DE19701840A1 - Ureteral catheter - Google Patents

Abstract

The invention relates to a ureteral catheter (10) which has an elongate shaft and a lumen (15) for ureteral peristalsis. The renal-pelvis end (11) of the ureteral catheter (10) is closed and a plurality of through openings (17) provide access to the lumen (15). The bladder end (12) of the ureteral catheter (10) is open. At least one electrode (19, 20) connected to a current source is provided at the renal-pelvic end (11) of the catheter (10) and can deliver at least electrical pulses to adjacent tissue. In another embodiment, the ureteral catheter may extend from the kidney out into an extra-corporeal area, and the through openings are only provided at the renal-pelvis end of the ureteral catheter. In said embodiment, the renal pelvis can be filled via the ureteral catheter with a fluid from outside, and it is easier to wash out fragments of stone in the ureter.

Description

The invention relates to a ureteral catheter

• - an elongated shaft and a lumen for drainage, its closed end on the kidney side into one rollable shaft section with several passage openings passages related to the lumen and
• - An open end or an open end on the bladder side.

Such a ureteral catheter is known from EP-A-208841 known.  

Known ureteral catheters have two rollable shaft ends on that fix the catheter and an uncontrollable Prevent wandering into the kidney pelvis or bladder. The bladder end of such ureteral catheters can also alternatively be provided with a valve mechanism which also an uncontrolled migration of the ureteral catheter and especially prevents vesico-ureteral reflux. The Ureteral catheters bridge the ureter and ensure it a safe flow of urine from the kidney into the bladder. Han however, it is pyeloureteral peristalsis disorders, which disrupt the natural flow of urine, can be in itself knew ureteral catheters the problem requiring treatment do not solve alone.

Pyeloureteral drainage disorders occur in newborns and Children in about 0.8 to 1% of births. You can due to chronic recurrent urinary retention to Nierenschä den (hydronephrosis), ureteral enlargement (megaureters), severe infections and other lengthy treatment cause needy problems. A drug influence Solution of the clinical picture is because of the systemic addition effect of the active pharmaceuticals practically impossible. So often only the operative consequence remains. To do this, the urine conductor separated from the bladder and directly with the outer Skin bandaged (cranial or terminal ureterostomy).

The object of the present invention is therefore a To create a ureteral catheter that is inserted into the renal pelvis is bar and the pyeloureteral Ab Flow disorders lower the flow of urine from the kidney to the bladder supports and promotes or to potentiate the ure terperistalsis, e.g. B. in connection with the forced Aus driving stone fragments after shock wave lithotrypsia,  can be used.

This object is achieved in that on Kidney pelvis end of the ureteral catheter at least one ne can be coupled or connected to a power source electrode is designed such that it at least can give electrical impulses to an adjacent tissue, or that the open end is a body-free end, that the openings on the kidney-side end limit and that at the kidney-side end of the Kathe ters at least one that can be coupled or related electrode is formed such that they at least electrical impulses to an adjacent tissue can give up.

The ureteral catheter according to the invention thus has the essential Chen advantage that it is in the upper urinary tract Pacemaker centers (pacemaker centers) of the art can stimulate the ureter to rhythmic Contractions are stimulated for a regulated urine transport from the kidney pelvis to the bladder. Are several Electrodes provided, so the different pace maker centers (middle calyx group, cone of the renal pelvis, upper, middle or lower ureter) with lower different frequencies and / or currents stimulated will. Although fundamentally different pacemaker legacy rich stimulated with the ureteral catheter according to the invention the middle cup group sti is preferred mulated. With the ureteral catheter according to the invention topical irritation by means of electrical current impulses in the Be one of these Pacemaker Centers, the peristalsis of Ureters started again.  

If the ureteral catheter according to the invention is used, then this leads to a general improvement in urodynamics of the decompensated upper urinary tract, so that primarily one surgical intervention can be avoided or at previously operated children, e.g. B. in cutaner ureterosto mie in mega meters or in operations of a decompensator ureteral stenosis with hydronephrosis and spontaneous Pacemaker loss and renal parenchyma damage to the urine river is further improved.

