions that,
when executed, cause the controller 714 to receive information from
sensors 174 located on or associated with portions of the assembly
100. Information about a condition of the patient can be determined
based on information from the sensors 174. Information from the
sensors 174 can also be used to determine and implement operating
parameters for the pump 710.
[0315] In some examples, the controller 714 is incorporated in a
separate and remote electronic device in communication with the
pump 710, such as a dedicated electronic device, computer, tablet
PC, or smart phone. Alternatively, the controller 714 can be
included in the pump 710 and, for example, can control both a user
interface for manually operating the pump 710, as well as system
functions such as receiving and processing information from the
sensors 174.
[0316] The controller 714 is configured to receive information from
the one or more sensors 174 and to store the information in the
associated computer-readable memory 716. For example, the
controller 714 can be configured to receive information from the
sensor 174 at a predetermined rate, such as once every second, and
to determine a conductance based on the received information. In
some examples, the algorithm for calculating conductance can also
include other sensor measurements, such as urine temperature, to
obtain a more robust determination of conductance.
[0317] The controller 714 can also be configured to calculate
patient physical statistics or diagnostic indicators that
illustrate changes in the patient's condition over time. For
example, the system 700 can be configured to identify an amount of
total sodium excreted. The total sodium excreted may be based, for
example, on a combination of flow rate and conductance over a
period of time.
[0318] With continued reference to FIG. 19, the system 700 can
further comprise a feedback device 720, such as a visual display or
audio system, for providing information to the user. In some
examples, the feedback device 720 can be integrally formed with the
pump 710. Alternatively, the feedback device 720 can be a separate
dedicated or a multipurpose electronic device, such as a computer,
laptop computer, tablet PC, smart phone, or other handheld
electronic devices. The feedback device 720 is configured to
receive the calculated or determined measurements from the
controller 714 and to present the received information to a user
via the feedback device 720. For example, the feedback device 720
may be configured to display current negative pressure (in mmHg)
being applied to the urinary tract. In other examples, the feedback
device 720 is configured to display current flow rate of urine,
temperature, current conductance in mS/m of urine, total urine
produced during the session, total sodium excreted during the
session, other physical parameters, or any combination thereof.
[0319] In some examples, the feedback device 720 further comprises
a user interface module or component that allows the user to
control operation of the pump 710. For example, the user can engage
or turn off the pump 710 via the user interface. The user can also
adjust pressure applied by the pump 710 to achieve a greater
magnitude or rate of sodium excretion and fluid removal.
[0320] Optionally, the feedback device 720 and/or pump 710 further
comprise a data transmitter 722 for sending information from the
device 720 and/or pump 710 to other electronic devices or computer
networks. The data transmitter 722 can utilize a short-range or
long-range data communications protocol. An example of a
short-range data transmission protocol is Bluetooth.RTM..
Long-range data transmission networks include, for example, Wi-Fi
or cellular networks. The data transmitter 722 can send information
to a patient's physician or caregiver to inform the physician or
caregiver about the patient's current condition. Alternatively, or
in addition, information can be sent from the data transmitter 722
to existing databases or information storage locations, such as,
for example, to include the recorded information in a patient's
electronic health record (EHR).
[0321] With continued reference to FIG. 19, in addition to the
urine sensors 174, in some examples, the system 700 further
comprises one or more patient monitoring sensors 724. Patient
monitoring sensors 724 can include invasive and non-invasive
sensors for measuring information about the patient's urine
composition, as discussed in detail above, blood composition (e.g.,
hematocrit ratio, analyte concentration, protein concentration,
creatinine concentration) and/or blood flow (e.g., blood pressure,
blood flow velocity). Hematocrit is a ratio of the volume of red
blood cells to the total volume of blood. Normal hematocrit is
about 25% to 40%, and preferably about 35% and 40% (e.g., 35% to
40% red blood cells by volume and 60% to 65% plasma).
[0322] Non-invasive patient monitoring sensors 724 can include
pulse oximetry sensors, blood pressure sensors, heart rate sensors,
and respiration sensors (e.g., a capnography sensor). Invasive
patient monitoring sensors 724 can include invasive blood pressure
sensors, glucose sensors, blood velocity sensors, hemoglobin
sensors, hematocrit sensors, protein sensors, creatinine sensors,
and others. In still other examples, sensors may be associated with
an extracorporeal blood system or circuit and configured to measure
parameters of blood passing through tubing of the extracorporeal
system. For example, analyte sensors, such as capacitance sensors
or optical spectroscopy sensors, may be associated with tubing of
the extracorporeal blood system to measure parameter values of the
patient's blood as it passes through the tubing. The patient
monitoring sensors 724 can be in wired or wireless communication
with the pump 710 and/or controller 714.
[0323] In some examples, the controller 714 is configured to cause
the pump 710 to provide treatment for a patient based information
obtained from the urine analyte sensor 174 and/or patient
monitoring sensors 724, such as blood monitoring sensors. For
example, pump 710 operating parameters can be adjusted based on
changes in the patient's blood hematocrit ratio, blood protein
concertation, creatinine concentration, urine output volume, urine
protein concentration (e.g., albumin), and other parameters. For
example, the controller 714 can be configured to receive
information about a blood hematocrit ratio or creatinine
concentration of the patient from the patient monitoring sensors
724 and/or analyte sensors 174. The controller 714 can be
configured to adjust operating parameters of the pump 710 based on
the blood and/or urine measurements. In other examples, hematocrit
ratio may be measured from blood samples periodically obtained from
the patient. Results of the tests can be manually or automatically
provided to the controller 714 for processing and analysis.
