U.S. patent number 3,863,622 [Application Number 05/322,221] was granted by the patent office on 1975-02-04 for incontinence system and methods of implanting and using same.
Invention is credited to Robert Enno Buuck.
United States Patent |
3,863,622 |
Buuck |
February 4, 1975 |
INCONTINENCE SYSTEM AND METHODS OF IMPLANTING AND USING SAME
Abstract
An inflatable cuff unit has an expansible chamber formed by a
readily deformable wall and a relatively rigid wall. The relatively
rigid wall contains a number of threads or cords embedded therein
with projecting end portions that are tied together when the cuff
is implanted in an encircling relation with an excretory vessel
within a person's body. The deformable wall is placed against the
vessel to be controlled. Also implanted is a reservoir containing a
radio-opaque fluid. Strategically located elastomeric bulbs are
disposed innerjacent the skin, together with internally located
check valves and appropriate connecting tubes, enable the user to
squeeze the proper bulb, doing so through his skin, so as to pump
fluid to and from the cuff. When the cuff is under pressure, it
acts in a manner resembling the sphincter surrounding the urethra
when the urethra constitutes the vessel to be controlled A
basically similar cuff may be used for gastro intestinal tract
control.
Inventors: |
Buuck; Robert Enno (Golden
Valley, MN) |
Family
ID: |
23253942 |
Appl.
No.: |
05/322,221 |
Filed: |
January 9, 1973 |
Current U.S.
Class: |
600/31;
128/DIG.25; 128/DIG.26 |
Current CPC
Class: |
A61F
2/004 (20130101); A61F 2250/0098 (20130101); Y10S
128/26 (20130101); Y10S 128/25 (20130101) |
Current International
Class: |
A61F
2/00 (20060101); A61f 001/00 (); A61b 017/00 () |
Field of
Search: |
;128/1R,325-327,346,DIG.25 ;3/1 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
timm et al., IEEE Trans. Bio-Med Engr., Oct. 1970, Vol. 17, No. 4,
pg. 352. .
Kintzonidis et al., Trans. Amer. Soc. Artific. Inter. Orgs., Vol.
XVII, 1971, pp. 138-140, 142..
|
Primary Examiner: Truluck; Dalton L.
Attorney, Agent or Firm: Peterson; Stuart R.
Claims
We claim:
1. A method of implanting an incontinence system in an animal body
comprising the steps of placing at one location within said body a
cuff device having a deformable wall so that said wall resides in a
proximal relation with a vessel having a passage extending
therethrough which passage is to be opened and closed, placing at a
second location within said body a pump bulb having fluid
communication with said cuff device, said second location being
spaced from said first location and sufficiently near the inner
surface of the animal's skin so that said bulb can be squeezed
through the skin to force fluid under pressure into said cuff
device, placing at a third location within said body spaced from
said second location a reservoir having fluid communication with
said pump bulb for storing at least some of said fluid which is to
be pumped into said cuff device by the squeezing of said bulb,
placing a first check valve between said reservoir and said pump
bulb and a second check valve between said pump bulb and said cuff
device, said first check valve permitting fluid flow only from said
reservoir to said pump bulb and said second check valve permitting
fluid flow only from said pump bulb to said cuff device, placing
within said body a second pump bulb at still another location
spaced from said cuff device and from said first pump bulb, and
also third and fourth check valves, said third check valve being
between said cuff device and said second pump bulb and said fourth
check valve being between said pump bulb and said reservoir, said
third check valve permitting fluid flow only from said cuff to said
second pump bulb and said fourth check valve permitting fluid flow
only from said second pump bulb to said reservoir, each check valve
including a plug member and a coil spring urging its said plug
member in a direction to prevent fluid flow, the coil spring in
said second check valve having a greater strength than the spring
in said fourth check valve, and said spring in said fourth valve
having a greater strength than the springs in said first and third
check valves.
2. The method set forth in claim 1 in which each plug member has a
generally cylindrical portion against which its said coil spring
acts and a tapered end portion for preventing said fluid flow.
3. The method set forth in claim 2 in which each check valve has a
generally circular seat against which a tapered end portion bears
to prevent said fluid flow.