If the open end is a body-free end, one can spontaneous emptying and relief of the kidney pelvis over the catheter outwards into the body-free area In addition, there is a retrograde filling of the kidney pelvis hollow system possible with a liquid from the outside. over the retrograde artificial filling of the pyelon can be achieve an optimal urine bolus. Through the electrode in the The area of Pacemaker Centers can be the Peristaltic stimulates the ureter and the transport activity of the Ureters are encouraged. Kidney stones, for example after shock wave lithotrypsia (extra corporeal shock wave-lithotripsy [ESWL]) in large numbers as stone fragments present in the ureter, possibly at least partially wise, block and / or possibly a renal pelvis May cause overpressure with an externally supplied led liquid improved and above all temporal shortens safely and completely washed out into the bladder the.

Alternatively, the body-free end is via a percutaneous ne phrotomy led directly to the outside. This has with the forcier expelling stone fragments the advantage that the ure ter itself is not loaded with a catheter system. The  In this case, electrical stimulation takes place via the kidneys pelvic electrode. Antigrad applied liquids higher viscosity than urine support the forced out driving stone fragments over the ureters.

Colic or inflammation of the kidney that cannot be excluded can be prevented. This flushing can also occur with Liquids of higher viscosity are made. over the amount of liquid supplied and discharged can be the Ef detect the effectiveness of the electrical stimulation and it can on known radiological or electromyographic methods to be dispensed with.

In a preferred embodiment of the invention Kidney pelvis end of the catheter before two electrodes seen.

This has the advantage that the ureteral catheter according to the invention ter not only be operated unipolar but also bipolar can. The bipolar mode of operation is more effective, safe rer and burdened the patient with less side effects After each kidney cup has its own dynamic with appropriate frequency and flow rate, it can from Be an advantage, even more electrodes on the fiction to operate according to ureteral catheters.

In a further embodiment of the invention is the electrode or are the electrodes made of an electrically conductive Material, preferably platinum, made and are on Outer circumference of the ureteral catheter attached helically, or the electrode or electrodes are axially er stretching metallic pipe pieces in the outer surface of the Ureteral catheter incorporated.  

This has the advantage that the electrode or electrodes not only are they compatible with tissue, but they are also si permanently fixable on the shaft of the ureteral catheter. With an increase or decrease in the number of coils who also affects the performance of each electrode the.

Are the electrode or electrodes made of pipe pieces? forms, so they can be incorporated into the catheter shaft and the lines run in the catheter shaft up to free end of the catheter in the body-free area. There can the line or the lines back in or in several on the outer surface of the catheter brought pipe pieces open that serve as connecting contacts for a power source to be connected must be provided.

In a development of the invention, the electrode or are the electrodes in the outer surface of the Catheter incorporated.

This has the advantage that the ureteral catheter according to the invention If possible, insert it through the urethra into the ureter gently advanced on the inner walls of the hollow organs can be. For additional protection from adjacent Tissue and safer electrode operation this additionally with an electrically conductive Protective film.

In a further embodiment of the ure according to the invention The catheter is or the electrodes are off an electrically conductive plastic formed as Shaft section is worked into the ureteral catheter.  

This has the advantage that the electrodes are material-locking can be incorporated into the shaft of the ureteral catheter. The ge entire shaft surface can have a uniform surface quality te received, and the flexibility of the ureteral catheter under does not differ significantly in the area of the electrodes from the other shaft areas.

In a further embodiment of the invention, the electrical de or the electrodes connected to lines that in the Catheter wall run and at the bladder end of the Ka emerge from theters.

This has the advantage that the electrodes with an arbitrary can be coupled to the power source. The lines who that with the ureteral catheter placed over the bladder and the Urethra led out of the body.

In a further embodiment of the invention, the lines are at least outside the catheter with an insulating jacket tion, and at their free ends are the lines with connection means for a power source to be connected equipped.

With such a design of the lines, the ureter catheters according to the invention are operated safely.

In a further embodiment, the electrode or the electrodes are connected to a power source, which in the catheter wall or at the free end of the bladder Catheter is provided. This has the advantage that the lei the urethra from a patient's body must be brought out. As a power source, miniatu  batteries are used that have a long life have duration and also operate microprocessors that the Specify the pulse frequency or pulse duration. Are these bat teries formed as accumulators, so you can at Be allowed to inductively from outside a patient's body like who are being charged.