[0324] As discussed herein, measured hematocrit values for the
patient can be compared to predetermined threshold or clinically
acceptable values for the general population. Generally, hematocrit
levels for females are lower than for males. In other examples,
measured hematocrit values can be compared to patient baseline
values obtained prior to a surgical procedure. When the measured
hematocrit value is increased to within the acceptable range, the
pump 710 may be turned off ceasing application of negative pressure
to the ureter or kidneys. In a similar manner, the intensity of
negative pressure can be adjusted based on measured parameter
values. For example, as the patient's measured parameters begin to
approach the acceptable range, intensity of negative pressure being
applied to the ureter and kidneys can be reduced. In contrast, if
an undesirable trend (e.g., a decrease in hematocrit value, urine
output rate, and/or creatinine clearance) is identified, the
intensity of negative pressure can be increased in order to produce
a positive physiological result. For example, the pump 710 may be
configured to begin by providing a low level of negative pressure
(e.g., between about 0.1 mmHg and 10 mmHg). The negative pressure
may be incrementally increased until a positive trend in patient
creatinine level is observed. However, generally, negative pressure
provided by the pump 710 will not exceed about 50 mmHg.
[0325] With reference to FIGS. 20A and 20B, an exemplary pump 710
for use with the system is illustrated. In some examples, the pump
710 is a micro-pump configured to draw fluid from the catheter(s)
112, 114 (shown, for example, in FIG. 1) and having a sensitivity
or accuracy of about 10 mmHg or less. Desirably, the pump 710 is
capable of providing a range of flow of urine between 0.05 ml/min
and 3 ml/min for extended periods of time, for example, for about 8
hours to about 24 hours per day, for one (1) to about 30 days or
longer. At 0.2 ml/min, it is anticipated that about 300 mL of urine
per day is collected by the system 700. The pump 710 can be
configured to provide a negative pressure to the bladder of the
patient, the negative pressure ranging between about 0.1 mmHg and
50 mmHg or about 5 mmHg to about 20 mmHg (gauge pressure at the
pump 710). For example, a micro-pump manufactured by Langer Inc.
(Model BT100-2J) can be used with the presently disclosed system
700. Diaphragm aspirator pumps, as well as other types of
commercially available pumps, can also be used for this purpose.
Peristaltic pumps can also be used with the system 700. In other
examples, a piston pump, vacuum bottle, or manual vacuum source can
be used for providing negative pressure. In other examples, the
system can be connected to a wall suction source, as is available
in a hospital, through a vacuum regulator for reducing negative
pressure to therapeutically appropriate levels.
[0326] In some examples, the pump 710 is configured for extended
use and, thus, is capable of maintaining precise suction for
extended periods of time, for example, for about 8 hours to about
24 hours per day, for 1 to about 30 days or longer. Further, in
some examples, the pump 710 is configured to be manually operated
and, in that case, includes a control panel 718 that allows a user
to set a desired suction value. The pump 710 can also include a
controller or processor, which can be the same controller that
operates the system 700 or can be a separate processor dedicated
for operation of the pump 710. In either case, the processor is
configured for both receiving instructions for manual operation of
the pump and for automatically operating the pump 710 according to
predetermined operating parameters. Alternatively, or in addition,
operation of the pump 710 can be controlled by the processor based
on feedback received from the plurality of sensors associated with
the catheter.
[0327] In some examples, the processor is configured to cause the
pump 710 to operate intermittently. For example, the pump 710 may
be configured to emit pulses of negative pressure followed by
periods in which no negative pressure is provided. In other
examples, the pump 710 can be configured to alternate between
providing negative pressure and positive pressure to produce an
alternating flush and pump effect. For example, a positive pressure
of about 0.1 mmHg to 20 mmHg, and preferably about 5 mmHg to 20
mmHg can be provided followed by a negative pressure ranging from
about 0.1 mmHg to 50 mmHg.
Treatment for Removing Excess Fluid from a Patient with
Hemodilution
[0328] According to another aspect of the disclosure, a method for
removing excess fluid from a patient with hemodilution is provided.
In some examples, hemodilution can refer to an increase in a volume
of plasma in relation to red blood cells and/or a reduced
concentration of red blood cells in circulation, as may occur when
a patient is provided with an excessive amount of fluid. The method
can involve measuring and/or monitoring patient hematocrit levels
to determine when hemodilution has been adequately addressed. Low
hematocrit levels are a common post-surgical or post-trauma
condition that can lead to undesirable therapeutic outcomes. As
such, management of hemodilution and confirming that hematocrit
levels return to normal ranges is a desirable therapeutic result
for surgical and post-surgical patient care.
[0329] Steps for removing excess fluid from a patient using the
devices and systems described herein are illustrated in FIG. 24. As
shown in FIG. 24, the treatment method comprises deploying a
urinary tract catheter, such as a ureteral catheter, in the ureter
and/or kidney of a patient such that flow of urine from the ureter
and/or kidney, as shown at box 910. The catheter may be placed to
avoid occluding the ureter and/or kidney. In some examples, a fluid
collecting portion of the catheter may be positioned in the renal
pelvis of the patient's kidney. In some examples, a ureter catheter
may be positioned in each of the patient's kidneys. In other
examples, a urine collection catheter may be deployed in the
bladder or ureter. In some examples, the ureteral catheter
comprises one or more of any of the retention portions described
herein. For example, the ureteral catheter can comprise a tube
defining a drainage lumen comprising a helical retention portion
and a plurality of drainage ports. In other examples, the catheter
can include an inflatable retention portion (e.g., a balloon
catheter), funnel-shaped fluid collection and retention portion, or
a pigtail coil.
[0330] As shown at box 912, the method further comprises applying
negative pressure to the ureter and/or kidney through the catheter
to induce production of urine in the kidney(s) and to extract urine
from the patient. Desirably, negative pressure is applied for a
period of time sufficient to reduce the patient's blood creatinine
levels by a clinically significant amount.