4. A method of implanting an incontinence system in the body of an
animal in order to thereafter control the opening and closing of a
biologically provided urethra comprising the steps of applying a
cuff unit having an inwardly deformable wall and a relatively rigid
outer wall in a circumscribing relationship with the urethra,
implanting pump means including a pair of elastomeric bulbs within
said body at locations innerjacent the skin so that fluid under
pressure can thereafter be delivered into said cuff unit in order
to cause said deformable wall to be flexed inwardly to reduce the
cross section of said urethra, implanting in said animal body
reservoir means for storing some of the fluid to be delivered to
and withdrawn from said cuff unit by said pump means, and also
implanting valve means for controlling the direction of fluid flow
when said pump means is later actuated, said valve means including
a first check valve for permitting fluid to flow only from said
reservoir to one of said bulbs, a second check valve for permitting
fluid to flow only from said one bulb to said cuff unit, a third
check valve for permitting fluid to flow only from said cuff unit
to the other of said bulbs, and a fourth check valve for permitting
fluid to flow only from said other bulb to said reservoir means,
said fourth check valve providing a greater resistance to flow than
said third check valve, said second check valve providing a greater
resistance to flow than said fourth check valve, and said first and
third check valves providing a lesser resistance to fluid flow to
both said second and fourth check valves.
5. An incontinence system for implanting within an animal body
comprising an inflatable cuff unit for circumscribing the vessel to
be opened and closed, a reservoir for storing at least some of the
fluid to be supplied to said cuff unit, a pair of elastomeric
bulbs, a first check valve connected between said reservoir and one
of said pump bulbs for permitting fluid flow only from said
reservoir to said one pump bulb, a second check valve between said
one pump bulb and said cuff unit for permitting fluid flow only
between said one pump bulb and said cuff unit, a third check valve
for permitting fluid flow only between said cuff unit and the other
of said pump bulbs, a fourth check valve for permitting fluid flow
only from said other pump bulb to said reservoir, a coil spring
contained in each of said check valves, said fourth check valve
containing a coil spring having a greater spring constant than the
coil springs contained in said first and third check valves, and
the coil spring in said second check valve having a greater spring
constant than the coil spring contained in said fourth check
valve.
6. An incontinence system for implanting within an animal body
comprising a cuff unit for circumscribingly engaging the vessel to
be opened and closed, said cuff unit having an inwardly deformable
wall and a relatively rigid outer wall to form a chamber
therebetween, a reservoir for storing at least some of the fluid to
be supplied to the chamber of said cuff unit, a pair of elastomeric
bulbs, a first check valve including therein a plug member having a
tapered end portion, a first flexible tube connected to said
reservoir and to said check valve, said first check valve including
a coil spring having one spring constant for biasing said plug
member in a direction to cause its said tapered end portion to seat
against the end of said first flexible tube which is connected to
said first check valve to prevent fluid flow from said first check
valve to said first flexible tube, a second flexible tube connected
to said first check valve and to one of said elastomeric bulbs, a
second check valve including therein a plug member having a tapered
end portion, a third flexible tube connected to said one
elastomeric bulb and to said second check valve, said second check
valve including a coil spring having a spring constant which is
greater than that of the spring included in said first check valve,
said last-mentioned spring biasing the plug member of said second
check valve in a direction to cause its tapered end portion to seat
against the end of said third flexible tube which is connected to
said second check valve to prevent fluid flow from said second
check valve to said third flexible tube, a fourth flexible tube
connected to said second check valve and to said cuff unit, a third
check valve including therein a plug member having a tapered end
portion, a fifth flexible tube connected to said cuff unit and to
said third check valve, said third check valve including a coil
spring having a spring constant corresponding to that of the spring
included in said first check valve, said last-mentioned spring
biasing the plug member of said third check valve in a direction to
cause its tapered end portion to seat against the end of said fifth
flexible tube which is connected to said third check valve to
prevent fluid flow from said third check valve to the said cuff
unit, a sixth flexible tube connected to said third check valve and
to the other of said pair of elastomeric bulbs, a fourth check
valve including therein a plug member having a tapered end portion,
a seventh flexible tube connected to said other elastomeric bulb
and to said fourth check valve, said fourth check valve including a
coil spring having a spring constant greater than the spring
included in said first and third check valves but less than that of
the spring included in said second check valve, said last-mentioned
spring biasing the plug member of said fourth check valve in a
direction to cause its tapered end portion to seat against the end
of said seventh flexible tube which is connected to said fourth
check valve to prevent fluid flow from said fourth check valve to
said seventh tube, and an eighth flexible tube connected to said
fourth check valve and to said reservoir, whereby manipulation or
squeezing of said one elastomeric bulb will cause the tapered end
portion of the plub member included in said first check valve to
seat more tightly against said first flexible tube and to cause
fluid to be forced from said one elastomeric bulb through said
third flexible tube to overcome the biasing action of the coil
spring included in the second check valve, thereby causing the
tapered end portion of the plug member included in said second
check valve to unseat to permit fluid to flow through said second
