PATHWAY VAGINAL EMG/STIM PERINEOMETER SENSOR, PATHWAY ANAL EMG/STIM PERINEOMETER SENSOR

K993976 · The Prometheus Group · KPI · Feb 22, 2000 · Gastroenterology, Urology

Device Facts

• Record ID: K993976
• Device Name: PATHWAY VAGINAL EMG/STIM PERINEOMETER SENSOR, PATHWAY ANAL EMG/STIM PERINEOMETER SENSOR
• Applicant: The Prometheus Group
• Product Code: KPI · Gastroenterology, Urology
• Decision Date: Feb 22, 2000
• Decision: SESE
• Submission Type: Traditional
• Regulation: 21 CFR 876.5320
• Device Class: Class 2
• Attributes: Therapeutic

Intended Use

Urinary Incontinence : Stress, Urge and Mixed Incontinence * Neuromuscular Reeducation * Fecal Incontinence (EMG use only)

Device Story

Single-user plastic sensors with stainless steel electrode contacts; inserted vaginally or rectally by patient. Connects to external surface EMG device for biofeedback or stimulator device for muscle contraction assistance. Used in clinic, hospital, or home settings. Provides pelvic floor muscle activity monitoring or electrical stimulation to improve muscle strength and control. Healthcare providers use output to guide incontinence treatment plans; patients use biofeedback to visualize muscle activity.

Clinical Evidence

Clinical testing involved test subjects performing pelvic floor contractions and relaxations using subject sensors and predicate devices. EMG sessions were recorded via PC; stimulators were used to generate contractions. Performance was validated by monitoring resulting contractions with a pressure perineometer in the alternate placement (vagina or rectum). Results demonstrated accurate EMG monitoring and stimulation performance equivalent to the predicate device.

Technological Characteristics

Single-user plastic sensor; stainless steel electrode contacts; three-electrode configuration (two active, one ground); shielded cable; 1/8" stereo plug connector; includes retention bulb and orientation tabs. Passive sensing/stimulation device; no internal power source. Biocompatibility: skin sensitization, systemic injection, L929 MEM elution, pyrogen, and irritation testing performed.

Indications for Use

Indicated for patients with stress, urge, or mixed urinary incontinence, fecal incontinence (EMG use only), and those requiring neuromuscular reeducation of the pelvic floor muscles.

Regulatory Classification

Identification

A nonimplanted electrical continence device is a device that consists of a pair of electrodes on a plug or a pessary that are connected by an electrical cable to a battery-powered pulse source. The plug or pessary is inserted into the rectum or into the vagina and used to stimulate the muscles of the pelvic floor to maintain urinary or fecal continence. When necessary, the plug or pessary may be removed by the user. This device excludes an AC-powered nonimplanted electrical continence device and the powered vaginal muscle stimulator for therapeutic use (§ 884.5940).

Predicate Devices

• Pathway Vaginal/Rectal EMG Perineometer Sensor (K974036)
• InCare Vaginal EMG/Stimulation Perineometer Sensor (K891773)
• InCare Anal EMG/Stimulation Perineometer Sensor (K930530)

Submission Summary (Full Text)

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| The Prometheus Group |
|----------------------|
|----------------------|

| One Washington Street, #303 Dover , NH 03801 | |
|----------------------------------------------|--------------|
| Phone: | 603-749-0733 |
| Fax: | 603-749-0511 |

K993976 PG. 1 of 5

FEB 2 2 2 2000

# 510(k) SUMMARY Safety and Effectiveness Summary

# Pathway Vaginal EMG/Stimulation Perineometer Sensor Pathway Anal EMG/Stimulation Perineometer Sensor

#### Submitted by:

Peter A Sullivan One Washington Street Suite 303 Dover, NH 03820 Phone: [phone] Fax: [phone]

## Contact Person:

Richard Horton

Date Submitted: Feb 4, 2000

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#### NAME OF DEVICE

Pathway Vaginal EMG/Stimulation Perineometer Sensor Trade name: Pathway Anal EMG/Stimulation Perineometer Sensor Common name: Perineometer Sensor Classification name: Perineometer (per 21 CFR section 884,1425)

#### IDENTIFICATION OF PREDICATE DEVICE

The device to which we claim substantial equivalence is the Pathway Vaginal/Rectal EMG Perineometer Sensor 510(k) number K974036, the InCare Vaginal EMG/Stimulation Perineometer Sensor and the InCare Anal EMG/Stimulation Perineometer Sensor 510(k) numbers K891773 and K930530. The Pathway Vaginal/Rectal EMG Perineometer Sensor, the InCare Vaginal EMG/Stimulation Sensor and the InCare Anal EMG/Stimulation Sensor are also singleuser plastic sensors with stainless steel electrode contacts.

