CA2635435C - Controlled urinary incontinence treatment - Google Patents

Abstract

A urinary incontinence treatment apparatus comprises a restriction device (56) implantable in a patient, for engaging the urethra or urine bladder to form a restricted urine passageway in the urethra or urine bladder. The restriction device is operable by an implantable operation device (60) to change the restriction of the urine passageway. A control device (62 and 64) is provided for controlling a source of energy, which may or may not be implanted, from outside the patient's body, to release energy for use in connection with the operation of the restriction device, i.e. to power the operation device.

Description

CONTROLLED URINARY INCONTINENCE TREATMENT

This is a divisional application of Canadian Patent Application No. 2,397,279 filed February 8, 2001.

The present invention relates to a urinary incontinence treatment apparatus, comprising a restriction device implantable in a patient suffering from urinary incontinence for engagir.ig the urethra or urine bladder toform a restricted urine passageway in the urethra or urine bladder, wherein the restriction device is operable to change the restriction of the urine passage:way.

Urine incontinence is a widespread problem. Many people are helped through training of the muscles in the pelvic floor but too many have severe problems with urine leakage. Many different go7.utiona to this problem have been tried. Vor example, there is a prior ma.ixually upe1.aLed urine ineontizience ticatinent appii:ratuo having an artificial hydraulic sphincter device engaging the urethra and connected to an -elastic reservoir implanted in the scrotum or in the region of the labia majora. A disadvantage of this prior apparatus is that over time hard fibrosis is developed around the reservoir which may cause malfunction of ptunping components. Furthermore, it is a rather complicated task to manually squeeze the elastic implanted reservoir to pump hydraulic fluid to open the sphincter device when the patient needs to urinate. In particular women can get their fingers wet.
The created fibrosis will sooner or later become a hard fibrotic layer, which may make it even more difficult to pump the reservoir. Yet a further disadvantage is that the use of hydraulic fluid always entails a risk of fluid leaking from implanted hydraulic components.

A prior hydraulic apparatus designed to compress the urethra is disclosed in U.S. Pat. No. 5520606. Prosthetic sphincters with an inflateable cuff, which surrounds the urethra or encloses it on two sides is disclosed in for example U.S. Pat.
Nos. 4571749 and 4222377. U.S. Pat. No. 4969474 discloses a d t

2 hydraulic method for treating both men and women with urinary incontinence problems in the same way. The apparatus of U.S. Pat.
No. 4969474 includes a reservoir containing fluid and- an inflatable compression means designed to compress urethra without risking tissue loss or necrosis to occur. An artificial hydraulically operated urethral sphincter employing an external magnet to achieve closure of the urethral cuff is disclosed in U.S. Pat. No. 5562598.

A prior mechanical prosthetic sphincter, disclosed in U.S.
Pat. No. 4619245, comprises a manually controllable actuating component for implanting at a convenient location in the patients body.

The object of the present invention is to provide: a new convenient urinary incontinence treatment apparatus, the performance of which may be affected by the patient at any time after operation, in particular when various needs arise over the course of a day, so that the patient substantially always is satisfied or comfortable.

This object is achieved by a urinary incontinence treatment apparatus of the kind stated initially, which is characterised in that a source of energy is provided, and a control. device operable from outside the patient's body is provided for controlling the source of energy to release energy for use in connection with the operation of the restriction device, when the restriction device is implanted.

As a result, the advantage is achieved that the restriction device can be non-invasively operated, when the restriction device has to be adjusted. Furthermore, the apparatus of the invention provides a simple and effective control of the energy supplied to implanted components of the apparatus which ensures an extended and reliable functionality of the apparatus, possibly .

3 PC'I'/SE01/00252 for the rest of the patient's life and at least many years.

The control device may also control the restriction device.
The control device may comprise an internal control unit, preferably including a microprocessor, implantable in the patient for controlling the restriction device. The control device may further comprise an external control unit outside the patient's body, wherein the internal control unit is programmable by the external control unit, for example for controlling the restriction device over time. Alternatively, the internal control unit may control the restriction device over time in accordance with an activity schedule program, which may be adapted to the patient's needs_ Agreat advantage is that the patient i s Pn.ah1ed t.ti adjiiet the restriction of the urine passageway by usiiig the eontrol device whenever he likes during the day.

Conveniently, the external control unit may load the internal control unit with data in accordance with a loading mode only authorized for a doctor. For specialized controls of the restriction device, the external control unit may control the internal control unit in accordance with a doctor mode only authorized for the doctor. For simple controls of the restriction device, the external control unit may control the internal control unit in accordance with a patient mode permitted for the patient. Thus, by using the external control unit in accordance with different modes it is possible to have certains functions of the restriction device controlled by the patient and other more advanced functions controlled by the doctor, which enables a flexible post-operation treatment of the patient.

The"control device may be adapted to control the source of energy to release energy, for instance to intermittently release energy in the form of a train of energy pulses, for di-iect use in connection with the operation of the restriction device. In WO 01/47433 PC'I'/SE01/00252

4 accordance with a suitable embodiment the control device controls the source of energy to release electric energy, and the apparatus further comprises an implantable capacitor for producing the train of energy pulses from the released energy.

In this case the term "direct" is used to mean, on one hand, that the released energy is used while it is being released. by the control device, on the other hand, that the released energy may be somewhat delayed, in the order of seconds, by for instance an energy stabilizer before being used in connection with the operation of the restriction device. The restriction device may be operable in non-manual, a non-magnetic or non-mechanical itianner by use of the releasPd energy.

In accordance with a preferred embod.imeiit of the i11-v-entivil, the apparatus comprises implantable electrical coinponents including at least one, or only one single voltage level guard and a capacitor or accumulator, wherein the charge and discharge of the capacitor or accumulator is controlled by use of the voltage level guard. As a result, there is no need for any implanted current detector and/or charge level detector for the control of the capacitor, which makes the apparatus simple and reliable.

Generally, the apparatus further comprises an operation device implantable in the patient for operating the restriction device, wherein the control device controls the operation device to operate the restriction device. The control device may directly power the operation device with energy released from the source of energy and/or power other implantable energy consuming components of the apparatus. In this case the term "directly" is used to mean, on one hand, that the operation device is powered by released energy while the latter is being released by the control device, on the other hand, that the released energy may be somewhat delayed, in the order of seconds, by for instance an ~ F

energy stabilizer before powering the operation device. The advantage of directly using energy as it is released is that the apparatus can be of a very simple design and the few cornponents involved makes the apparatus reliable.