In a preferred embodiment of the invention Ureteral catheter is the electrode or electrodes coupled with connections of a coil or coils that the Supply the electrode or electrodes inductively with current.

This has the advantage that a placed ureteral catheter from outside, d. H. from outside a patient's body can be controlled and regulated. The power source can un implanted or worn on the skin. The stimulation skin can be operated in this way ability, intensity, etc. can be influenced wirelessly.

In a further embodiment of the invention is the electrode or the electrodes are connected to means that the Electrode or electrodes freely selectable current and span strengths, given a pulse duration and pulse size ability to dispense.

This has the advantage of being pyeloureteral stimulation done very differentiated and best possible on the patients ten can be coordinated.

In a further embodiment of the invention, the uretera theter such a length that the ureteral catheter ter from the kidney through the ureter, the bladder or the Urethra out into an area outside the body  extends.

This has the advantage that such a trained Ureteral catheter with an external fluid for irrigation the kidney pelvis and ureter. The lines for the electrodes can also be used through the hollow organs to the outside.

In a further embodiment of the invention is a body-free Provide a Luer lock connection at the end. About this type Coupling fluid systems to the invention According to the ureteral catheter, it is liquid-tight and quickly detachable couple.

In a further embodiment of the invention, the outer surface surface of the ureteral catheter has a hydrophilic property, which is achieved in particular through a hydrophilic coating becomes. Due to the hydrophilic coating, stone fragments can te relieved in the space between the invention Ureteral catheter and the adjacent inner surface wall of the ureter.

There is also an end of the ureter on the kidney side Catheter can be fixed in the kidney pelvis using a synthetic fiber. This has the advantage of being a placed ureteral catheter cannot move unintentionally.

The ureteral catheters according to the invention are preferably with egg Provide an outer marking so that the endoscopic pla ornamentation of this catheter is facilitated.

Further advantages result from the description of the added drawing. Likewise, the above  and the features listed further according to the invention individually or in any combination with each other be used. The mentioned embodiments are not to understand as a final list, but have rather exemplary character.

The invention is shown in the drawing. It shows:

Fig. 1 is a ureteral catheter with the invention on to the ends of roll-up shaft ends, on the shank end never renbeckenseitigen two electrodes are seen;

Fig. 2 is a urethral catheter according to the invention with an inserted guidewire, over which the free ends are axially aligned;

Figure 3 shows a kidney-side end of a ureter catheter according to the invention, partially in cross section, with helically applied electrodes;

Fig. 4 shows a kidney-side end of a fictional ureteral catheter, partially in cross section, with the electrode incorporated into the catheter shaft, which are made of an electrically conductive plastic material;

Fig. 5 is a view according to VV of Fig. 1;

Fig. 6 is a view according to VI-VI of Fig. 1;

Fig. 7 is a view according to VII-VII of Fig. 1;

Figure 8 is a cross section through a catheter shaft of a ureteral catheter according to the invention with integrated processing ended current sources in the catheter wall.

9 shows a portion of a ureter catheter according to the invention showing a through-hole, line lumina and a drainage lumen.

Fig. 10 shows a further embodiment of a ureteral catheter with a erfindungsge MAESSEN nierenbeckensei term stem end and a free body de properties.

The individual figures of the drawing show the Invention The subject is partly highly schematic and are not to be understood to scale. The individual items are partially greatly enlarged in the individual figures because with its structure can be shown better.

Fig. 1 shows at 10 a urethral catheter according to the invention having a renal pelvis-side end 11 and a bladder-side end 12. Both the kidney-side end 11 and the bladder-side end 12 are designed as roll-up shaft ends, which fix the uterine catheter in the placed state both in the kidney pelvis and in the bladder la.