check valve into the chamber of said cuff unit, the unsqueezing of
said one elastomeric bulb causing fluid to be drawn from said
reservoir through said first and second tubes, the coil spring
included in said first check valve at this time yielding to permit
the unseating of the tapered end portion of the plug member
included in said first check valve, the tapered end portion of the
plug member included in said second check valve at this time
seating against the third tube to prevent fluid flow from said cuff
unit back through said second check valve into the said one
elastomeric bulb, the coil spring included in said fourth check
valve during the squeezing of said one bulb determining the amount
of pressure that can be built up in the chamber of said cuff unit,
and whereby squeezing of the other of said elastomeric bulbs
overcomes the biasing action of the coil spring included in said
fourth check valve to cause the tapered end portion of the plug
member included in said fourth check valve to unseat from said
seventh flexible tube, the tapered end portion of the plug member
included in said third check valve during this period seating
against said fifth flexible tube to prevent fluid flow from the
said other elastomeric bulb back through said sixth and fifth
tubes, the unsqueezing of said other elastomeric bulb causing the
tapered end portion of the plug member included in said third check
valve to unseat and permit fluid to flow from said cuff unit into
said other elastomeric bulb and the coil spring included in said
fourth check valve biasing the plug member included in said fourth
check valve in a direction to cause its tapered end portion to seat
against said seventh tube, the repetitive squeezing and unsqueezing
of said one elastomeric bulb thus causing said cuff unit to inflate
with said inner wall portion being deformed against the vessel in a
constricting manner to thereby close said vessel and the repetitive
squeezing and unsqueezing of said other elastomeric bulb permitting
said inner wall portion causing said cuff unit to deflate with said
inner wall then releasing its constrictive action against said
vessel and thereby open said vessel, the spring included in said
second check valve which has the greatest spring constant of the
four springs, biasing the plug member included in said second check
valve in a direction to cause its tapered end portion to seat
against said third flexible tube and thus prevent fluid from
flowing from said third tube through said second check valve into
said fourth tube and thus prevent fluid from flowing into the
chamber of said cuff unit when said cuff unit is deflated.
Description
BACKGROUND OF THE INVENTION
1. Field of the Invention
This invention relates generally to a system functioning as an
artificial muscle, such as a sphincter muscle, and pertains more
particularly to a system that can be completely implanted within an
animal body and controlled exteriorally.
2. Description of the Prior Art
Artificial sphincters are not completely new. Owing to the rather
large number of persons afflicted with the vexing problem of
incontinence, it is no wonder that various attempts have been made
to simulate artificially the action that should be performed by the
natural muscles within an animal body. One such attempt is
portrayed in U.S. Pat. No. 2,455,959, granted on Dec. 7, 1948 to
Frederic E. B. Foley titled "ARTIFICIAL SPHINCTER AND METHOD" and
also in the same patentee's U.S. Pat. No. 2,533,924, issued on Dec.
12, 1950. In both instances, the artificial sphincter is only
suitable for external use, thereby further restricting it to
employment solely by males. Both of these patents, however, provide
a detailed description of the malady and the prior art up to that
time period, the two patent disclosures emphasizing the
difficulties experienced from the use of the so-called rather
common Cunningham incontinence clamp.
Various modifications of the Cunningham clamp have been devised.
Such clamps carry the same shortcomings of the Cunningham clamp in
that they are cumbersome, large and relatively uncomfortable.
Other efforts in the past have resorted to valve mechanisms that
are inserted directly into the canal or passage to be controlled.
Also, various blockage schemes, both external and internal, have
been tried on at least an experimental basis, especially in an
effort to correct for rectal incontinence.
Prior art devices have been designed for both internal and external
application. The implanted devices have in common the fact that the
integrity of the outflow tract is disrupted, thereby damaging the
biological content therein. The external devices are inherently
bulky and cumbersome, and can only be applied to males.
SUMMARY OF THE INVENTION
One important object of the present invention is to provide an
incontinence system that is contained completely within an animal
body, but external to the outflow tract itself.
Another object is to provide a system of the foregoing character
for use by humans that will be devoid of cosmetic detraction. In
this regard, not only will the system be completely concealed from
view, and thereby unnoticeable when the user is unclothed, but its
operation will be virtually imperceptible, thereby eliminating any
possible embarrassment or adverse social reaction from others.
Another object is to provide a system requiring no source of power
other than that furnished by the user himself. Stated more
specifically, the pumping is achieved manually from outside, there
being a pair of elastomeric bulbs innerjacent the individual's skin
that can be squeezed or kneaded to produce the requisite operating
pressure.
A further object is to provide an incontinence system in which the
pressural condition necessary to simulate the muscular action is
easily achieved and then automatically maintained without further
attention or effort from the user. An additional aim is to enable
an equally facile reduction in pressure to be realized when the
passage is to be opened to allow flow therethrough.
Yet another object of the invention is to provide an incontinence
system that can be employed by both males and females. For
instance, our system can be installed in the scrotum, although not
restricted to this region, of a male or the major labia of a
female, also not necessarily restricted to this area, in the
correction of an urethral malfunction.