5 The control device may release magnetic, electromagnetic, kinetic, sonic or thermal energy, or non-magnetic, non-sonic, non-thermal, non-electromagnetic or non-kinetic energy.

However, preferably the operation device comprises an electrical operation device.

Typically the apparatus of the invention comprises an adjustment device for adjusting the restriction device to change the restriction of the urinc passageway. The adjustment device may be adapted to mer-hanically a_djuFt the rcotriction device.
Alternatively, the adjustment device may be adapted to hydraulically adjust the restriction device by using hydraulic means which is devoid of hydraulic fluid of the kind having a viscosity that substantially increases when exposed to heat or a magnetic field, i.e. the hydraulic fluid would not become more viscous when exposed to heat or influenced by magnetic forces.

The restriction device may be non-inflatable, i.e. with no hydraulic fluid involved for the adjustments of the restriction device. This eliminates problems with fluid leaking f:rom the restriction device.

The operation device may comprise hydraulic means and at least one valve for controlling a fluid flow in the hydraulic means. The control device may suitably comprise a wireless remote control for controlling the valve. The restriction device may comprise hydraulic means and the operation device may comprise a reservoir forming a fluid chamber with a variable volume connected to the hydraulic means. The operation device may distribute fluid from the chamber to the hydraulic means by reduction of the volume of the chamber and withdraw fluid from

6 the hydraulic means to the chamber by expansion of the volume of the chamber.

In accordance with a first main aspect of the invention, the source of energy is external to the patient's body and the control device controls the source of energy to release wireless energy. The external source of energy may be of any conceivable kind, such as a nuclear source of energy or a chemical source of energy.

An energy storage device, preferably an electric accumulator, may be implantable in the patient for storing the wireless energy released from the external source of energy. The elec:tric a.c;curaulator may r;omprise aL least one cdpac:i.Lor or dt,.
least one recha.i7qeable battery, or a combination of at least one capacitor and at least one rechargeable battery. Alternatively, a battery may be implantable in the patient for supplying electric energy to implanted electric energy consuming components of the apparatus, in addition to the supply of wireless energy. Where the control device compr_i.ses an implantable control unit the electronic circuit thereof and the restriction device may be directly powered by transformed wireless energy, or energy from either the implantable energy storage device or battery.

In accordance with a second main aspect of the invention, the wireless energy is directly used for operation of the restriction device, i.e. the restriction device is operated as the wireless energy is released from the external source of energy by the control device. In this case the term "directly"
is used to mean, on one hand, that the restriction device is promptly operated by using the released energy whithout first storing the latter, on the other hand, that the released energy may be somewhat delayed, in the order of seconds, by for instance an energy stabilizer before being used for the operation of the 1 ~ 23038-156D

7 restriction device. As a result, a very simple control of the restriction device is achieved and there are only a few implanted components of the apparatus. For example, there is no implanted source of energy, such as a battery, nor any implanted complicated signal control system. This gives the advantage that the apparatus will be extremely reliable.
Generally, the control device controls and directly or indirectly powers the operation device with wireless energy released from the source of energy and/or powers other implanted energy consuming components of thie apparatus.

Accordinqly, the present invention relates to an urinary incontinence treatment apparatus, comprising a restriction device implantable in a patient suffering from urinary incontinence for engaging the urethra or urine bladder to form a restricted urine passageway in the urethra or urine bladder, the restriction device being operable to change the restriction of the urine passageway, a source of energy, and a control device operable from outside the patient's body for controlling the source of energy to release energy for operating the restriction device, characterised by a switch implantable in the patient for directly or indirectly switching the operation of the restriction device.

The present invention further relates to an urinary incontinence treatment apparatus, comprising a restriction device implantable in a patient suffering from urinary incontinence for engaging the urethra or urine bladder to form a restricted urine passageway in the urethra or urine bladder, the restriction device being operable to change the restriction of the urine passageway, a source of 7a energy, and a control device operable from outside the patient's body for controlling the source of energy to release energy, characterised by a motor implantable in the patient for operating the restriction device, wherein the control device is adapted to control the source of energy to power the motor.

The present invention also relates to an urinary incontinence treatment apparatus, comprising a restriction device implantable in a patient suffering from urinary incontinence for engaging the urethra or urine bladder to form a restricted urine passageway in the urethra or urine bladder, the restriction device being hydraulically operable to change the restriction of the urine passageway, a source of energy, and a control device nperable from outside the patient's body for controlling the source of energy to release energy, characterised by a pump implantable in the patient for operating the restriction device, wherein the control device is adapted to control the source of energy to release energy for driving the pump.

In a first particular embodiment in accordance with the first and second main aspects of the invention, the operation device comprises a motor, preferably an electr_Lc motor which may have electrically conductive parts made of plastics. The motor may include a rotary motor, wherein the control device is adapted to control the rotary motor to rotate a desired number of revolutions. Alternatively, the motor may include a linear motor, or a hydraulic or pneumatic fluid motor, wherein the control device is adapted to control the fluid flow through the fluid motor. Motors currently available on the market are getting smaller and smaller. Furthermore, there is a great variety of control methods and miniaturized control equipment available. For 7b example, a number of revolutions of a rotary motor may be analyzed by a Hall-element just a few mm in size.

In a second particular embodiment in accordance with the first and second main aspects of the invention, the control device is adapted to shift polarity of the released energy to reverse the operation device. The operation device may suitably comprise an electric motor and the released energy may comprise electric energy.

In a third particular embodiment in accordance with the first and second main aspects of the invention, the restriction . ~ ... .
WO 01/47433 PC"TISE01/00252 s device is operable to perform a reversible function and there is a reversing device implantable in the patient for reversing the function performed by the restriction device. Such a reversing function preferably involves. enlarging and restricting the urine passageway by the restriction device, suitably in a stepless manner. In this connection, the control device suitably controls the reversing device, which may include a switch, to reviarse the function performed by the restriction device. The reversing device may comprise hydraulic means including a valve for shifting the flow direction of a fluid in the hydraulic means.
Alternatively, the reversing device may comprise a mechanical zdvexs.ii.ig c7.dvi.c:e, suc:li a.b a swiLLti ur a yearbox.

Where the reversing device compri_ses A. switch the control device suitably controls the operation of the switch by shifting polarity of released energy supplied to the switch. The switch may comprise an electric switch and the source of energy may supply electric energy for the operation of the switch. The switch mentioned above may comprise an electronic swj'_tch or, where applicable, a mechanical switch.

In accordance with the third particular embodiment, the operation device preferably comprises a motor, wherein the reversing device reverses the motor.