The ureteral catheter 10 is made of a tissue-compatible, flexible and nevertheless dimensionally stable plastic material. A tip 13 of the kidney-side end 11 is closed. One end 14 of the bladder-side end 12 is open and opens into a lumen 15 which shaft 16 passes through the entire catheter 16 of the ureteral catheter 10 to the closed tip 13 . The tip 13 itself is rounded. The catheter shaft 16 is penetrated by numerous conditions 17 which are connected to the lumen 15 . The passage openings 17 are shown in the exemplary embodiment along the entire catheter shaft 16 , but they can also be formed only in sections on the ureter catheter 10 . The passage openings 17 can be formed on one side but also on both sides of the ureteral catheter 10 . On the catheter shaft 16 markings 18 are further provided, which facilitate placement of the ureteral catheter 10 . Likewise, an X-ray-proof strip can be incorporated into the catheter shaft 16 , so that the placement of the ureter catheter 10 can be checked on the one hand and on the other hand to recognize the direction in which the free shaft ends curl.

At the kidney-side end 11 , two electrodes 19 , 20 are attached to the outer circumference of the catheter shaft 16 . The electrodes 19 , 20 have an electrical connection which leads into the catheter wall and connects there to lines 21 , 22 . The lines 21, 22 are, starting from the electrodes 19, 20, led through the entire longitudinal extent of the ureter catheter 10 and exit at the vesical end 12 of the ureteral catheter 10 from. The lines 21 , 22 can be made in the shape of a delta in the catheter wall over the entire longitudinal extension of the ureteral catheter 10 . At the free ends of the lines 21 , 22 appropriate Konnektiermit tel are to be provided for a power source.

The electrodes 19 , 20 are wound helically on the outer circumference of the catheter shaft 16 . The electrodes 19 , 20 can be made from any electrically conductive material that is tissue compatible. The electrodes 19 , 20 are preferably 1 cm to 1.5 cm apart from each other, so that in the area of the electrodes 19 , 20 a well-defined electric field for triggering contraction builds up (bipolar operation). In addition to the electrodes 19 , 20 , sensors can also be provided on the ureter catheter 10 , which recognize the body's electrical signals for activating the peristalsis. By means of the electrodes 19 , 20 , the body's own signals can be amplified and / or synchronized if necessary. The electrodes 19 , 20 can also perform the function of the sensors in a double function.

One or more electrodes become unipolar on the ureteral catheter ter operated, these electrodes work with others electrodes attached to the patient's skin.

Fig. 2 shows a ureteral catheter 10 , which does not necessarily have to correspond in all physical features to the ureteral catheter of Fig. 1, with a guide wire 25 , which can be inserted into the lumen 15 of the ureteral catheter 10 shown in dashed lines, and which is the kidney pelvis and bladder side rolled ends 11 , 12 can stretch straight. If the guidewire 25 is removed from the ureter catheter 10 , then again rolled-up ends 11 , 12 on the renal side and bladder side form again. The ureter catheter 10 is shaped at its ends by a plastic material that has a memory effect.

The electrodes 19 , 20 and the passage openings are also shown in FIG. 2. The markings 18 are applied between the passage openings 17 . The lines 21 , 22 connect the electrodes 19 , 20 with a current source.

Fig. 3 shows the renal pelvic end 11 of a ureter catheter according to the inven tion with inserted guide wire 25th The guide wire 25 is inserted into the lumen 15 up to the tip 13 . With the guide wire 25 , the rolled-up end 11 on the kidney side is stretched and aligned in a straight line. The electrodes 19 , 20 are made of a bendable metallic material, platinum wire in the exemplary embodiment, which can change the direction shown without damaging the electrical connection. In the front area, the kidney-side end 11 is shown in cross section, and it can be seen that the passage opening 17 opens free access to the lumen 15 . The lines 21 , 22 are guided in the catheter wall.

Fig. 4 shows another embodiment of a pelvis-side end 11 of the ureteral catheter 10th Through the Füh approximately wire 25 , the kidney-side end 11 is straight stretched. In the tip area, electrodes 27 , 28 are incorporated into the catheter material. The electrodes 27 , 28 can for example be made of a graphite plastic mass. Electrically conductive particles are, for example, mixed into the plastic material in some areas and form the electrodes. The electrodes 27 , 28 are in turn connected to the lines 21 , 22 which connect the electrodes 27 , 28 to a power source.

In Fig. 4, the passage openings 17 are connected to the Lu men 15 , so that drainage can take place via the passage openings 17 as soon as the guide wire 25 is removed from the lumen 15 .

FIG. 5 shows a cross section of the ureteral catheter 10 of FIG. 1 in the area of the tip 13 . The cross section shows that the ureteral catheter 10 consists of a solid material in this area.