Also, an object is to provide a versatile system generally suited
to controlling either the flow of urine or fecal waste.
Still another object is to provide a system that can be implanted
in various types of animals, particularly humans, without
difficulty and without injury to neighboring organs and tissue.
Equally readily, should circumstances so dictate, the entire system
can be removed without damage to the body.
Further, our system has the capability of performing for prolonged
periods, even during the remaining life of a patient, without
either professional or user attention. As mentioned above, while it
is expected that the system will function as intended without
difficulty, the system, even though completely contained within the
body, lends itself readily to utilizing a radiation-impermeable
fluid which will obstruct the passage of X-rays or other radiant
energy so as to enable detection and localizing of an improperly
performing part or member of the system. An aim of the invention,
however, is to provide a system so simple that it is not apt to get
out of order in the first place, all as mentioned above.
Still another object is to provide an implantable system which can
be constructed, at least as far as its tissue-contacting surfaces
are concerned, of non-toxic material which the body can tolerate
and will not reject. The integrity of the outflow tract is
maintained since the incontinence system is external to it.
Briefly, our invention involves the implanting of a self-contained
system within an animal body by making an incision through the skin
in the region of the affected vessel and then exposing a section of
the vessel for application of an inflatable cuff having a
deformable wall that is flexed against the vessel in a constrictive
fashion so as to prevent fluid flow therethrough. In the case of
humans, pressure is developed by the person himself, a simple
repetitive squeezing through the person's skin of one of two
elastomeric bulbs being all that is necessary in order to force
fluid into the interior or expansion chamber of the cuff. Each time
the squeezing is stopped fluid is withdrawn automatically from the
reservoir, which is implanted at the same time that the cuff is
implanted, in preparation for the next squeezing of the bulb.
Squeezing of the second bulb returns fluid back to the reservoir to
reduce the pressure within the cuff sufficiently to open the vessel
and allow fluid flow therethrough.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a front sectional view depicting the trunk of a human
body having our incontinence system implanted therein in an
encircling relation with a section of that person's urethra;
FIG. 2 is an enlarged sectional detail taken in the direction of
line 2--2 of FIG. 1 for the purpose of demonstrating how one of the
elastomeric bulbs is squeezed through the skin to pump fluid into
the inflatable cuff that encircles the urethra in FIG. 1;
FIG. 3 is an enlarged front elevational view of the reservoir
appearing in the abdominal cavity, as suggested in FIG. 1;
FIG. 4 is a sectional view taken in the direction of line 4--4 of
FIG. 3 for the purpose of illustrating the construction of the
reservoir;
FIG. 5 is a side view of the inflatable cuff that circumscribes the
fragmentarily shown urethra depicted in FIG. 1, the view being
taken in the direction of line 5--5 of FIG. 1 but being on a
considerably larger scale;
FIG. 6 is a plan view of the cuff before it is implanted, the end
portions of the threads or cords which are used in tying the cuff
in place projecting from the opposite ends of the cuff;
FIG. 7 is a sectional view taken in the direction of line 7--7 of
FIG. 6 for the purpose of showing to better advantage how the
threads or cords are embedded in one wall of the cuff;
FIG. 8 is a sectional view taken in the direction of line 8--8 of
FIG. 7;
FIG. 9 is a view corresponding generally to FIG. 5 but illustrating
an intermediate step in the implanting of the cuff around the
urethra;
FIG. 10 is a perspective view taken generally in the direction of
line 10--10 of FIG. 1 picturing the manner in which the ends of the
threads or cords are tied together to maintain the circumscribed
relationship, the view being opposite in direction to FIG. 5,
showing to better advantage the two flexible tubes via which fluid
is introduced and withdrawn from the cuff;
FIG. 11 is an enlarged elevational view of one of the check valves
appearing in FIG. 1;
FIG. 12 is a greatly enlarged sectional view taken in the direction
of line 12--12 of FIG. 11;
FIG. 13 is an enlarged elevational view of one of the elastomeric
pump bulbs of FIG. 1;
FIG. 14 is a sectional view taken in the direction of line 14--14
of FIG. 13, and
FIG. 15 illustrates on a larger scale the system appearing in FIG.