In a fourth particular embodiment in accordance with the first and second main aspects of the invention, the restriction device comprises hydraulic means, for example including an expansible/contractibl.e cavity for fluid. Preferably, the operation device is adapted to conduct hydraulic fluid in the hydraulic means, and comprises a motor, a valveless fluid. conduit connected to the hydraulic means of the restriction device, and a reservoir for fluid, wherein the reservoir forms part of the conduit. The operation device suitably comprises a pump operated by the motor. All of the hydraulic components involved are . ' WO 01/47433 PC'T/5E01/00252 preferably deviod of any non-return valve. This is of great advantage, because with valves involved there is always a risk of malfunction due to inproperly working valves, especially when long time periods passes between valve operations. The reservoir may form a fluid chamber with a variable volume, and the pump may distribute fluid from the chamber to the hydraulic means of the restriction device by reduction of the volume of the chamber and withdraw fluid from the hydraulic means_ to the chamber by expansion of the volume of the chamber.

In accordance with a third main aspect of the invention, the source of energy is implantable in the patient. Thus, iivhen the source of energy is implanted in a patient the control device controla it from outside the paticnt'3 body to relco.3o cnergy.
This solution is advantageous for embodiments of the apparatus that have a relatively high consumption of energy, which cannot be satisfied by direct supply of wireless energy.

The implantable source of energy may comprise an accumulator, preferably an electric source of energy, such as a battery having a lifetime of at least 10 years.

In accordance with a fourth main aspect of the invention, the apparatus comprises a switch implanted in the patient for directly or indirectly switching the operation of the restriction device and an internal source of energy, such as a battery, implanted in the patient for supplying energy for the operation of the restriction device, wherein the switch directly or indirectly affects the supply of energy from the internal source of energy. This solution is advantageous for embodiments of the apparatus that have a relatively high energy consumption which cannot be met by direct supply of wireless energy.

In a first particular embodiment in accordance with the fourth main aspect of the invention, the switch switches between an off mode, in which the internal source of energy is not in WO 01/47433 PC'IYSE01/00252 use, and an on mode, in which the internal source of energy supplies energy for the operation of the restriction device_ In this case, the switch is conveniently operated by the wireless energy released from the external source of energy to switch 5 between the on and off modes. The control device, preferably comprising.a wireless remote control, may control the external source of energy to release the wireless energy. The advantage of this embodiment is that the lifetime of-the implanted source of energy, such as a battery, can be significantly prolonged, 10 since the implanted source of energy does not supply energy when the switch is in its off mode.

Ill a ser:oiicl parl:icular etul.xx.liltietil. ixi. acccrcia.ric elov_il.ls l.he fourth maiii aspect of the invention, the control device comprises a wireless remote control for controlling the internal source of energy. In this case, the switch is operable by the wireless energy from the external source of energy to switch between an off mode, in which the internal source of energy and remote control are not in use, and a standby mode, in which the remote control is permitted to control the internal source of energy to supply energy for the operation of the restriction device.

In a third particular embodiment in accordance with the fourth main aspect of the invention, the apparatus further comprises an energy transforming device implanted in the patient for transforming the wireless energy into storable energy, wherein the internal source of energy is capable of storing the storable energy. The internal source of energy preferably comprises an electric accumulator, at least one capacitor or at least one rechargeable battery, or a combination of at least one capacitor and at least one rechargeable battery. In this case, the switch switches from an off mode, in which the internal source of energy is not in use, to an on mode, in which the internal source of energy supplies energy for the operation of WO 01/47433 PC'T/SE01/00252 the restriction device.

The control device, preferably comprising a wireless remote control, may control the switch to switch between the on and off modes.

Alternatively, in this third particular embodiment an energy storage device may be implanted in the patient f or sto:ring the storable energy instead of the internal source of energy, wherein the switch is operable by energy from the implanted energy storage device to switch between an off mode, in which the internal source of energy is not in use, and an on mode, in which the internal source of energy supplies energy for the operation of the restriction device. In this case, th? Cont--rnl dPvlr.P (i_he wircle-c remote control) controls the enerqy storage device to operate the switch.

The internal source of energy preferably comprises an electric source of energy, such as an accumulator or a battery having a lifetime of at. least 10 years. However, other kinds of sources are also conceivable, such as a nuclear source of energy or a chemical source of energy.

The above first, second, third and fourth particular embodiments described in connection with the first and second main aspects of the invention are also applicable in accordance with the third main aspect of the invention, i.e. where the source of energy is implantable, and in accordance with the fourth main aspect of the invention, i.e. where the apparatus comprises an implantable switch.

All of the above embodiments may be combined with at least one implantable sensor for sensing at least one physical parameter of the patient, wherein the control device may control the restriction device in response to signals from the sensor.
For example, the sensor may comprise a pressure sensor for directly or indirectly sensing the pressure in the urethra or 1 t WO 01/47433 PC'1'/SE01/00252 urine bladder. The expression "indirectly sensing the pressure in the urethra or urine bladder" should be understood to encompass the cases where the sensor senses the pressure against the restriction device or human tissue of the patient. Where the 5; control device comprises an internal control unit to be implanted in the patient, the internal control unit may suitably ciirectly control the restriction device in response to- signals from the sensor. In response to signals from the -sensor, for example pressure, the patient's position or any other important physical parameter, the internal control unit may send information thereon to outside the patient's body. The control unit m-ay also a'uLoiudL:i.c;ally c:utiL.tol Llie rdstri.cLion device in L'dsipuiise Lu sic7nals from the sensor. For exdznple, the control unit may control the restriction device to firmly close the urine passageway in response to the sensor sensing that the patient is lying, or enlarge the urine passageway in response to the sensor, sensing an abnormally high pressure against the restriction device.

Where the control device comprises an external control unit outside the patient's body, the external control unit may, suitably directly, control the restriction device in response to signals from the sensor. The external control unit may store information on the physical parameter sensed by the sensor and may be manually operated to control the restriction device based on the stored information. In addition, there may be at least one implantable sender for sending information on the physical parameter sensed by the sensor.

An external data communicator may be provided outside the patient's body and an internal data communicator to be implanted in the patient may be provided for communicating with the external data communicator. The internal data communicator may feed data related to the patient, or related to the restriction device, back to the external data communicator. Alternat:ively or in combination, the external data communicator may feed data to the internal data communicator. The internal data commtunicator may suitably feed data related to at least one physical signal of the patient.

Generally, the apparatus of the invention may conlprise a switch implantable in the patient for directly or indirectly switching the energy released from the source of energy. For example, the restriction device may be operable to open and close the urine passageway or may steplessly control the restriction of the urine passageway. A pressure sensor may be provided for directly or i.ncii_rectly oensing the preCaurc in the urcthra or urine bladder_ The control devicc may control the restriction device in response to signals from the pressure sensor.