[0331] Negative pressure may continue to be applied for a
predetermined period of time. For example, a user may be instructed
to operate the pump for the duration of a surgical procedure or for
a time period selected based on physiological characteristics of
the patient. In other examples, patient condition may be monitored
to determine when sufficient treatment has been provided. For
example, as shown at box 914, the method may further comprise
monitoring the patient to determine when to cease applying negative
pressure to the patient's ureter and/or kidneys. In a preferred and
non-limiting example, a patient's hematocrit level is measured. For
example, patient monitoring devices may be used to periodically
obtain hematocrit values. In other examples, blood samples may be
drawn periodically to directly measure hematocrit. In some
examples, concentration and/or volume of urine expelled from the
body through the catheter may also be monitored to determine a rate
at which urine is being produced by the kidneys. In a similar
manner, expelled urine output may be monitored to determine protein
concentration and/or creatinine clearance rate for the patient.
Reduced creatinine and protein concentration in urine may be
indicative of over-dilution and/or depressed renal function.
Measured values can be compared to the predetermined threshold
values to assess whether negative pressure therapy is improving
patient condition, and should be modified or discontinued. For
example, as discussed herein, a desirable range for patient
hematocrit may be between 25% and 40%. In other preferred and
non-limiting examples, as described herein, patient body weight may
be measured and compared to a dry body weight. Changes in measured
patient body weight demonstrate that fluid is being removed from
the body. As such, a return to dry body weight represents that
hemodilution has been appropriately managed and the patient is not
over-diluted.
[0332] As shown at box 916, a user may cause the pump to cease
providing negative pressure therapy when a positive result is
identified. In a similar manner, patient blood parameters may be
monitored to assess effectiveness of the negative pressure being
applied to the patient's kidneys. For example, a capacitance or
analyte sensor may be placed in fluid communication with tubing of
an extracorporeal blood management system. The sensor may be used
to measure information representative of blood protein, oxygen,
creatinine, and/or hematocrit levels. Measured blood parameter
values may be measured continuously or periodically and compared to
various threshold or clinically acceptable values. Negative
pressure may continue to be applied to the patient's kidney or
ureter until a measured parameter value falls within a clinically
acceptable range. Once a measured values fails within the threshold
or clinically acceptable range, as shown at box 916, application of
negative pressure may cease.
Treatment of Patients Undergoing a Fluid Resuscitation
Procedure
[0333] According to another aspect of the disclosure, a method for
removing excess fluid for a patient undergoing a fluid
resuscitation procedure, such as coronary graft bypass surgery, by
removing excess fluid from the patient is provided. During fluid
resuscitation, solutions such as saline solutions and/or starch
solutions, are introduced to the patient's bloodstream by a
suitable fluid delivery process, such as an intravenous drip. For
example, in some surgical procedures, a patient may be supplied
with between 5 and 10 times a normal daily intake of fluid. Fluid
replacement or fluid resuscitation can be provided to replace
bodily fluids lost through sweating, bleeding, dehydration, and
similar processes. In the case of a surgical procedure such as
coronary graft bypass, fluid resuscitation is provided to help
maintain a patient's fluid balance and blood pressure within an
appropriate rate. Acute kidney injury (AKI) is a known complication
of coronary artery graft bypass surgery. AKI is associated with a
prolonged hospital stay and increased morbidity and mortality, even
for patients who do not progress to renal failure. See Kim, et al.,
Relationship between a perioperative intravenous fluid
administration strategy and acute kidney injury following off-pump
coronary artery bypass surgery: an observational study, Critical
Care 19:350 (1995). Introducing fluid to blood also reduces
hematocrit levels which has been shown to further increase
mortality and morbidity. Research has also demonstrated that
introducing saline solution to a patient may depress renal
functional and/or inhibit natural fluid management processes. As
such, appropriate monitoring and control of renal function may
produce improved outcomes and, in particular, may reduce
post-operative instances of AKI.
[0334] A method of treating a patient undergoing fluid
resuscitation is illustrated in FIG. 25. As shown at box 1010, the
method comprises deploying a ureteral catheter in the ureter and/or
kidney of a patient such that flow of urine from the ureter and/or
kidney is not prevented by occlusion of the ureter and/or kidney.
For example, a fluid collecting portion of the catheter may be
positioned in the renal pelvis. In other examples, the catheter may
be deployed in the bladder or ureter. The catheter can comprise one
or more of the ureter catheters described herein. For example, the
catheter can comprise a tube defining a drainage lumen and
comprising a helical retention portion and a plurality of drainage
ports. In other examples, the catheter can include an inflatable
retention portion (e.g., a balloon catheter) or a pigtail coil.
[0335] As shown at box 1012, optionally, a bladder catheter may
also be deployed in the patient's bladder. For example, the bladder
catheter may be positioned to seal the urethra opening to prevent
passage of urine from the body through the urethra. The bladder
catheter can include an inflatable anchor (e.g., a Foley catheter)
for maintaining the distal end of the catheter in the bladder. As
described herein, other arrangements of coils and helices may also
be used to obtain proper positioning of the bladder catheter. The
bladder catheter can be configured to collect urine which entered
the patient's bladder prior to placement of the ureteral
catheter(s). The bladder catheter may also collect urine which
flows past the fluid collection portion(s) of the ureteral catheter
and enters the bladder. In some examples, a proximal portion of the
ureteral catheter may be positioned in a drainage lumen of the
bladder catheter. In a similar manner, the bladder catheter may be
advanced into the bladder using the same guidewire used for
positioning of the ureteral catheter(s). In some examples, negative
pressure may be provided to the bladder through the drainage lumen
of the bladder catheter. In other examples, negative pressure may
only be applied to the ureteral catheter(s). In that case, the
bladder catheter drains by gravity.
[0336] As shown at box 1014, following deployment of the ureteral
catheter(s), negative pressure is applied to the ureter and/or
kidney through the ureteral catheter(s). For example, negative
pressure can be applied for a period of time sufficient to extract
urine comprising a portion of the fluid provided to the patient
during the fluid resuscitation procedure. As described herein,
negative pressure can be provided by an external pump connected to
a proximal end or port of the catheter. The pump can be operated
continually or periodically dependent on therapeutic requirements
of the patient. In some cases, the pump may alternate between
applying negative pressure and positive pressure.