1, the pump bulbs, check valves and cuff being shown in cross
section.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring first to FIG. 1, the trunk of a human body has been
denoted generally by the reference numeral 10. More specifically,
the region selected therein for exemplifying the invention is the
pelvic cavity labeled 12. Within the pelvic cavity 12 are the right
and left hip bones 13, 14 and, for the sake of completion, upper
ends of the thigh bones 16 have also been illustrated. The person's
skin has been assigned the reference numeral 18. The reference
numeral 20 represents an excretory vessel biologically provided
within the body 10. To illustrate the invention, the urethra has
been selected as the collapsible vessel 20, a section thereof
having been pictured. However, it will be recognized that the
vessel 20 might very well constitute the gastro intestinal tract
where fecal control is needed. In any event, it will be appreciated
that a broad objective of the present invention is to provide an
artificial sphincter that acts to close a canal or passage 22
extending through the vessel 20. Thus, when the vessel 20
constitutes the urethra, the function of the present invention is
to collapse the urinary tract to prevent undesired discharge of
urine from the person's bladder. In other words, the cross section
of the tubular vessel 20, being open in FIGS. 5 and 9, is reduced
or collapsed to such an extent that its passage 22 is completely
closed.
The system exemplifying our invention is shown in its entirety in
FIG. 1, and also in FIG. 15, being denoted by the reference numeral
30. It is believed helpful to refer to the system in a broad sense
initially and then describe the various components with greater
particularity hereinafter. Accordingly, it will be observed that
the system 30 includes a reservoir 32 which is implanted in the
lower portion of the patient's abdominal cavity or the upper
portion of the pelvic cavity 12 as illustrated in FIG. 1.
A first flexible tube 34 extends from the reservoir 32 to a check
valve 36, the check valve 36 permitting flow only in the direction
of the arrow 38. Another tube 40 leads from the check valve 36 to
an elastomeric bulb 42 that functions as a first pump. Still
another tube 44 extends from the bulb 42 to a second check valve 46
which allows fluid flow only in the direction of the arrow 48.
A tube 50 connects with an inflatable cuff unit or device denoted
generally by the reference numeral 52. The cuff 52 circumscribes
the excretory vessel 20 in FIG. 1 which in the illustrated
situation constitutes the urethra as already explained. The cuff
52, being toroidal, functions to constrict the urethra and thereby
close its passage 22 to prevent the flow or discharge of urine from
the bladder. Inasmuch as the cuff 52 is contained wholly within the
body of the person or other animal, it lends itself to being
installed in either a male or female. Hence, it will be appreciated
that the cuff 52 is located before the penis as far as the male is
concerned and also before the vaginal orifice as far as a female is
concerned. It can also be appreciated that the cuff 52 is exterior
to the excretory vessel being regulated so that any potential
complications or hazards resulting from foreign materials in
contact with sensitive biologic substances are not adversely
affected.
An additional tube 54 extends from the cuff 52 to still another
check valve 56 which permits fluid flow only in the direction of
the arrow 58. From the check valve 56 there extends a tube 60
having communication with another elastomeric bulb 62 which
functions as a second pump. There is still another tube 64 leading
from the bulb 62 to a fourth check valve 66 allowing fluid to flow
only in the direction of the arrow 68. A final tube 70 connects the
fourth check valve 66 to the earlier-mentioned reservoir 32.
As best understood from FIG. 15, the system is initially filled
with a fluid under slight pressure, more specifically a liquid 72
containing a radio-opaque dye therein. Quite obviously, the fluid
that is selected must be physiologically compatible with the body
tissue and its organs in case a leak should develop in the system.
By rendering the fluid 72 opaque to radiation, such as X-rays, the
flow of fluid can be readily traced with the result that any
malfunctioning of the system 30 or impairment of the individual
components comprising the system can be easily detected and
surgical correction then made if need be.
At this time, the reservoir 32 will be referred to in greater
detail. From FIG. 4 it will be discerned that the reservoir 32 is
formed with two flexible panels labeled 74, 76. The marginal edges
78 of the panels 74, 76 form a lap joint, being sealed together
with a suitable adhesive so as to prevent leakage from the
reservoir. The two tubes 34, 70 connecting with the bottom of the
reservoir 32 are also sealed in place. It might be explained that
the panels 74, 76 do not have to be resilient or elastic.
Consequently, when silicone rubber, which is the preferred
material, is used for the panels 74, 76 it can be reinforced with
polyester fibers.
With respect to the various tubes that have been referred to, these
tubes can be also of silicone rubber. An implantable grade of
adhesive can be employed to assure a liquid tight connection of the
tubes 34, 70 with the reservoir 32. Type A adhesive, manufactured
by Dow Corning Corporation of Midland, Mich., is an example of one
adhesive that has proved satisfactory.