The apparatus may comprise an implantable energy transforming device, wherein the control device releases electric energy and the energy transforming device transforms the electric energy into kinetic energy for, preferably direct, operation of the =restriction device. Suitably, an implantable stabilizer, such as a capacitor or a rechargeable accuinulator, or the like, may be provided for stabilizing the electric energy released by the control device. In addition, the control device may control the source of energy to release energy for a determined time period or in a determined number of energy pulses. Finally, the restriction device may be non-inflatable.
All of the above embodiments are preferably remote controlled. Thus, the control device advantageously comprises a wireless remote control transmitting at least one jvireless control signal for controlling the restriction device. With such 30. a remote control it will be possible to adapt the function of the apparatus to-the patient's need in a daily basis, which is beneficial with respect to the treatment of the patient.

, , .
WO 01/47433 &'C'1'/SE01/00252 The wireless remote control may be capable of obtaining information on the condition of the restriction device and of controlling the restriction device in response to the information. Also, The remote control may be capable of sending information related to the restriction device from inside the patient's body to the outside thereof. -In a particular embodiment of the invention, the vaireless remote control comprises at least one external signal transmitter or transceiver and at least one internal signal receiver or transceiver implantable in the patient. In another particular embodiment of the invention, the wireless remote control c;emlii=iscs aL leasL oile extcrnal signal zeclever or transcz:ivez and at least one i.riL-eriial aigi.lul Lri_uljtui.Lter ur Li:wiac:uiver implantable in the patient.

The remote control may transmit a carrier signal for carrying the control signal, wherein the carrier signal is frequency, amplitude or frequency and amplitude modulated and is digital, analog or digital and analog. Also the control signal used with the carrier signal may be frequency, amplitude or frequency and amplitude modulated.

The control signal may comprise a wave signal, for example, a sound wave signal, such as an ultrasound wave sicFnal, an electromagnetic wave signal, such as an infrared light signal, a visible light signal, an ultra violet light signal, a laser signal, a micro wave signal, a radio wave signal, an x-ray radiation signal, or a gamma radiation signal.. Where applicable, two or more of the above signals may be combined.

The control signal may be digital or analog, and may comprise an electric or magnetic field. Suitably, the wireless remote control may transmit an electromagnetic carrier wave signal for carrying the digital or analog control signal. For example, use of an analog carrier wave signal carrying a digital WO 01/47433 PC'T/SE01/00252 control signal would give safe communication. The contro:l signal may be transmitted in pulses by the wireless remote control.

In all of the above solutions, the control device advantageously releases energy from the source of energy in a 55 non-invasive, magnetic, non-magnetic, mechanical or non-mechanical manner.

The control device may release magnetic, electromagnetic, kinetic or thermal energy, or non-magnetic, non-thermal, non-electromagnetic or non-kinetic energy.

10 The control device may be activated in a manual or non-manual manner to control the source of energy to release energy.
The above-presented embodiments of the invention. may be modified in accordance with the following suggestions. The released energy may comprise electric energy and an implantable 15 capacitor having a capacity less than 0,1 F may be provided for producing the above-mentioned train of energy pulses.

An implantable motor or pump may be provided for operating the restriction device, wherein the control device is adapted to control the source of energy to directly power the motor or pump with the released energy. Specifically, the control device may be adapted to release wireless energy in the form of a magnetic field or electromagnetic waves (excluding radio waves) for direct power of the motor or pump, as the wireless energy is being released. Where a pump is used it preferably is not a plunger type of pump.

Generally, the wireless energy comprises a signal.

The apparatus may further comprise implantable energy transforming device for transforming wireless energy directly or indirectly into energy different than=the wireless energy, for operation of the restriction device. For example, the motor or pump may be powered by the transformed energy.

The energy transforming device may transform the wireless WO 01/47433 1'CT/SE01100252 energy in the form of sound waves, preferably directly, into electric energy for operation of the restriction device. The energy transforming device may comprise a capacitor adapted to produce electric pulses from the transformed electric energy.

The motor mentioned in the present specification may also be directly powered with wirelessly transmitted electro;magnetic or magnetic energy in the form of signals, as the energy is transmitted. Furthermore, all the various functions of the motor and associated components described in the present specification may be used where applicable.

Generally, the restriction device advantageously is embedded in a eoft or gel-like itial:uridl, such as a silicone material ha-cri ng hA.rdnPsg -1 Pgs than ?.0 Shore.

Of course, the restriction device preferably is adjustable in a non-manual manner.

All the above described various components, such as the motor, pump and capacitor, may be combined in the different embodiments where applicable. Also the various functions described in connection with the above embodiments of the invention may be used in different applications, where applicable.

All the various, ways of transferring energy and cor.itrolling the energy presented in the present specification may be practised by using all of the various components and solutions described.

The present invention also provides methods for treating urinary incontinent patients.

Accordingly, in accordance with a first alternative method, there isprovided a method of treating a patient suffering from urinary incontinence, comprising the steps of implai:iting an operable restriction device in the patient, so that the restriction device engages the urethra or urine bladder to form WO 01/47433 PC'T/SE01/00252 a restricted urine passageway in"the urethra or urine bladder, providing a source of energy for energizing the restriction device, and controlling the source of energy to release energy for use in connection with the operation of the restriction device. The method may -further comprise using energy released from the source of energy to operate the restriction device to open and close, respectively, the urine passageway.

In accordance with a second alternative method, there is provided a method of treating a patient suffering fromurinary incontinence, comprising the steps of placing at least two laparascopical trocars in the patient's body, inserting a dissecting too! through the trocars and dissecting an area of the urethra or urine bladder, placing an operable restriction device in the dissected area, so that the restriction device engages the urethra or urine bladder to form a restricted urine passageway in the urethra or urine bladder, implanting a source of energy in the patient, and controlling the implanted source of energy from outside the patient's body to release energy for use in connection with the operation of the restriction device.

In accordance with a third alternative method, there is provided a method of treating a patient suffering from urinary incontinence, comprising: (a) Surgically implanting in the patient an operable restriction device engaging the patient's urethra or urine bladder to form a restricted urine passageway in the urethra or urine bladder. (b) Providing a source of energy external to the patient's body. (c) Controlling the external source of energy from outside the patient's body to release wireless energy... And (d) using the released wireless e:nergy in connection with the operation of the restriction device.