Fig. 6 shows a section along VI-VI of Fig. 1. It can be seen that the ureteral catheter 10 has the lumen 15 in this area, and a catheter wall is provided with a Lei lumen 31 which receives a line that the Electrode electrically connected to a power source.

Fig. 7 shows a cross-section VII-VII of Fig. 1. This cross-section shows that the ureteral catheter 10 in this loading area besides the lumen 15 has the line lumen 31 and a wide res line lumen 32 . The lead lumens 31 , 2 connect the electrodes to a current source. In the thether shaft wall 30 , further lumens can be guided for further lines to further electrodes.

Fig. 8 shows a further cross section through the catheter shaft 16 of the ureter catheter 10 , which in this embodiment is equipped with energy sources 33 , 34 , miniaturized batteries, which are placed in the catheter shaft wall 30 . The lumen 15 is kept completely open with respect to its free cross-sectional area. These energy sources 33 , 34 do not create a constriction. Are 30 energy sources 33 , 34 incorporated into the catheter shaft, then no lines have to be led out of the catheter shaft 16 . Further processors can also be incorporated into the catheter shaft 30 , which control and regulate the intensity of stimulation by the electrodes. If the energy sources 33 , 34 are accumulators, they can be charged from the outside without a wire.

FIG. 9 shows a short section of a shaft of the ureter catheter 10 in the region of a passage opening 17 . In this shaft section area, in addition to the lumen 15 , the line lumens 31 , 32 for current-carrying lines are also provided, which connect the electrodes to a current source.

Fig. 10 shows a ureteral catheter 40 with a pelvis-side end 41 and a free end 42 of the body. A tip 43 of the kidney-side end 41 is closed sen. One end 44 of the body-free end 42 is open and opens into a lumen 45 which runs through the entire catheter shaft 46 of the body-free 40 to the closed tip 43 . Passage openings 47 are provided only in the region of the end 41 never on the ren pool side. The passage openings 47 are in communication with the lumen 45 . Along the catheter shaft 46 may be markings on the catheter shaft 46 be provided so that an endoscopic placement of the ureteral catheter is facilitated 40th

An electrode 49 is formed in the region of the end 41 on the kidney pelvis on the ureter catheter 40 . The electrode 49 is connected to a line 51 which runs in the catheter shaft 46 and opens into an electrical connection 52 at the body-free end 42 . The line 51 can extend helically in the catheter shaft 46 . Both the electrical circuit 52 and the electrode 49 can be made from a metallic pipe section.

The ureteral catheter 40 is designed with respect to its axial length in such a way that it can be guided out of the kidney 53 through the urine 54 and the bladder 55 to the outside into the body-free area. The body-free end 42 is provided with a Luer lock connector 56 so that fluid systems can be securely coupled to the ureteral catheter 40 . About the fluid systems not shown in the figure, the kidney pelvis can be filled with a liquid from the outside, so that stone fragments 57 located in the ureter 54 can be improved and washed out more easily.

A ureteral catheter 10 has an elongated shaft and a lumen 15 for drainage between the kidney pelvis and bladder and / or for the supply of liquids into the kidney pelvis. The kidney-side end 11 of the ureter catheter 10 is closed and a plurality of passage openings 17 ensure access to the lumen 15 . The blow-side end 12 of the ureteral catheter 10 is open. At the kidney end 11 of the catheter 10 there is at least one electrode 19 , 20 which is connected to a current source and which can at least give electrical impulses to an adjacent tissue for activating the ureter peristalsis. In a further embodiment, the ureteral catheter can extend from the kidney to the outside in a body-free area, and the passage openings are only provided at the end of the ureteral catheter on the kidney side. In such an embodiment, the kidney pelvis can be filled with a liquid from the outside via the ureteral catheter and stone fragments located in the ureter can be washed out more easily.