#### DESCRIPTION OF DEVICE

The Pathway Vaginal EMG/Stimulation Perineometer Sensor and the Pathway Anal EMG/Stimulation Perineometer Sensor are EMG OR Stimulation perineometer sensors used to monitor OR stimulate the pelvic floor muscles for the treatment of incontinence. This sensor is connected to a surface EMG device to provide Bio-feedback to the patient. This allows the patient to monitor their pelvic muscle activity which is otherwise difficult due to the anatomical location of the pelvic floor muscles. This sensor is connected to a stimulator device to provide stimulation to the patient. This assists the patient with muscle contractions.

The Pathway Vaginal EMG/Stimulation Perineometer Sensor and the Pathway Anal EMG/Stimulation Perineometer Sensor are single-user plastic sensors with stainless steel electrode contacts. The patient inserts the sensor into the vagina or rectum and uses a surface EMG instrument to monitor the muscle activity during contraction and relaxation of the pelvic floor muscles. The patient can instead use a stimulator to electrically stimulate the pelvic floor muscles to assist the contraction. The aim is to improve the strength and control of the pelvic floor muscles.

#### INTENDED USE

Indications For Use:

- * Urinary Incontinence : Stress, Urge and Mixed Incontinence
- * Neuromuscular Reeducation
- * Fecal Incontinence (EMG use only)

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### SUMMARY OF TECHNICAL CHARACTERISTIC COMPARISON TO PREDICATE DEVICE

| Feature | Pathway<br>Vaginal | Pathway<br>Anal | Pathway<br>Vag/Rect | InCare<br>Vaginal | InCare<br>Anal |
|----------------------------------------------------------------------------|--------------------|-----------------|---------------------|-------------------|----------------|
| Single-User Perineometer Sensor | Yes | Yes | Yes | Yes | Yes |
| Plastic Sensor with Metal Contacts | Yes | Yes | Yes | Yes | Yes |
| Three Electrode Contacts | Yes | Yes | Yes | No | No |
| Two Active, One Ground Contact | Yes | Yes | Yes | No | No |
| Separate Ground Connection for EMG | No | No | No | Yes | Yes |
| Shielded Cable | Yes | Yes | Yes | Yes | Yes |
| Safety 1/8" Stereo Plug Connector | Yes | Yes | Yes | No | No |
| 1/8" Stereo Plug Connector | No | No | No | Yes | Yes |
| Urinary Incontinence | Yes | Yes | Yes | Yes | Yes |
| Fecal Incontinence<br>(EMG use only) | Yes | Yes | Yes | No | No |
| Vaginal Use | Yes | No | Yes | Yes | No |
| Rectal Use | No | Yes | Yes | No | Yes |
| Clinic, Hospital & Home Use | Yes | Yes | Yes | Yes | Yes |
| Bulb at Tip of Sensor to Assist Retention<br>of Sensor During Use | Yes | Yes | No | No | Yes |
| Tab at Base of Sensor for Insertion/Removal<br>and Control Insertion Depth | Yes | Yes | Yes | No | No |
| Arrow on Bottom of Sensor for Orientation | Yes | Yes | No | No | No |
| Tab at Base of Sensor for Orientation | Yes | Yes | Yes | No | No |
| Use for EMG measurement | Yes | Yes | Yes | Yes | Yes |
| Use for Stimulation | Yes | Yes | No | Yes | Yes |
| Overall Length | 2.9" | 2.4" | 2.9" | 4.3" | 2.3" |
| Sensing Diameter | .70" | .50" | .73" | 1.0" | .47" |

### NON-CLINICAL PERFORMANCE DATA

A series of bench tests were performed using the Pathway Vaginal EMG/Stimulation Perineometer Sensor and the Pathway Anal EMG/Stimulation Perineometer Sensor to show the sensor accurately measures EMG signals and is substantially equivalent to the predicate device, The sensors were used to measure a known input signal and the measured value was compared to the known input signal to check the accuracy of the measurement. The same bench tests were performed on the predicate device.

The bench tests show the Pathway Vaginal EMG/Stimulation Perineometer Sensor and the Pathway Anal EMG/Stimulation Perineometer Sensor accurately measure EMG signals. The bench tests also show that the Pathway Vaginal EMG/Stimulation Perineometer Sensor and the Pathway Anal EMG/Stimulation Perineometer Sensor perform similarly to the predicate device. The readings obtained using the Pathway Vaginal EMG/Stimulation Perineometer Sensor and the

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Pathway Anal EMG/Stimulation Perineometer Sensor were generally within 2% of the readings obtained using the predicate device.