[0337] Negative pressure may continue to be applied for a
predetermined period of time. For example, a user may be instructed
to operate the pump for the duration of a surgical procedure or for
a time period selected based on physiological characteristics of
the patient. In other examples, patient condition may be monitored
to determine when a sufficient amount of fluid has been drawn from
the patient. For example, as shown at box 1016, fluid expelled from
the body may be collected and a total volume of obtained fluid may
be monitored. In that case, the pump can continue to operate until
a predetermined fluid volume has been collected from the ureteral
and/or bladder catheters. The predetermined fluid volume may be
based, for example, on a volume of fluid provided to the patient
prior to and during the surgical procedure. As shown at box 1018,
application of negative pressure to the ureter and/or kidneys is
stopped when the collected total volume of fluid exceeds the
predetermined fluid volume.
[0338] In other examples, operation of the pump can be determined
based on measured physiological parameters of the patient, such as
measured creatinine clearance, blood creatinine level, or
hematocrit ratio. For example, as shown at box 1020, urine
collected form the patient may be analyzed by one or more sensors
associated with the catheter and/or pump. The sensor can be a
capacitance sensor, analyte sensor, optical sensor, or similar
device configured to measure urine analyte concentration. In a
similar manner, as shown at box 1022, a patient's blood creatinine
or hematocrit level could be analyzed based on information obtain
from the patient monitoring sensors discussed hereinabove. For
example, a capacitance sensor may be placed in an existing
extracorporeal blood system. Information obtained by the
capacitance sensor may be analyzed to determine a patient's
hematocrit ratio. The measured hematocrit ratio may be compared to
certain expected or therapeutically acceptable values. The pump may
continue to apply negative pressure to the patient's ureter and/or
kidney until measured values within the therapeutically acceptable
range are obtained. Once a therapeutically acceptable value is
obtained, application of negative pressure may be stopped as shown
at box 1018.
[0339] In other examples, as shown at box 2024, patient body weight
may be measured to assess whether fluid is being removed from the
patient by the applied negative pressure therapy. For example, a
patient's measured bodyweight (including fluid introduced during a
fluid resuscitation procedure) can be compared to a patient's dry
body weight. As used herein, dry weights is defined as normal body
weight measured when a patient is not over-diluted. For example, a
patient who is not experiencing one or more of: elevated blood
pressure, lightheadedness or cramping, swelling of legs, feet,
arms, hands, or around the eyes, and who is breathing comfortably,
likely does not have excess fluid. A weight measured when the
patient is not experiencing such symptoms can be a dry body weight.
Patient weight can be measured periodically until the measured
weight approaches the dry body weight. When the measured weight
approaches (e.g., is within between 5% and 10% of dry body weight),
as shown at box 1018, application of negative pressure can be
stopped.
EXPERIMENTAL EXAMPLES
[0340] Inducement of negative pressure within the renal pelvis of
farm swine was performed for the purpose of evaluating effects of
negative pressure therapy on renal congestion in the kidney. An
objective of these studies was to demonstrate whether a negative
pressure delivered into the renal pelvis significantly increases
urine output in a swine model of renal congestion. In Example 1, a
pediatric Fogarty catheter, normally used in embolectomy or
bronchoscopy applications, was used in the swine model solely for
proof of principle for inducement of negative pressure in the renal
pelvis. It is not suggested that a Fogarty catheter be used in
humans in clinical settings to avoid injury of urinary tract
tissues. In Example 2, the ureteral catheter 112 shown in FIGS. 2A
and 2B, and including a helical retention portion for mounting or
maintaining a distal portion of the catheter in the renal pelvis or
kidney, was used.
Example 1
[0341] Method
[0342] Four farm swine 800 were used for purposes of evaluating
effects of negative pressure therapy on renal congestion in the
kidney. As shown in FIG. 21, pediatric Fogarty catheters 812, 814
were inserted to the renal pelvis region 820, 821 of each kidney
802, 804 of the four swine 800. The catheters 812, 814 were
deployed within the renal pelvis region by inflating an expandable
balloon to a size sufficient to seal the renal pelvis and to
maintain the position of the balloon within the renal pelvis. The
catheters 812, 814 extend from the renal pelvis 802, 804, through a
bladder 810 and urethra 816, and to fluid collection containers
external to the swine.
[0343] Urine output of two animals was collected for a 15 minute
period to establish a baseline for urine output volume and rate.
Urine output of the right kidney 802 and the left kidney 804 were
measured individually and found to vary considerably. Creatinine
clearance values were also determined.
[0344] Renal congestion (e.g., congestion or reduced blood flow in
the veins of the kidney) was induced in the right kidney 802 and
the left kidney 804 of the animal 800 by partially occluding the
inferior vena cava (IVC) with an inflatable balloon catheter 850
just above to the renal vein outflow. Pressure sensors were used to
measure IVC pressure. Normal IVC pressures were 1-4 mmHg. By
inflating the balloon of the catheter 850 to approximately three
quarters of the IVC diameter, the IVC pressures were elevated to
between 15-25 mmHg. Inflation of the balloon to approximately three
quarters of IVC diameter resulted in a 50-85% reduction in urine
output. Full occlusion generated IVC pressures above 28 mmHg and
was associated with at least a 95% reduction in urine output.
[0345] One kidney of each animal 800 was not treated and served as
a control ("the control kidney 802"). The ureteral catheter 812
extending from the control kidney was connected to a fluid
collection container 819 for determining fluid levels. One kidney
("the treated kidney 804") of each animal was treated with negative
pressure from a negative pressure source (e.g., a therapy pump 818
in combination with a regulator designed to more accurately control
the low magnitude of negative pressures) connected to the ureteral
catheter 814. The pump 818 was an Air Cadet Vacuum Pump from
Cole-Parmer Instrument Company (Model No. EW-07530-85). The pump
818 was connected in series to the regulator. The regulator was an
V-800 Series Miniature Precision Vacuum Regulator--1/8 NPT Ports
(Model No. V-800-10-W/K), manufactured by Airtrol Components
Inc.