Similarly, a liquid-tight connection is made between the tubes 34,
40, 44, 50, 54, 60, 64, 70 and the various check valves 36, 46, 56,
66. FIG. 11 elevationally shows the check valve 36 and FIG. 12
sectionally illustrates this same check valve 36 on a greatly
expanded scale. Thus, the end portions of the two tubes 34, 40 are
sealed within the ends of this check valve 36. More specifically,
it will be noted that the check valve 36 comprises a cylindrical
housing or casing denoted by the reference numeral 80 and that the
two tubes extend through its end walls 82 into the chamber assigned
the reference numeral 84. Within the chamber 84, as can be seen
from FIG. 12, there is a plug member 86 having a cylindrical body
88. One end portion is tapered or conical at 90 and seats against
the end of the attached tube 34. The other end has a cylindrical
boss 92 integral therewith, the boss being of lesser diameter than
the body 88 so as to form a shoulder 94. A stainless steel coil
spring 96 is confined between the shoulder 94 and the other right
end wall 82. Thus, the plug member 86 is biased to the right or
against the end of the tube 34, this being by reason of the coil
spring 96 which is always under a slight amount of compression
within the chamber 84.
Consequently, it should be clear from FIG. 12 that the check valve
36 permits fluid to flow only in the direction of the arrow 38 in
FIGS. 1 and 15 and also only in the direction of the subsidiary
arrows 98 and 100 applied to FIG. 12. In other words, fluid 72 can
flow from the reservoir 32 through the tube 34 (as indicated by the
arrow 98 in FIG. 12), past the plug 86 contained within the chamber
84, the spring 96 yielding sufficiently to permit passage, and then
through the tube 44 (in the direction of the arrow 100 in FIG.
12).
Passing now to a description of the elastomeric bulb 42 appearing
at the left (the right side of the user's body) in FIGS. 1 and 15,
and shown on an enlarged scale in FIGS. 13 and 14, it will be
appreciated from FIG. 14 that this bulb constitutes a resilient,
and readily compressible, envelope. More specifically, the bulb 42
is fabricated from silicone rubber that is thin and elastic, yet
readily creates a negative internal pressure when not being
compressed so that it readily refills, the two tubes 40 and 44
extending into the interior of the bulb 42 through its bottom wall
102. As with the components 32 and the various check valves 36, 46,
56 and 66, the tubes 40, 44 are retained in a sealed relationship
with the wall 102 of the bulb 42.
The check valve 46, although consisting of the same basic
components or parts as the check valve 36 has a much stronger
spring 96a than the spring 96. In other words, the spring 96a has a
spring constant much greater than that of the spring 96 so that the
plug 86 of the check valve 46 seats firmly against the end of the
tube 46 to prevent any leakage back through the tube 44, yet
permitting flow in the direction of the arrow 48 appended to FIGS.
1 and 15.
Playing a very important role in the practicing of our invention is
the cuff unit 52. While the cuff 52 has been referred to as
inflatable, it does not have to be elastic as the term is normally
understood. It is necessary, though, that the cuff 52 have a
readily deformable portion. Thus, as can be discerned from FIGS. 7
and 8, the cuff 52 has a deformable wall 104 which is considerably
thinner than the opposite wall indicated by the reference numeral
106. Actually, the more rigid wall 106 is approximately twice the
thickness of the deformable wall 104, being composed of two layers
of rubber adhered together. The wall 106 has embedded therein a
number of polyester threads or cords 108. The end portions 108a,
108b of these strings project from the opposite ends of the cuff
52. The cuff can be made of the same material as the reservoir 32
and bulb 42, but when silicone rubber reinforced with polyester
sheeting is used, the cuff material contains a more pliable
polyester mesh. It is further formed with curved side walls 104a
and 104b, being integral continuations of the layer or wall 104;
continuations 104c and 104d are inturned at the ends of the cuff 52
and are appropriately sealed to the bottom layer of the wall 106.
In this way, an expansion chamber 110 is formed therewithin into
which some of the opaque fluid 72 is pumped. It will be appreciated
that the various walls forming the cuff 52 can be of adhered layers
or laminations which are simply sealed together as best understood
from FIG. 7 or the difference in thickness between the walls 104
and 106 can be achieved by molding techniques. Thus, the deformable
wall 104 may constitute a single thickness or layer, whereas the
more rigid wall 106, as illustrated, can constitute two layers that
are adhered together with the cords 108 therebetween. The ends of
the tubes 50 and 54 are in fluid communication with the chamber
110, entering through the side wall 104a in a sealed relation
therewith.