The method may further comprise (e) implanting in the human or animal an operation device which can adjust the restricted urine passageway in response to supplied energy, and (f) using the released wireless energy to activate the implanted operation device so as (i) to enlarge the restricted urine passageway to allow urine to readily pass therethrough but normally restrict the urine passageway. In the method (f) may be practiced at least s once a day, normally several times (e.g. 2-10) a day.

In accordance with a fourth alternative method, there is provided a method of treating a patient suffering from urinary incontinence, comprising the steps of placing at least two laparascopical trocars in the patient's body, insE:rting a dissecting tool through the trocars and dissecting an area of the urethra or urine bladder, placing an operable restriction device i_n the dissected area, so that the restriction device PnclagPo f:.hc urethra or uiine bladder Lo L-orm a restricted urine pas3ageway in the urethra or urine bladder, providing an external source of energy outside the patient's body, controlling the external source of energy from outside the patient's body to release wireless energy, and using the released wireless energy in connection with the operation of the restriction device.

In accordance with a fifth alternative method, there is provided a method of treating a patient suffering froni urinary incontinence, comprising the steps of placing at least two laparascopical trocars in the patient's body, inserting a dissecting tool through the trocars and dissecting an area of the urethra or urine bladder, implanting an operable restriction device in the dissected area, so that the restriction device engages the urethra or urine bladder to form a restricted urine passageway in the urethra or urine bladder, implanting Em energy transforming device, providing an external source of energy, controlling the external source of energy to release wireless energy, and transforming the wireless energy by the energy transforming device into energy different than the wireless energy for use in connection with the operation of the WO 01/47433 1'CT/SE01100252 restriction device. This method may further comprise implanting a stabilizer in the patient for stabilizing the energy transformed by the energy transforming device.

5~ The invention is described in more detail in the following with reference to the accompanying drawings, in which FIGURES 1 to 6 are schematic block diagrams illustrating six embodiments, respectively, of the invention, in which wireless energy released from an external source of energy is used for direct operation of a restriction device engaging the urethra or urine bladder of a patient;

FIGURES 7 to 10 are schematic block diagr_amg 111.1741-ra.t-:i.ng four embodiments, reepectively, of the invention, in which energy is released from an implanted source of energy;

FIGURES 11 to 15 are schematic block diagrams illustrating five embodiments, respectively, of the invention, in which a switch is implanted in the patient for directly or indirectly switching the operation of the restriction device;

FIGURE 16 is a schematic block diagram illustrating conceivable combinations of implantable components for achieving various communication options;

FIGURE 17 illustrates the apparatus in accordance with the invention implanted in a patient;

FIGURE 18 is a block diagram illustrating remote control components of an embodiment of the invention; and FIGURE 19 is a schematic view of exemplary circuitry used for the components of the block diagram of FIGURE 18.

Referring to the drawing figures, like reference numerals designate identical or corresponding elements throughout the several figures.

FIGURE 1 schematically shows an embodiment of the urinary incontinence treatment apparatus of the invention having some parts implanted in a patient and other parts located outside the patient's body. Thus, in FIGURE 1. all parts placed to the right of the patient's skin 2 are implanted and all parts placed to the 5 left of the skin 2 are located outside the patient's body. The apparatus of FIGURE 1 comprises an implanted operable restriction device 4, which engages the patient's urethra (or alternatively .the urine bladder) to form a restricted uxine passageway. The restriction device 4 is capable of performing a reversible 10 function, i.e. to open and close the urine passageway. An implanted control unit 6 controls the restriction device 4 via a control line 8 to form an adcquate restriction of thLe of the "t:ti- i r~to- pa~;sayc-way. Ati rxY.e;:r n.al. cc~l:~l.r~~l 7111i1_. 1 0 t..l1C:L~_I.clr satl external source of energy and a wireless remote control 15 transmitting a control signal generated by the external source of energy. The control signal is received by a signal receiver incorporated in the implanted control unit 6, whereby the control unit 6 controls the implanted restriction device 4 in response to the control signal. The implanted control unit 6 also uses 20 energy from the control signal for operating the re.striction device 4 via a power supply line 12.

FIGURE 2 shows an embodiment of the invention identical to that of FIGURE 1, except that a reversing device in the form of a switch 14 operable by energy also is implanted in the patient for reversing the restriction device 4. The control un::Lt 6 uses the switch 14 to reverse the function performed by the restriction device 4. More precisely, the external control unit 10 releases energy carried by a wireless signal and the implanted control unit 6 transforms the wireless energy into a current for operating the switch 14. When the control unit 6 shifts the polarity of the current the switch 14 reverses the function performed by the restriction device 4.

FIGURE 3 shows an embodiment of the invention identical to that of FIGURE 1, except that an operation device in the form of a motor 16 also is implanted in the patient. The implanted control unit 6 powers the motor 16 with wireless energy released from the external source of energy of the external control unit 10. The implanted control unit 6 controls the operation of the motor 16 in response to a control signal from the remote control of the external control unit 10. -FIGURE 4 shows an embodiment of the invention identical to that of FIGURE 1, except that an assembly 16 including a motor/pump unit 18 and a fluid reservoir 20 also is implanted in the patient. In this case the restriction device 4 is hydraulically opcratcd, i.c. hydxauli.c fluid is punipe-c9 by the motor/pump unit 18 from the reservoir 20 through a conduit 22 to the restriction device 4 to restrict the urine passageway, and hydraulic fluid is pumped by the motor/pump unit 18 back from the restriction device 4 to the reservoir 20 to enlarge the urine passageway. The external control unit 10 releases energy carried by a wireless signal and the implanted control unit 6 transforms the wireless energy into a current, for example a current, for powering the motor/pump unit 18 via an electric power supply line 24. The implanted control unit 6 controls the motor/pump unit 16 and the restriction device 4 via control lines 26 and 27.

FIGURE 5 shows an embodiment of the invention comprising the restriction device 4, hydraulically operated, and the implanted control unit 6, and further comprising a hydraulic fluid reservoir 230, a.motor/pump unit 232 and a reversing device in the form of a hydraulic valve shifting device 234, all of which are implanted in the patient. The motor of the motor/p-iunp unit 232 is an electric motor.

FIGURE 6 shows an embodiment of the invention identical to that of FIGURE 1, except that an accumulator 28 also is implanted WO 01/47433 1'CT/SE01/00252 in the patient. The control unit 6 stores energy received from the external control unit 10 in t.he accumulator 28. In response to a control signal from the external control unit 10 the implanted control unit 6 releases energy from the accumulator 28 via a power- line 30 for the operation of the restriction device 4.