[0346] The pump 818 was actuated to induce negative pressure within
the renal pelvis 820, 821 of the treated kidney according to the
following protocol. First, the effect of negative pressure was
investigated in the normal state (e.g., without inflating the IVC
balloon). Four different pressure levels (-2, -10, -15, and -20
mmHg) were applied for 15 minutes each and the rate of urine
produced and creatinine clearance were determined. Pressure levels
were controlled and determined at the regulator. Following the -20
mmHg therapy, the IVC balloon was inflated to increase the pressure
by 15-20 mmHg. The same four negative pressure levels were applied.
Urine output rate and creatinine clearance rate for the congested
control kidney 802 and treated kidney 804 were obtained. The
animals 800 were subject to congestion by partial occlusion of the
IVC for 90 minutes. Treatment was provided for 60 minutes of the 90
minute congestion period.
[0347] Following collection of urine output and creatinine
clearance data, kidneys from one animal were subjected to gross
examination then fixed in a 10% neutral buffered formalin.
Following gross examination, histological sections were obtained,
examined, and magnified images of the sections were captured. The
sections were examined using an upright Olympus BX41 light
microscope and images were captured using an Olympus DP25 digital
camera. Specifically, photomicrograph images of the sampled tissues
were obtained at low magnification (20.times. original
magnification) and high magnification (100.times. original
magnification). The obtained images were subjected to histological
evaluation. The purpose of the evaluation was to examine the tissue
histologically and to qualitatively characterize congestion and
tubular degeneration for the obtained samples.
[0348] Surface mapping analysis was also performed on obtained
slides of the kidney tissue. Specifically, the samples were stained
and analyzed to evaluate differences in size of tubules for treated
and untreated kidneys. Image processing techniques calculated a
number and/or relative percentage of pixels with different
coloration in the stained images. Calculated measurement data was
used to determine volumes of different anatomical structures.
[0349] Results
[0350] Urine Output and Creatinine Clearance
[0351] Urine output rates were highly variable. Three sources of
variation in urine output rate were observed during the study. The
inter-individual and hemodynamic variability were anticipated
sources of variability known in the art. A third source of
variation in urine output, upon information and belief believed to
be previously unknown, was identified in the experiments discussed
herein, namely, contralateral intra-individual variability in urine
output.
[0352] Baseline urine output rates were 0.79 ml/min for one kidney
and 1.07 ml/min for the other kidney (e.g., a 26% difference). The
urine output rate is a mean rate calculated from urine output rates
for each animal.
[0353] When congestion was provided by inflating the IVC balloon,
the treated kidney urine output dropped from 0.79 ml/min to 0.12
ml/min (15.2% of baseline). In comparison, the control kidney urine
output rate during congestion dropped from 1.07 ml/min to 0.09
ml/min (8.4% of baseline). Based on urine output rates, a relative
increase in treated kidney urine output compared to control kidney
urine output was calculated, according to the following
equation:
(Therapy Treated/Baseline Treated)/(Therapy Control/Baseline
Control)=Relative increase
(0.12 ml/min/0.79 ml/min)/(0.09 ml/min/1.07 ml/min)=180.6%
[0354] Thus, the relative increase in treated kidney urine output
rate was 180.6% compared to control. This result shows a greater
magnitude of decrease in urine production caused by congestion on
the control side when compared to the treatment side. Presenting
results as a relative percentage difference in urine output adjusts
for differences in urine output between kidneys.
[0355] Creatinine clearance measurements for baseline, congested,
and treated portions for one of the animals are shown in FIG.
22.
[0356] Gross Examination and Histological Evaluation
[0357] Based on gross examination of the control kidney (right
kidney) and treated kidney (left kidney), it was determined that
the control kidney had a uniformly dark red-brown color, which
corresponds with more congestion in the control kidney compared to
the treated kidney. Qualitative evaluation of the magnified section
images also noted increased congestion in the control kidney
compared to the treated kidney. Specifically, as shown in Table 1,
the treated kidney exhibited lower levels of congestion and tubular
degeneration compared to the control kidney. The following
qualitative scale was used for evaluation of the obtained
slides.
TABLE-US-00001 Lesion Score None: 0 Mild: 1 Moderate: 2 Marked: 3
Severe: 4
TABLE-US-00002 Lesion Score None: 0 Mild: 1 Moderate: 2 Marked 3
Severe: 4
TABLE-US-00003 TABLE 1 TABULATED RESULTS Histologic lesions Slide
Tubular Animal ID/Organ/Gross lesion number Congestion hyaline
casts Granulomas 6343/Left Kidney/Normal R16-513-1 1 1 0 6343/Left
Kidney/Normal with R16-513-2 1 1 0 hemorragic streak 6343/Right
Kidney/Congestion R16-513-3 2 2 1 6343/Right Kidney/Congestion
R16-513-4 2 1 1
[0358] As shown in Table 1, the treated kidney (left kidney)
exhibited only mild congestion and tubular degeneration. In
contrast, the control kidney (right kidney) exhibited moderate
congestion and tubular degeneration. These results were obtained by
analysis of the slides discussed below.
[0359] FIGS. 23A and 23B are low and high magnification
photomicrographs of the left kidney (treated with negative
pressure) of the animal. Based on the histological review, mild
congestion in the blood vessels at the corticomedullary junction
was identified, as indicated by the arrows. As shown in FIG. 23B, a
single tubule with a hyaline cast (as identified by the asterisk)
was identified.