Claims (15)

1. Ureteral catheter with an elongated shaft and a Lu men ( 15 ) for drainage, the kidney pelvis-side closed end ( 11 ) in a rollable Schaftab section with several passage openings ( 17 ), which are connected to the lumen ( 15 ) and one Bladder-side open end ( 12 ), characterized in that at the kidney-basin-side end ( 11 ) of the catheter ( 10 ) at least one electrode ( 19 , 20 ; 27 , 28 ) which can be coupled or connected to a current source is designed such that it at least can give electrical impulses to an adjacent tissue. 2. Ureteral catheter with an elongated shaft and a Lu men ( 45 ), the kidney pelvic closed En de ( 41 ) merges into a rollable shaft section with several passages ( 47 ) which are in communication with the Lu men ( 45 ) and an open end, characterized in that the open end of a body free end (42), in that the passage openings (47) are limited to the renal pelvis-side end (41) and that at the renal pelvis-side end (11) of the catheter (40) at least one of a current source couplable or in connection standing electrode ( 49 ) is designed such that it can emit at least electrical impulses to an adjacent tissue. 3. Ureteral catheter according to claim 1 or 2, characterized in that at the kidney-side end ( 11 ; 41 ) of the catheter ( 10 ; 40 ) two electrodes ( 19 , 20 ; 27 , 28 ; 49 ) are seen before. 4. Ureteral catheter according to claim 1, 2 or 3, characterized in that the one electrode ( 49 ) or the electrodes ( 19 , 20 ) made of an electrical material, preferably platinum, are helically attached to the outer circumference of the catheter ( 10 ), or are worked into the outer surface of the ureteral catheter ( 10 ; 40 ) as an axially extending metallic tube piece or tube pieces. 5. Ureteral catheter according to one of claims 1 to 4, characterized in that the one electrode ( 49 ) or the electrodes ( 19 , 20 ) are incorporated into the outer surface of the ureteral catheter ( 10 ; 40 ). 6. Ureteral catheter according to claim 1, 2 or 3, characterized in that the one electrode ( 49 ) or the electrodes ( 27 , 28 ) are formed from an electrically conductive plastic which is worked as a shaft section in the ureteral catheter. 7. ureteral catheter according to one of claims 1, 3, 4, 5 or 6, characterized in that the electrode or electrodes ( 19 , 20 ; 27 , 28 ) are connected to lines ( 21 , 22 ) which terwand in the Kathe ( 30 ) run and emerge at the bladder end 12 of the catheter ( 10 ). 8. ureteral catheter according to claim 7, characterized in that the lines ( 21 , 22 ) at least outside the Ka theter ( 10 ) have an insulating jacket and are provided at their free ends with connecting means for a power source to be closed. 9. ureteral catheter according to claim 1 or one of claims 3 to 6, characterized in that the electrode or electrodes ( 19 , 20 ; 27 , 28 ) are connected to a power source which in the Ka theterwandung ( 30 ) or on the bladder side Free en de ( 12 ) of the catheter ( 10 ) is provided. 10. Ureteral catheter according to claim 1 or one of claims 3 to 6, characterized in that the electrode or the electrodes ( 19 , 20 ; 27 , 28 ) are coupled to connections of a coil or coils which are the electrode or the electrodes ( 19 , 20 ; 27 , 28 ) supply inductively with current. 11. Ureteral catheter according to one of claims 1 to 10, characterized in that the one electrode ( 49 ) or the electrodes ( 19 , 20 ; 27 , 28 ) are connected by means which the electrode or the electrodes ( 19 , 20th ; 27 , 28 ) freely selectable current and voltage strengths, under specification of a pulse duration and pulse frequency. 12. Ureteral catheter according to one of claims 2 to 6, or claim 11, characterized in that the ureteral catheter ( 40 ) has a length such that the ureteral catheter ( 40 ) from the Nie re ( 53 ) via the ureter ( 54th ), the bladder ( 55 ) and the urethra extends outward into an area outside a body. 13. Ureteral catheter according to one of claims 2 to 6, or claim 11, 12, characterized in that a body-free end ( 42 ) is provided with a decouplable Luer lock connection ( 56 ). 14. Ureteral catheter according to one of claims 1 to 13, characterized in that the outer surface of the uterine catheter ( 10 ; 40 ) has hydrophilic properties, in particular due to a coating. 15. Ureteral catheter according to one of claims 1 to 14, characterized in that a renal pelvic end ( 41 ) of the ureteral catheter ( 40 ) can be fixed via a plastic fiber in the renal pelvis.