The check valve 56 can be of identical construction with the check
valve 36 in that it contains a spring having the same spring
strength as the spring 96; consequently its spring carries the same
reference numeral. Likewise, the bulb 62 can be identical with the
other bulb 42 that has already been described in considerable
detail. While the fourth check valve is basically similar to the
three check valves 36, 46 and 56, it differs by reason of a coil
spring 96b (FIG. 15) having a greater spring constant than the
springs 96 contained in the check valves 36 and 56 but a lesser
spring constant than the spring 96a. An effort has been made to
pictorially demonstrate the relative spring strengths in FIG. 15 by
showing a spring having convolutions possessing a greater cross
section than that of the springs 96 and a smaller cross section
than the spring 96a; also a fewer number of convolutions are
depicted so as to make it graphically clear that the spring 96b
does not compress as readily as the springs 96 housed in the check
valves 36 and 56. It is not deemed necessary to show the valve on
the scale used for showing the valve 36 in FIG. 12 inasmuch as only
a heavier coil spring is substituted for the particular coil spring
96 appearing in FIG. 12. As the description progresses, the manner
in which the spring 96b is selected will become clearer. However,
at this stage it can be pointed out that it governs or limits the
maximum pressure that can be built up within the cuff chamber
110.
The system 30 is quite compact, being constructed with components
of small size, thereby occupying little space within the body 10.
To provide some idea as to the physical dimensions and volumetric
capacities the following illustrative data is presented:
reservoir 32 30-40 cc bulbs 42, 62 1-2 cc each cuff 52 3-5 cc tubes
34, 40 etc 3.2 mm O.D. 1.6 mm I.D.
The volume or capacity of the reservoir 32, it can be explained, is
approximately 10 times that of each pump bulb 42, 62, whereas the
cuff 52, more specifically its chamber 110, has a volume of one to
three times the volume of the bulb 42 or 62. The width (FIG. 6) or
cylindrical length of the toroidal configuration (FIGS. 1 and 10)
is approximately one to one and one-half times the diameter of the
vessel 20 (FIG. 5).
OPERATION
For the moment it will be assumed that the system 30 has already
been implanted within the trunk 10 of the body appearing in FIG. 1
and that it has been filled with fluid 72, actually under a slight
initial pressure. From FIG. 2 it will be perceived that the user
himself can squeeze the particular bulb 42 through the portion of
the skin 18 overlying the bulb on the right side of the patient. In
other words, the innerjacency of the bulb 42 with respect to the
skin enables the user to apply squeezing pressure through the skin
(and any intervening tissue). Hence, fingers 112, 114 have been
shown in FIG. 2 which simply knead or squeeze the bulb 42 to force
fluid 72 therefrom under pressure through the check valve 46
containing the strongest spring of the four check valves, the valve
46 being located between said bulb 42 and the cuff 52 as earlier
pointed out. In other words, when the bulb 46, which itself
functions as an expansion chamber device, is compressed, the fluid
is forced therefrom through the tube 44, the check valve 46 and the
tube 50 into the cuff 52. In so doing, the plug 86 in the check
valve 46 is forced to the right or away from the end of the tube 44
as viewed in FIG. 15, the coil spring 96 of this particular valve
46 compressing enough to permit flow of fluid in the direction of
the arrow 48. Due to its heavy construction, though, the spring 96a
is effective to prevent any fluid leakage to the left or back to
the bulb 42 when the bulb 42 is allowed to return to its normal or
uncompressed size as explained below.
When pressure applied through the skin 18 against the bulb 42 is
relaxed, the bulb 42 immediately returns to its normal shape and
volume, the resiliency of the rubber constituting this bulb being
such as to assure such return to its original, uncompressed state.
In the process of doing this, it draws fluid from the reservoir 32
via the tubes 34 and 40 as well as through the check valve 36
connected in fluid circuit therewith. In other words, the plug 86
of the check valve 36 is drawn away from the inwardly projecting
end of the tube 34, the particular coil spring 96 housed within the
casing 80 of this valve being compressed sufficiently to allow
fluid flow therethrough in the direction of the arrow 38. However,
whenever the bulb 42 is squeezed, the check valve 36 prevents flow
in a reverse direction from the bulb 42 back to the reservoir 32.
Thus, when the squeezing operation or manipulation is successively
repeated, each time the bulb 42 is compressed there is more fluid
forced into the cuff 52 and thus the pressure within the cuff is
incrementally increased by this manipulative action because the
spring 96a prevents any reverse flow by forcibly seating the plug
86 of the valve 46 against the end of the tube 44.
It should be apparent that the increase in fluid pressure within
the cuff 52 causes the cuff to be expanded or inflated. Inasmuch as
the wall 104 is readily deformable, it is forced inwardly against
the vessel 20 and thus applies a constrictive force against this
vessel to collapse its walls and thus close the passage 22 therein.
It should be equally apparent that there cannot be any reverse flow
from the cuff 52 back to the reservoir 32 through the check valves
46 and 36 (and also the bulb 42) because the plugs 86 housed
therein simply abut or seat against the ends of the tubes 44 and
34, respectively, that extend into the casings 80 of these two
check valves.