[0360] FIGS. 23C and 23D are low and high resolution
photomicrographs of the control kidney (right kidney). Based on the
histological review, moderate congestion in the blood vessel at the
corticomedullary junction was identified, as shown by the arrows in
FIG. 23C. As shown in FIG. 23D, several tubules with hyaline casts
were present in the tissue sample (as identified by asterisks in
the image). Presence of a substantial number of hyaline casts is
evidence of hypoxia.
[0361] Surface mapping analysis provided the following results. The
treated kidney was determined to have 1.5 times greater fluid
volume in Bowman's space and 2 times greater fluid volume in tubule
lumen. Increased fluid volume in Bowman's space and the tubule
lumen corresponds to increased urine output. In addition, the
treated kidney was determined to have 5 times less blood volume in
capillaries compared to the control kidney. The increased volume in
the treated kidney appears to be a result of (1) a decrease in
individual capillary size compared to the control and (2) an
increase in the number of capillaries without visible red blood
cells in the treated kidney compared to the control kidney, an
indicator of less congestion in the treated organ.
[0362] Summary
[0363] These results indicate that the control kidney had more
congestion and more tubules with intraluminal hyaline casts, which
represent protein-rich intraluminal material, compared to the
treated kidney. Accordingly, the treated kidney exhibits a lower
degree of loss of renal function. While not intending to be bound
by theory, it is believed that as severe congestion develops in the
kidney, hypoxemia of the organ follows. Hypoxemia interferes with
oxidative phosphorylation within the organ (e.g., ATP production).
Loss of ATP and/or a decrease in ATP production inhibits the active
transport of proteins causing intraluminal protein content to
increase, which manifests as hyaline casts. The number of renal
tubules with intraluminal hyaline casts correlates with the degree
of loss of renal function. Accordingly, the reduced number of
tubules in the treated left kidney is believed to be
physiologically significant. While not intending to be bound by
theory, it is believed that these results show that damage to the
kidney can be prevented or inhibited by applying negative pressure
to a catheter inserted into the renal pelvis to facilitate urine
output.
Example 2
[0364] Method
[0365] Four (4) farm swine (A, B, C, D) were sedated and
anesthetized. Vitals for each of the swine were monitored
throughout the experiment and cardiac output was measured at the
end of each 30-minute phase of the study. Ureteral catheters, such
as the ureteral catheter 112 shown in FIGS. 2A and 2B, were
deployed in the renal pelvis region of the kidneys of each of the
swine. The deployed catheters were a 6 Fr catheter having an outer
diameter of 2.0.+-.0.1 mm. The catheters were 54.+-.2 cm in length,
not including the distal retention portion. The retention portion
was 16.+-.2 mm in length. As shown in the catheter 112 in FIGS. 2A
and 2B, the retention portion included two full coils and one
proximal half coil. The outer diameter of the full coils, shown by
line D1 in FIGS. 2A and 2B, was 18.+-.2 mm. The half coil diameter
D2 was about 14 mm. The retention portion of the deployed ureteral
catheters included six drainage holes, plus an additional hole at
the distal end of the catheter tube. The diameter of each of the
drainage holes was 0.83.+-.0.01 mm. The distance between adjacent
drainage holes 132, specifically the linear distance between
drainage holes when the coils were straightened, was 22.5.+-.2.5
mm.
[0366] The ureteral catheters were positioned to extend from the
renal pelvis of the swine, through the bladder, and urethra, and to
fluid collection containers external to each swine. Following
placement of the ureteral catheters, pressure sensors for measuring
IVC pressure were placed in the IVC at a position distal to the
renal veins. An inflatable balloon catheter, specifically a
PTS.RTM. percutaneous balloon catheter (30 mm diameter by 5 cm
length), manufactured by NuMED Inc. of Hopkinton, N.Y., was
expanded in the IVC at a position proximal to the renal veins. A
thermodilution catheter, specifically a Swan-Ganz thermodilution
pulmonary artery catheter manufactured by Edwards Lifesciences
Corp. of Irvine, Calif., was then placed in the pulmonary artery
for the purpose of measuring cardiac output.
[0367] Initially, baseline urine output was measured for 30
minutes, and blood and urine samples were collected for biochemical
analysis. Following the 30-minute baseline period, the balloon
catheter was inflated to increase IVC pressure from a baseline
pressure of 1-4 mmHg to an elevated congested pressure of about 20
mmHg (+/-5 mmHg). A congestion baseline was then collected for 30
minutes with corresponding blood and urine analysis.
[0368] At the end of the congestion period, the elevated congested
IVC pressure was maintained and negative pressure diuresis
treatment was provided for swine A and swine C. Specifically, the
swine (A, C) were treated by applying a negative pressure of -25
mmHg through the ureteral catheters with a pump. As in
previously-discussed examples, the pump was an Air Cadet Vacuum
Pump from Cole-Parmer Instrument Company (Model No. EW-07530-85).
The pump was connected in series to a regulator. The regulator was
a V-800 Series Miniature Precision Vacuum Regulator--1/8 NPT Ports
(Model No. V-800-10-W/K), manufactured by Airtrol Components Inc.
The swine were observed for 120 minutes, as treatment was provided.
Blood and urine collection were performed every 30 minutes, during
the treatment period. Two of the swine (B, D) were treated as
congested controls (e.g., negative pressure was not applied to the
renal pelvis through the ureteral catheters), meaning that the two
swine (B, D) did not receive negative pressure diuresis
therapy.
[0369] Following collection of urine output and creatinine
clearance data for the 120-minute treatment period, the animals
were sacrificed and kidneys from each animal were subjected to
gross examination. Following gross examination, histological
sections were obtained and examined, and magnified images of the
sections were captured.