## CLINICAL PERFORMANCE DATA

The Pathway Vaginal EMG/Stimulation Perineometer Sensor and the Pathway Anal EMG/Stimulation Perineometer Sensor were used in a series of simple clinical tests to show the sensors accurately measured EMG signals and provided stimulation and to show they were equivalent to the predicate device. A test subject was instructed to perform a series of contractions and relaxations using the Pathway Vaginal EMG/Stimulation Perineometer Sensor, the Pathway Anal EMG/Stimulation Perineometer Sensor, and also the predicate device. These EMG sessions were recorded using a personal computer. The test subject also used a viariety of stimulators with the sensors to generate contractions. The resulting contractions were monitored using a pressure perineometer sensor in the alternate placement (vagina or rectum) to compare the performance of the sensors.

The clinical tests show the Pathway Vaginal EMG/Stimulation Perineometer Sensor and the Pathway Anal EMG/Stimulation Perineometer Sensor accurately monitor and provide stimulation to the pelvic floor muscles. The clinical tests also show the Pathway Vaginal EMG/Stimulation Perineometer Sensor and the Pathway Anal EMG/Stimulation Perineometer Sensor perform similarly to the predicate device

### BIOCOMPATIBILITY TESTING

The Pathway Vaginal EMG/Stimulation Perineometer Sensor and the Pathway Anal EMG/Stimulation Perineometer Sensor have been laboratory tested for the safety of the materials. The Pathway Vaginal EMG/Stimulation Perineometer Sensor and the Pathway Anal EMG/Stimulation Perineometer Sensor were found to be safe under the standards required for each test. A listing of each performed test and the result:

| Test | Result |
|-----------------------------------------------------------------------|----------------------------------------------------|
| SKIN SENSITIZATION KLIGMAN MAXIMIZATION TEST<br>Date of Test: 9/25/97 | 0% Sensitization;<br>Weak allergenic potential |
| SYSTEMIC INJECTION TEST<br>Date of Test: 9/9/97 | Negative;<br>No significant biological<br>reaction |
| L929 MEM ELUTION TEST<br>Date of Test: 8/21/97 | Non-cytotoxic |
| PYROGEN TEST (Material Mediated)<br>Date of Test: 9/3/97 | Non-pyrogenic |
| PRIMARY VAGINAL TEST - REPEATED EXPOSURE<br>Date of Test: 10/14/97 | Minimal irritant |

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RECTAL IRRITATION TEST - REPEATED EXPOSURE Non-irritant Date of Test: 9/26/97

## CONCLUSION

The Pathway Vaginal EMG/Stimulation Perineometer Sensor and the Pathway Anal EMG/Stimulation Perineometer Sensor are safe and effective for their intended use. The Pathway Vaginal EMG/Stimulation Perineometer Sensor and the Pathway Anal EMG/Stimulation Perineometer Sensor are substantially equivalent to the predicate device.

# END OF 510(k) SUMMARY

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### FEB 2 2 2000

Mr. Richard Horton The Prometheus Group 2 Mallards Cove Duxbury, MA 02332

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Re: K993976 Pathway Vaginal EMG/Stimulation Perineometer Sensor and Pathway Anal EMG/Stimulation Perineometer Sensor Dated: February 4, 2000 Received: February 8, 2000 Requiatory Class: II 21 CFR §876.5320/Procode: 78 KPI 21 CFR §884.1425/Procode: 85 HIR

Dear Mr. Horton:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with the Current Good Manufacturing Practice requirements, as set forth in the Quality System Regulation (OS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic QS inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regult in regulatory action. In addition, FDA may publish further announcements concerning your device in the Federal Register. Please note: this response to your premarket notification submission does not affect any obligation you might have under sections 531 through 542 of the Act for devices under the Electronic Product Radiation Control provisions, or other Federal laws or requlations.

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionaily 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at [phone]. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at [phone]. Also, please note the requlation entitled. "Misbranding by reference to premarket notification"(21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number [phone] or [phone], or at its internet address "http://www.fda.gov/cdrh/dsma/dsmamain.html".

Sincerely yours,

CAPT Daniel G. Schultz, M.D. Acting Director, Division of Reproductive, Abdominal, Ear, Nose and Throat, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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#### STATEMENT OF INDICATIONS FOR USE

K993976 510(k) Number (if known): Pathway Vaginal EMG/Stimulation Perineometer Sensor and Device Name: _________________________________________________________________________________________________________________________________________________________________ Pathway Anal EMG/Stimulation Perineometer Sensor

#### Indications for Use:

Indications For Use

- * Urinary Incontinence : Stress, Urge and Mixed Incontinence
- * Neuromuscular Reeducation
- * Fecal Incontinence (EMG Use only)

Torish a. Hegeman

(Division Sign-Off) (Division Sign-On)
Division of Reproductive, Abdominal, ENT, and Radiological De 510(k) Number

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use:_ X (Per 21 CFR 801.109)

OR

Over-the-Counter Use:_

A-S