FIGURE 7 shows an embodiment of the invention comprising the restriction device 4, hydraulically operated, and the implanted cont-rol unit 6, and further comprising a source of energy in the form of a battery 32, a hydraulic fluid reservoir. 34, a motor/pump unit 36 and a reversing device in the form of a hydraulic valve shifting device 38, all, of which are implanted irs L}..te pd.Liesit:. The iuvl.c.G- u,G i:},le iliiVtCJ,t/pU.lup uadL 36 is d11 electric motor. An external control unit 40 includes a wireless remote control transmitting a control signal which is received by the signal receiver incorporated in the implanted control unit 6.
In response to a control signal from the external control unit 40 the implanted control unit 6 powers the motor/pump unit 36 with energy from the battery 32, whereby the motor/pump unit 36 distributes hydraulic fluid between the reservoir 34. and the restriction device 4. The control unit 6 controls the shifting device 38 to shift the hydraulic fluid flow direction between one direction in which the fluid is pumped by the motor/pump unit 36 from the reservoir 34 to the restriction device 4 to restrict the urine passageway, and another opposite direction in which the fluid is pumped by the motor/pump unit 36 back from the restriction device 4 to the reservoir 34 to enlarge the urine passageway.

FIGURE 8 shows an embodiment of the invention identical to that of FIGURE 6, except that a battery 42 is substituted for the accumulator 28, the external control unit 40 of the embodiment of FIGURE 5 is substituted for the external control unit 10 and an electric motor 44 is implanted in the patient for operating the restriction device 4. In response to a control signal from the external control unit 40 the implanted control unit 6 powers 5; the motor 44 with energy from the battery 42, whereby the motor 44 operates the restriction device 4.

FIGURE 9 shows an embodiment of the invention identical to that of FIGURE 8, except that the motor/pump unit 36 of the embodiment of FIGURE 7 is substituted for the motor 44 and a fluid reservoir 46 also is implanted in the patient. The reservoir 46 is via fluid conduits 48 and 50 connected to the motor/pump unit 36 and restriction device 4, which in th.is case is hydraulic:ally upcraLucl.. Ii1 tcaYun:3c= tu a. i:ui],Lxul s.iyl:lal fruui the external control unit 40, the implanted control unit 6 powers the electric motor of the motor/pump unit 36 with energy from the battery 42, whereby the motor/pump unit 36 distributes hydraulic fluid between the fluid reservoir 46 and the restrictior.L device 4.

FIGURE 10 shows an embodiment of the invention identical to that of FIGURE 8, except that a mechanical reversing device in the form of a gearbox 52 also is implanted in the patient. The implanted control unit 6 controls the gearbox 52 to reverse the function performed by the restriction device 4 (mechanically operated).

25- FIGURE 11 shows an embodiment of the invention coniprising the restriction device 4, the external control unit 10, an implanted source.of energy 236 and an implanted switch 238. The switch 238 is operated by wireless energy released from the external source of energy of the external control un:Lt 6 to switch between an off mode, in which the implanted source of energy 236 is not in use, and an on mode, in which the implanted source of energy 236 supplies energy for the operation of the . ~ .

restriction device 4.

FIGURE 12 shows an embodiment of the invention identical to that of FIGURE 11, except that also the control unit 6 is implanted, in order to receive a control signal from the wireless L remote control of the external control unit 10. The switch 238 is operated by the wireless energy from the external source of energy 10 to switch between an off mode, in which the implanted source of energy 236 and the wireless remote control. of the external control unit 10 are not in use, i.e. the control unit 6 is not capable of receiving the control signal, and a. standby mode, in which the wireless remote control is permitted to control the internal source of energy 236, via the implanted control unit 6, to smppl.y Pnar.gy fnr the nperztion ot thc restriction device 4.

FIGURE 13 shows an embodiment of the invention ider.itical to that of FIGURE 12, except that an energy transforming device for transforming the wireless energy into storable energy i:s incorporated in the implanted control unit 6 and that the implanted source of energy 236 is of a type that is capable of storing the storable energy. In this case, in response to a control signal from the external control unit 10, the implanted control unit 6 controls the switch 238 to switch from an off mode, in which the implanted source of energy 236 is not: iri use, to an on mode, in which the source of energy 36 supplies energy for the operation of the restriction device 4.

FIGURE 14 shows an embodiment of the invention identical to that of FIGURE 13, except that an energy storage device 240 also is implanted in the patient for storing the storable energy, transformed from the wireless energy by the transforming device of the control unit 6. In this case, the implanted ontrol unit 6 controls the energy storage device 240 to operate the switch 238 to switch between an off mode, in which the implanted source WO 01/47433 PC'T/SE01/00252 of energy 236 is not in use, and an on mode, in which the implanted source of energy 236 supplies energy for the operation of the restriction device 4.

FIGURE 15 shows an embodiment of the invention identical to 5i that of FIGURE 13, except that a motor 242 and a mechanical reversing device in the form of a gearbox 244 also are iniplanted in the patient. The implanted control unit 6 controls the gearbox 244 to reverse the function performed by the restriction device 4 (mechanically operated), i.e. enlarging and restricting the 10 urine passageway.

FIGURE 16 schematically shows conceivable combinations of implantted components of the apparatus for achieving various communication possibiliLico. Basically, there are the implanted restriction device 4, the implanted control unit 6 and the 15 external control unit 10 including the external source of energy and the wireless remote control. As already described above the remote control transmits a control signal generated by the external source of energy, and the control signal is reciaived by a signal receiver incorporated in the implanted control unit 6, 20 whereby the control unit 6 controls the implanted restriction device 4 in response to the control signal.

A sensor 54 may be implanted in the patient for sensing a physical parameter of the patient, such as the pressure in the stomach. The control unit 6, or alternatively the external 25 control unit 10, may control the restriction device 4 in response to signals from the sensor 54. A transceiver may be combined with the sensor 54 for sending information on the sensed physical parameter to the external control unit 10. The wireless remote control of the external control unit 10 may comprise a signal transmitter or transceiver and the implanted control unit 6 may.
comprise a signal receiver or transceiver. Alternatively, the wireless remote control of the external control unit 10 may WO 01/47433 1'C'TlSE01/00252 comprise a signal receiver or transceiver and the implanted control unit 6 may comprise a signal transmitter or transceiver.
The above transceivers, transmitters and receivers may be used for sending information or data related to the restriction device 3from inside the patient's body to the outside thereof.

The motor 44 may be implanted for operating the restriction device 4 and also the battery 32 may be implanted for powering the motor 44. The battery 32 may be equipped with a transceiver for sending information on the charge condition of the battery.