[0370] Results
[0371] Measurements collected during the Baseline, Congestion, and
Treatment periods are provided in Table 2. Specifically, urine
output, serum creatinine, and urinary creatinine measurements were
obtained for each time period. These values allow for the
calculation of a measured creatinine clearance as follows:
Creatinine .times. .times. Clearance .times. : .times. CrCl = Urine
.times. .times. Output .times. .times. ( ml .times. / .times. min )
* Urinary .times. .times. Creatinine .times. .times. ( mg .times. /
.times. dl ) Serum .times. .times. Creatinine .times. .times. ( mg
.times. / .times. dl ) ##EQU00001##
In addition, Neutrophil gelatinase-associated lipocalin (NGAL)
values were measured from serum samples obtained for each time
period and Kidney Injury Molecule 1 (KIM-1) values were measured
from the urine samples obtained for each time period. Qualitative
histological findings determined from review of the obtained
histological sections are also included in Table 2.
TABLE-US-00004 TABLE 2 Animal A B C D Treatment assignment
Treatment Control Treatment Control Baseline: Urine output (ml/min)
3.01 2.63 0.47 0.98 Serum creatinine (mg/dl) 0.8 0.9 3.2 1.0
Creatinine clearance (ml/min) 261 172 5.4 46.8 Serum NGAL (ng/ml)
169 * 963 99 Urinary KIM-1 (ng/ml) 4.11 * 3.59 1.16 Congestion:
Urine output (ml/min) 0.06 (2%) 0.53 (20%) 0.12 (25%) 0.24 (25%)
Serum creatinine (mg/dl) 1.2 (150%) 1.1 (122%) 3.1 (97%) 1.2 (120%)
Creatinine clearance (ml/min) 1.0 (0.4%) 30.8 (18%) 1.6 (21%) 16.2
(35%) Serum NGAL (ng/ml) 102 (60%) * 809 (84%) 126 (127%) Urinary
KIM-1 (ng/ml) 24.3 (591%) * 2.2 (61%) 1.39 (120%) Treatment: Urine
output (ml/min) 0.54 (17%) 0.47 (101%) 0.35 (36%) Serum creatinine
(mg/dl) 1.3 (163%) 3.1 (97%) 1.7 (170%) Creatinine clearance
(ml/min) 30.6 (12%) ** 18.3 (341%) 13.6 (29%) Serum NGAL (ng/ml)
197 (117%) 1104 (115%) 208 (209%) Urinary KIM-1 (ng/ml) 260 (6326%)
28.7 (799%) 233 (20000%) Histological findings: Blood volume in
capillary space 2.4% 0.9% 4.0% Hyaline casts Mild/Mod ** None Mod
Degranulation Mild/Mod None Mod Data are raw values (% baseline) *
not measured ** confounded by phenylephrine
[0372] Animal A: The animal weighed 50.6 kg and had a baseline
urine output rate of 3.01 ml/min, a baseline serum creatinine of
0.8 mg/dl, and a measured CrCl of 261 ml/min. It is noted that
these measurements, aside from serum creatinine, were
uncharacteristically high relative to other animals studied.
Congestion was associated with a 98% reduction in urine output rate
(0.06 ml/min) and a >99% reduction in CrCl (1.0 ml/min).
Treatment with negative pressure applied through the ureteral
catheters was associated with urine output and CrCl of 17% and 12%,
respectively, of baseline values, and 9.times. and >10.times.,
respectively, of congestion values. Levels of NGAL changed
throughout the experiment, ranging from 68% of baseline during
congestion to 258% of baseline after 90 minutes of therapy. The
final value was 130% of baseline. Levels of KIM-1 were 6 times and
4 times of baseline for the first two 30-minute windows after
baseline assessment, before increasing to 68.times., 52.times., and
63.times. of baseline values, respectively, for the last three
collection periods. The 2-hour serum creatinine was 1.3 mg/dl.
Histological examination revealed an overall congestion level,
measured by blood volume in capillary space, of 2.4%. Histological
examination also noted several tubules with intraluminal hyaline
casts and some degree of tubular epithelial degeneration, a finding
consistent with cellular damage.
[0373] Animal B: The animal weighed 50.2 kg and had a baseline
urine output rate of 2.62 ml/min and a measured CrCl of 172 ml/min
(also higher than anticipated). Congestion was associated with an
80% reduction in urine output rate (0.5 ml/min) and an 83%
reduction in CrCl (30 ml/min). At 50 minutes into the congestion
(20 minutes after the congestion baseline period), the animal
experienced an abrupt drop in mean arterial pressure and
respiration rate, followed by tachycardia. The anesthesiologist
administered a dose of phenylephrine (75 mg) to avert cardiogenic
shock. Phenylephrine is indicated for intravenous administration
when blood pressure drops below safe levels during anesthesia.
However, since the experiment was testing the impact of congestion
on renal physiology, administration of phenylephrine confounded the
remainder of the experiment.
[0374] Animal C: The animal weighed 39.8 kg and had a baseline
urine output rate of 0.47 ml/min, a baseline serum creatinine of
3.2 mg/dl, and a measured CrCl of 5.4 ml/min. Congestion was
associated with a 75% reduction in urine output (0.12 ml/min) and a
79% reduction in CrCl (1.6 ml/min). It was determined that baseline
NGAL levels were >5.times. the upper limit of normal (ULN).
Treatment with negative pressure applied to the renal pelvis
through the ureteral catheters was associated with a normalization
of urine output (101% of baseline) and a 341% improvement in CrCl
(18.2 ml/min). Levels of NGAL changed throughout the experiment,
ranging from 84% of baseline during congestion to 47% to 84% of
baseline between 30 and 90 minutes. The final value was 115% of
baseline. Levels of KIM-1 decreased 40% from baseline within the
first 30 minutes of congestion, before increasing to 8.7.times.,
6.7.times., 6.6.times., and 8.times. of baseline values,
respectively, for the remaining 30-minute windows. Serum creatinine
level at 2 hours was 3.1 mg/dl. Histological examination revealed
an overall congestion level, measured by blood volume in capillary
space, of 0.9%. The tubules were noted to be histologically
normal.