It should also be obvious that while flow might be expected to take
place through the check valves 56, 66 in the direction of the
arrows 58, 68, any such flow from the cuff 52 under these
conditions is effectively resisted by the fourth check valve 66. It
will be recalled that the coil spring 96b housed within the casing
80 of the check valve 66 is stronger than the springs 96 within the
casings of the check valves 36, 56 (but weaker than the spring 96a
in the check valve 46). Consequently, a maximum pressure can be
built up in the cuff 52 which is determined by the spring strength
of the spring 96b in the check valve 66. The specific spring 96b in
the check valve 66 is selected so as to enable the appropriate
pressure to be developed within the cuff 52, the pressure being
sufficient so as to produce the sufficient deformation of the wall
104 to effect only enough constriction of the vessel 20 to close or
block its passage 22, yet not enough pressure to cause discomfort
to the patient or user. Stated somewhat differently, the check
valve 66 acts as a directional safety or relief valve, yielding to
the proper pressure in the direction of the arrow 68 (but blocking
flow in a reverse direction). The increased pressure, that is the
pressure determined by the valve 66, will be maintained
automatically owing to the prevention of reverse flow back to the
reservoir 32 due to the checking action provided by the valves 36,
46.
The foregoing has dealt with the closing of the vessel 20. When the
user wishes to open, actually reopen, the vessel 20, he must
manipulate the bulb 62 located at his left side (at the right in
FIGS. 1 and 15), doing so in the same fashion that he manipulated
the bulb 42 located at his right side (at the left in FIGS. 1 and
15 and also in FIG. 2).
What transpires is that when the bulb 62 is squeezed, there can be
no flow of fluid 72 through the check valve 56 in a direction
opposite to the arrow 58. This result occurs because the plug 86 in
this particular check valve 56 is forced against the tube 54 to
block any reverse flow. However, when the bulb 62 is squeezed, the
plug 86 in the check valve 66 moves to the left or in the direction
of the arrow 68 to open the tube 64, the coil spring 96b, even
though heavier than the other coil springs 96, compressing to
permit this. Under these conditions, fluid 72 contained in the bulb
62 is forcibly returned to the reservoir 32.
The repeated kneading or squeezing of the bulb 62 will withdraw
fluid from the cuff 52, owing to the inherent resiliency of the
rubber constituting the bulb 62, with the consequence that the
deformable wall 104 no longer is forced inwardly against the vessel
20. Hence, flow can take place through the now open passage 22.
When the vessel 20 is to be closed again, the system 30 is operated
once more in the same manner outlined above. Thus, the bulb 62 at
the left in FIGS. 1 and 15 is repeatedly squeezed and the cuff 52
is again inflated so that its deformable wall 104 presses radially
inwardly against the vessel 20 to close its passage 22. The passage
22 can be reopened again by manipulating the pump bulb 62 as
already described. It will be appreciated, though, that the
pressure (and closure of the passage 22) developed by manipulating
the bulb 42 is maintained automatically until the bulb 62 is
manipulated.
IMPLANTING PROCEDURE
Inasmuch as the system 30 is to be installed completely within an
animal body, surgical procedures are resorted to. Assuming that the
system 30 is to be implanted in the trunk 10 as illustrated in FIG.
1, an abdominal incision is made through the skin 18 so as to
provide access to the pelvic cavity 12. With the pelvic cavity
open, the particular section of the urethra or vessel 20 to be
encircled is exposed by further cutting and forcing overlying
tissue to one side. The entire system 30 can be laid within the
trunk 10. In this particular type of operation, the left end
labeled 104c of the cuff 52 is advanced from the right to the left
beneath the urethra 20 as viewed in FIG. 1, assuming the patient to
be in a prone position. More specifically, the surgeon positions
the cuff 52 so that its ends 104c and 104d are substantially
equidistant from the urethra 20.
FIG. 9 exemplifies the next step of raising the ends 104c and 104d
of the cuff 52, thereby partially wrapping the cuff about the
vessel 20. The encircling or wrapping procedure is completed by
bringing the cuff ends in juxtaposition with each other. Then, the
surgeon ties each of the projecting end portions of the polyester
threads or cords 108a and 108b so as to assure that the
circumscribed toroidal relationship appearing in FIGS. 5 and 10,
and also in FIG. 1, will be maintained. Care is exercised, though,
to not draw the cuff 52 too tightly around the vessel 20, for no
initial constrictive force is to be applied to the vessel 20 as the
passage 22 should remain fully open under these conditions.
It will be fully appreciated, it is thought, that FIG. 1 is only
exemplary of the installation, being generic to both males and
females. In most cases, the system 30 will be implanted within the
scrotum of the male and in the major labia of the female. Our
system is sufficiently versatile to allow implanting in various
regions of the body. In this regard, it has already been mentioned
that the system is applicable to fecal control and in such a
situation it would be installed with the cuff circumscribing the
intestine.
* * * * *