Those skilled in the art will realize that the above various embodiments according to FIGURES 1-15 could be combined. in many different ways. For example, the energy operated switch 14 could be incox.-porated in any of t.he embodiitieiits u.C FIGURES 4, 6, 8-1_ 0.
The hydraulic shifting device 38 could be incorporated in any of the embodiments of FIGURES 4 and 9. The gearbox 52 could be incorporated in any of the embodiments of FIGURES 1,6 and 8.
FIGURE 17 illustrates how any of the above-described embodiments of the apparatus of the invention may be implanted in a patient. Thus, an assembly of the apparatus implanted in the patient comprises a restriction device 56 engaging the urethra 58, an operation device 60 for operating the restriction device 56 and an internal control unit 62, which includes a. signal receiver, for controlling the operation device 61. An external control unit 64 includes a signal transmitter for transmitting a wireless control signal to the signal receiver of the implanted control unit 62. The implanted control unit 62 is capable of transforming signal energy from the control signal into electric energy for powering the operation device 60 and for energizing energy consuming implanted components of the apparatus.

FIGURE 1.8 shows the basic parts of a wireless remote control-of the apparatus of the invention including an electric motor 128 for operating a restriction device, for example of the type , . ~ .
WO 01/47433 PC'iYSE 1J00252 illustrated in FIGURE 17. In this case, the remote control is based on the transmission of electromagnetic wave signals, often of high frequencies in the order of 100 kHz - 1 gHz, through the skin 130 of the patient. In FIGURE 18, all parts placed to the S; left of the skin 130 are located outside the patient's body and all parts placed to the right of the skin 130 are implanted. Any suitable remote control system may be used.

An external signal transmitting antenna 132 is to be positioned close to a signal receiving antenna. 134 implanted close to the skin 130. As an alternative, the receiving antenna 134 may be placed for example inside the abdomen of the patient.
The receiving antenna 134 comprises a coil, approximately 1-100 mm, prc=fera1,7.y ?..5 wm ir..i d:i_amc,,tu.r, wound with a veiy thin wire and tuned with a capacitor to a specific high frequency. A small coil is chosen if it is to be implanted under the skin of the patient and a large coil is chosen if it is to be implanted in the abdomen of the patient. The transmitting antenna 132 comprises a coil having about the same restriction as the coil of the receiving antenna 134 but wound with a thick wire that can handle the larger currents that is necessary. The coil of the transmitting antenna 132 is tuned to the same specific high frequency as the coil of the receiving antenna 134.

An external control unit 136 comprises a microprocessor, a high frequency electromagnetic wave signal generator and a power amplifier. The microprocessor of the control unit 136 is adapted to switch the generator on/off and to modulate signals generated by the generator to send digital information via the power amplifier and the antennas 132,134 to an implanted control unit 138. Toavoid that accidental random high frequency fields trigger control commands, digital signal codes are used. A
conventional keypad placed on the external control unit 136 is connected to-the microprocessor thereof. The keypad is used to WO 01/47433 PC'T/SE011'00252 order the microprocessor to send digital signals to activate the restriction device to either restrict or enlarge the urine passageway. The microprocessor starts a command by applying a -high frequency signal on the antenna 132. After a short time, when the signal has energized the implanted parts of the control system, commands are sent to restrict or enlarge the urine passageway in predefined steps. The commands are sent as digital packets in the form illust"rated below.

Start pattern, Command, Count, Checksum,

8 bits 8 bits a bits 8 bits The commands are sent continuously during a rather long time period (e.g. about 30 seconds or more). When a new restrict or enlarge step is desired the Count byte is increased by one to allow the implanted control unit 138 to decode and understand that another step is demanded by the external control unit 136.
If any part of the digital packet is erroneous, its content is simply ignored.

Through a line 140, an implanted energizer unit 126 draws ,energy from the high frequency electromagnetic wave signals received by the receiving antenna 134. The energizer unit 126 stores the energy in a power supply, such as a large capacitor, powers the control unit 138 and powers the electric motor 128 via a line 142.

The control unit 138 comprises a demodulator and a microprocessor. The demodulator demodulates digital signals sent from the external control unit 136. The microprocessor of the control unit 138 receives' the digital packet, decodes it and, provided that the power supply of the energizer unit 126 has sufficient energy stored, sends a signal via a signal line 144 to the motor 128 to either contract or enlarge the restriction device depending on the received command code.

Alternatively, the energy stored in the power supply of the energizer unit may only be used for powering a switch, and the c energy for powering the motor 128 may be obtained from. another implanted power source of relatively high capacity, for example a battery. In this case the switch is adapted to connect said battery to the control unit 138 in an on mode when said switch is powered by said power supply and to keep said battery disconnected from the control unit in a standby mode when said switch is unpowered.

With reference to FIGURE 19, the remote control ;4c-'hemati.ca.1.1y described above will now be described in ac,au~clartc:e with a more detailed embodiment. The external control unit 136 comprises a microprocessor 146, a signal generator 148 and a power amplifier 150 connected thereto. The microprocessor 146 is adapted to switch the signal generator 148 on/off and to modulate signals generated by the signal generator 148 with digital commands that are sent to implanted components of the apparatus. The power amplifier 150 amplifies the signals and sends them to the external signal transmitting antenna 132. The antenna 132 is connected in parallel with a capacitor 152 to form a resonant circuit tuned to the frequency generated by the signal generator 148.

The implanted signal receiving antenna coil 134 forms together with a capacitor 154 a resonant circuit that is tuned to the same frequency as the transmitting antenna 132. The signal receiving antenna coil 134 induces a current from the received high frequency electromagnetic waves arid a rectifying diode 160 rectifies the induced current, which charges a storage capacitor 158. A coil 156 connected between the antenna coil 134 and the diode' 160 prevents the capacitor 158 and the. diode 160 from WO 01/47433 PC'I'/SE01/00252 loading the circuit of the signal receiving antenna 134 at higher frequencies. Thus, the coil 156 makes it possible to charge the capacitor 158 and to transmit digital information using amplitude modulation.

5 A capacitor 162 and a resistor 164 connected in parallel and a diode 166 forms a detector used to detect amplitude modulated digital information. A filter circuit is formed by a resistor 168 connected in series with a resistor 170 connected in series with a capacitor 172 connected in series with the resistor 168 via 10 ground, and a capacitor 174, one terminal of which is connected between the resistors 168,170 and the other terminal of which is connected between the diode :1.66 an.d. the ci.r. cuit formeri by the capacitor 162 and re3i3tor 164. The filter circuit is used to filter out undesired low and high frequencies. The detected and 15 filtered signals are fed to an implanted microprocessor 176 that decodes the digital information and controls the motor 128 via an H-bridge 178 comprising transistors 180,182,184 and 186. The motor 128 can be driven in two opposite directions by the H-bridge 178.