[0375] Animal D: The animal weighed 38.2 kg and had a baseline
urine output of 0.98 ml/min, a baseline serum creatinine of 1.0
mg/dl, and a measured CrCl of 46.8 ml/min. Congestion was
associated with a 75% reduction in urine output rate (0.24 ml/min)
and a 65% reduction in Cr Cl (16.2 ml/min). Continued congestion
was associated with a 66% to 91% reduction of urine output and 89%
to 71% reduction in CrCl. Levels of NGAL changed throughout the
experiment, ranging from 127% of baseline during congestion to a
final value of 209% of baseline. Levels of KIM-1 remained between
1.times. and 2.times. of baseline for the first two 30-minute
windows after baseline assessment, before increasing to 190.times.,
219.times., and 201.times. of baseline values for the last three
30-minute periods. The 2-hour serum creatinine level was 1.7 mg/dl.
Histological examination revealed an overall congestion level
2.44.times. greater than that observed in tissue samples for the
treated animals (A, C) with an average capillary size 2.33 times
greater than that observed in either of the treated animals. The
histological evaluation also noted several tubules with
intraluminal hyaline casts as well as tubular epithelial
degeneration, indicating substantial cellular damage.
[0376] Summary
[0377] While not intending to be bound by theory, it is believed
that the collected data supports the hypothesis that venous
congestion creates a physiologically significant impact on renal
function. In particular, it was observed that elevation of the
renal vein pressure reduced urine output by 75% to 98% within
seconds. The association between elevations in biomarkers of
tubular injury and histological damage is consistent with the
degree of venous congestion generated, both in terms of magnitude
and duration of the injury.
[0378] The data also appears to support the hypothesis that venous
congestion decreases the filtration gradients in the medullary
nephrons by altering the interstitial pressures. The change appears
to directly contribute to the hypoxia and cellular injury within
medullary nephrons. While this model does not mimic the clinical
condition of AKI, it does provide insight into the mechanical
sustaining injury.
[0379] The data also appears to support the hypothesis that
applying negative pressure to the renal pelvis through ureteral
catheters can increase urine output in a venous congestion model.
In particular, negative pressure treatment was associated with
increases in urine output and creatinine clearance that would be
clinically significant. Physiologically meaningful decreases in
medullary capillary volume and smaller elevations in biomarkers of
tubular injury were also observed. Thus, it appears that by
increasing urine output rate and decreasing interstitial pressures
in medullary nephrons, negative pressure therapy may directly
decrease congestion. While not intending to be bound by theory, by
decreasing congestion, it may be concluded that negative pressure
therapy reduces hypoxia and its downstream effects within the
kidney in a venous congestion mediated AKI.
[0380] The experimental results appear to support the hypothesis
that the degree of congestion, both in terms of the magnitude of
pressure and duration, is associated with the degree of cellular
injury observed. Specifically, an association between the degree of
urine output reduction and the histological damage was observed.
For example, treated Swine A, which had a 98% reduction in urine
output, experienced more damage than treated Swine C, which had a
75% reduction in urine output. As would be expected, control Swine
D, which was subjected to a 75% reduction in urine output without
benefit of therapy for two and a half hours, exhibited the most
histological damage. These findings are broadly consistent with
human data demonstrating an increased risk for AKI onset with
greater venous congestion. See e.g., Legrand, M. et al.,
Association between systemic hemodynamics and septic acute kidney
injury in critically ill patients: a retrospective observational
study. Critical Care 17:R278-86, 2013.
Example 3
[0381] Method
[0382] Inducement of negative pressure within the renal pelvis of
farm swine was performed for the purpose of evaluating effects of
negative pressure therapy on hemodilution of the blood. An
objective of these studies was to demonstrate whether a negative
pressure delivered into the renal pelvis significantly increases
urine output in a swine model of fluid resuscitation.
[0383] Two pigs were sedated and anesthetized using ketamine,
midazolam, isoflurane and propofol. One animal (#6543) was treated
with a ureteral catheter and negative pressure therapy as described
herein. The other, which received a Foley type bladder catheter,
served as a control (#6566). Following placement of the catheters,
the animals were transferred to a sling and monitored for 24
hours.
[0384] Fluid overload was induced in both animals with a constant
infusion of saline (125 mL/hour) during the 24 hour follow-up.
Urine output volume was measured at 15 minute increments for 24
hours. Blood and urine samples were collected at 4 hour increments.
As shown in FIG. 21, a therapy pump 818 was set to induce negative
pressure within the renal pelvis 820, 821 (shown in FIG. 21) of
both kidneys using a pressure of -45 mmHg (+/-2 mmHg).
[0385] Results
[0386] Both animals received 7 L of saline over the 24 hour period.
The treated animal produced 4.22 L of urine while the control
produced 2.11 L. At the end of 24 hours, the control had retained
4.94 L of the 7 L administered, while the treated animal retained
2.81 L of the 7 L administered. FIG. 26 illustrates the change in
serum albumin. The treated animal had a 6% drop in the serum
albumin concentration over 24 hours, while the control animal had a
29% drop.
[0387] Summary
[0388] While not intending to be bound by theory, it is believed
that the collected data supports the hypothesis that fluid overload
induces clinically significant impact on renal function and,
consequently induces hemodilution. In particular, it was observed
that administration of large quantities of intravenous saline
cannot be effectively removed by even healthy kidneys. The
resulting fluid accumulation leads to hemodilution. The data also
appears to support the hypothesis that applying negative pressure
diuresis therapy to fluid overloaded animals can increase urine
output, improve net fluid balance and decrease the impact of fluid
resuscitation on development of hemodilution.
[0389] The preceding examples and embodiments of the invention have
been described with reference to various examples. Modifications
and alterations will occur to others upon reading and understanding
the foregoing examples. Accordingly, the foregoing examples are not
to be construed as limiting the disclosure.
* * * * *