20 The microprocessor 176 also monitors the amount of stored energy in the storage capacitor 158. Before sending signals to activate the motor 128, the microprocessor 176 checks whether the energy stored in the storage capacitor 158 is enough. If the stored energy is not enough to perform the requested operation, 25 the microprocessor 176 waits for the received signals to charge the storage capacitor 158 before activating the motor 128.

Claims (35)

CLAIMS:

1. An urinary incontinence treatment apparatus, comprising a restriction device implantable in a patient suffering from urinary incontinence for engaging the urethra or urine bladder to form a restricted urine passageway in the urethra or urine bladder, the restriction device being operable to change the restriction of the urine passageway, a source of energy, and a control device operable from outside the patient's body for controlling the source of energy to release energy for operating the restriction device, characterised by a switch implantable in the patient for directly or indirectly switching the operation of the restriction device.

2. An apparatus according to claim 1, wherein the source of energy is intended to be external to the patient's body when the restriction device is implanted therein, and the control device is adapted to control the external source of energy to release wireless energy for use in connection with the operation of the restriction device.

3. The apparatus according to claim 2, further comprising an internal source of energy implantable in the patient for supplying energy for the operation of the restriction device, wherein the switch directly or indirectly affects the supply of energy from the internal source of energy.

4. The apparatus according to claim 3, wherein the switch switches between an "off" mode, in which the internal source of energy is not in use, and an "on" mode, in which the internal source of energy supplies energy for the operation of the restriction device.

5. The apparatus according to claim 4, wherein the switch is operable by the wireless energy released from the external source of energy.

6. The apparatus according to claim 5, wherein the control device controls the external source of energy to release the wireless energy.

7. The apparatus according to claim 1 or 6, wherein the control device comprises a wireless remote control.

8. The apparatus according to claim 3, wherein the control device comprises a wireless remote control for controlling the internal source of energy.

9. The apparatus according to claim 8, wherein the switch is operable by the wireless energy from the external source of energy to switch between an "off" mode, in which the internal source of energy and remote control are not in use, and a "standby" mode, in which the remote control is permitted to control the internal source of energy to supply energy for the operation of the restriction device.

10. The apparatus according to claim 3, further comprising an energy transforming device implantable in the patient for transforming the wireless energy into storable energy and an energy storage device implantable in the patient for storing the storable energy.

11. The apparatus according to claim 10, wherein the switch is operable by energy from the implantable energy storage device to switch between an "off" mode, in which the internal source of energy is not in use, and an "on" mode, in which the internal source of energy supplies energy for the operation of the restriction device.

12. The apparatus according to claim 11, wherein the control device controls the energy storage device to operate the switch.

13. The apparatus according to claim 1 or 12, wherein the control device comprises a wireless remote control.

14. The apparatus according to claim 3, further comprising an energy transforming device implantable in the patient for transforming the wireless energy into storable energy, wherein the internal source of energy is capable of storing the storable energy.

15. The apparatus according to claim 14, wherein the switch switches from an "off" mode, in which the internal source of energy is not in use, to an "on" mode, in which the source of energy supplies energy for the operation of the restriction device.

16. The apparatus according to claim 15, wherein the control device controls the switch to switch between the "on"
and "off" modes.

17. The apparatus according to claim 16, wherein the control device comprises a wireless remote control.

18. The apparatus according to claim 3, wherein the internal source of energy comprises an electric source of energy.

19. The apparatus according to claim 18, wherein the electric source of energy comprises at least one accumulator, at least one capacitor or at least one rechargeable battery, or a combination of at least one capacitor and at least one rechargeable battery.

20. The apparatus according to claim 18, wherein the electric source of energy comprises an accumulator or a battery having a lifetime of at least 10 years.

21. An urinary incontinence treatment apparatus, comprising a restriction device implantable in a patient suffering from urinary incontinence for engaging the urethra or urine bladder to form a restricted urine passageway in the urethra or urine bladder, the restriction device being operable to change the restriction of the urine passageway, a source of energy, and a control device operable from outside the patient's body for controlling the source of energy to release energy, characterised by a motor implantable in the patient for operating the restriction device, wherein the control device is adapted to control the source of energy to power the motor.

22. An apparatus according to claim 21, wherein the motor comprises a rotary motor, and the control device controls the rotary motor to rotate a desired number of revolutions.

23. An apparatus according to claim 21, wherein the motor comprises a linear motor.

24. An apparatus according to claim 21, wherein the motor comprises a hydraulic or pneumatic fluid motor, and the control device controls the fluid motor.

25. An apparatus according to claim 21, wherein the motor comprises an electric motor having electrically conductive parts made of plastics.

26. An apparatus according to claim 21, wherein the control device is adapted to control the source of energy to directly power the motor with the released energy.

27. An apparatus according to claim 21, wherein source of energy is intended to be external to the patient's body and the control device is adapted to control the external source of energy to release wireless energy in the form of a magnetic field or electromagnetic waves for direct power of the motor, as the wireless energy is being released.

28. An apparatus according to claim 21, wherein the source of energy is implantable in the patient.

29. An apparatus according to claim 28, wherein the implantable source of energy comprises at least one accumulator, at least one capacitor or at least one rechargeable battery, or a combination of at least one capacitor and at least one rechargeable battery.

30. An apparatus according to claim 29, wherein the implantable source of energy comprises an electric source of energy.

31. An apparatus according to claim 30, wherein the electric source of energy comprises an accumulator, or a battery having a lifetime of at least 10 years.

32. An urinary incontinence treatment apparatus, comprising a restriction device implantable in a patient suffering from urinary incontinence for engaging the urethra or urine bladder to form a restricted urine passageway in the urethra or urine bladder, the restriction device being hydraulically operable to change the restriction of the urine passageway, a source of energy, and a control device operable from outside the patient's body for controlling the source of energy to release energy, characterised by a pump implantable in the patient for operating the restriction device, wherein the control device is adapted to control the source of energy to release energy for driving the pump.

33. An apparatus according to claim 32, wherein the control device is adapted to control the source of energy to directly drive the pump with the released energy.

34. An apparatus according to claim 32, wherein the source of energy is intended to be external to the patient's body and the control device is adapted to control the external source of energy to release wireless energy in the form of a magnetic field or electromagnetic waves for directly driving the pump, as the wireless energy is being released.

35. An apparatus according to claim 17, wherein the pump is not a plunger type of pump.