K Number
K060673
Device Name
PEDIATRIC URETERAL STENT
Date Cleared
2006-03-29

(15 days)

Product Code
Regulation Number
876.4620
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Applied Medical Pediatric Ureteral Stent is indicated to relieve obstruction from a variety of benign and malignant conditions in the ureter such as presence of stones and/or stone fragments, or other ureteral obstructions such as those associated with ureteral stricture, carcinoma of abdominal organs, retroperitoneal fibrosis, or in association with extracorporeal shockwave lithotripsy, (ESWL) in patients 2 years of age and older. The stent is also used after ureteroscopy to prevent obstruction due to edema or following accidental, or planned ureteral perforation/incision to provide drainage and a scaffold for the healing ureter. In the latter circumstance it is usually used in combination with a urethral drainage catheter (e.g. Foley Catheter). The stent may be placed using retrograde endoscopic and/or fluoroscopic techniques, or percutaneously using standard radiographic technique, or at open surgery. The stent is also indicated for use as a temporary indwelling ureteral catheter to assist in urine drainage through obstructed or strictured ureters.
Device Description
The Applied Medical Pediatric Ureteral Stent is substanually equvalant to its predicates devices the Cook Sof-Flex Pediatric Double Pigtail Stent and the Applied Medical Ureteral Stent in design methodology, principle of operation and clinical utility. The device introduces no new safety or effectiveness issues when used as instructed.
More Information

Missing from text

No
The summary describes a physical medical device (ureteral stent) and its intended use and performance characteristics. There is no mention of software, algorithms, image processing, or any terms related to AI/ML. The performance studies focus on physical properties of the stent.

Yes
The device is indicated to relieve obstruction and assist in urine drainage for various medical conditions, directly treating and managing patient health.

No

Explanation: The device, a ureteral stent, is used to relieve obstruction and assist in urine drainage. It is a therapeutic device, not a diagnostic one, as it does not diagnose a condition but rather treats or manages an existing one.

No

The device description clearly identifies the device as a "Pediatric Ureteral Stent," which is a physical, implantable medical device, not software. The performance studies also focus on physical characteristics like flow rate, elongation, and tensile strength.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use clearly describes a device that is physically inserted into the body (the ureter) to relieve obstruction and assist in urine drainage. This is a therapeutic and diagnostic procedure performed directly on the patient's anatomy.
  • Device Description: The description talks about a "Ureteral Stent," which is a physical implant.
  • Input Imaging Modality: The use of fluoroscopic and radiographic techniques indicates imaging of the patient's internal anatomy, not analysis of biological samples.
  • Anatomical Site: The device is used in the ureter, a part of the human body.
  • Performance Studies: The performance studies focus on physical characteristics of the stent like flow rate, strength, and friction, which are relevant to its function within the body.

IVD devices are used to examine specimens derived from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening. This device does not perform such analysis on biological samples.

N/A

Intended Use / Indications for Use

The Applied Medical Pediatric Ureteral Stent is indicated to relieve obstruction from a variety of benign and malignant conditions in the ureter such as presence of stones and/or stone fragments, or other ureteral obstructions such as those associated with ureteral stricture, carcinoma of abdominal organs, retroperitoneal fibrosis, or in association with extracorporeal shockwave lithotripsy, (ESWL) in patients 2 years of age and older. The stent is also used after ureteroscopy to prevent obstruction due to edema or following accidental, or planned ureteral perforation/incision to provide drainage and a scaffold for the healing ureter. In the latter circumstance it is usually used in combination with a urethral drainage catheter (e.g. Foley Catheter). The stent may be placed using retrograde endoscopic and/or fluoroscopic techniques, or percutaneously using standard radiographic technique, or at open surgery.

The stent is also indicated for use as a temporary indwelling ureteral catheter to assist in urine drainage through obstructed or strictured ureters.

Product codes

FAD

Device Description

The Applied Medical Pediatric Ureteral Stent is substanually equvalant to its predicates devices the Cook Sof-Flex Pediatric Double Pigtail Stent and the Applied Medical Ureteral Stent in design methodology, principle of operation and clinical utility. The device introduces no new safety or effectiveness issues when used as instructed.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Fluoroscopic techniques, standard radiographic technique

Anatomical Site

Ureter

Indicated Patient Age Range

2 years of age and older.

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Performance tests were selected based on the FDA document titled "Guidance for the Content of Premarket Notifications for Ureteral Stents", which advises that the 510(k) submission should include the following data to demonstrate substantial equivalence: Flow rate, Elongation and Tensile Strength, Curl Strength (Coil retention), and Coefficient of Friction. These characteristics were tested in the predicate device (Cook Sof-Flex 3F Pediatric Ureteral Stent) and in the Applied Medical devices.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

Not Found

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 876.4620 Ureteral stent.

(a)
Identification. A ureteral stent is a tube-like implanted device that is inserted into the ureter to provide ureteral rigidity and allow the passage of urine. The device may have finger-like protrusions or hooked ends to keep the tube in place. It is used in the treatment of ureteral injuries and ureteral obstruction.(b)
Classification. Class II (performance standards).

0

MAR 2 9 2006

510(k) SUMMARY

510(k) NUMBER: PENDING

SUBMITTED BY: Applied Medical Resources Corporation 22872 Avenida Empresa Rancho Santa Margarita, CA 92688 (949) 713-8327

CONTACT PERSON: Cheryl Blake V.P. Regulatory Affairs and Quality Systems

DATE OF PREPARATION: March 9, 2006

NAME OF DEVICE: Pediatric Ureteral Stents

CLASSIFICATION NAME:Ureteral Stent, 21 CFR 876.4620.

TRADE NAME: Not Determined

SUMMARY STATEMENT:

The Applied Medical Pediatric Ureteral Stent is indicated to relieve obstruction from a variety of benign and malignant conditions in the ureter such as presence of stones and/or stone fragments, or other ureteral obstructions such as those associated with ureteral stricture, carcinoma of abdominal organs, retroperitoneal fibrosis, or in association with extracorporeal shockwave lithotripsy, (ESWL) in patients 2 years of age and older. The stent is also used after ureteroscopy to prevent obstruction due to edema or following accidental, or planned ureteral perforation/incision to provide drainage and a scaffold for the healing ureter. In the latter circumstance it is usually used in combination with a urethral drainage catheter (e.g. Foley Catheter). The stent may be placed using retrograde endoscopic and/or fluoroscopic techniques, or percutaneously using standard radiographic technique, or at open surgery.

The stent is also indicated for use as a temporary indwelling ureteral catheter to assist in urine drainage through obstructed or strictured ureters.

The Applied Medical Pediatric Ureteral Stent is substanually equvalant to its predicates devices the Cook Sof-Flex Pediatric Double Pigtail Stent and the Applied Medical Ureteral Stent in design methodology, principle of operation and clinical utility. The device introduces no new safety or effectiveness issues when used as instructed.

1

Performance tests were selected based on the FDA document titled "Guidance for the Content of Premarket Notifications for Ureteral Stents", which advises that the 510(k) submission should include the following data to demonstrate substantial equivalence: Flow rate, Elongation and Tensile Strength, Curl Strength (Coil retention), and Coefficient of Friction. These characteristics were tested in the predicate device (Cook Sof-Flex 3F Pediatric Ureteral Stent) and in the Applied Medical devices.

2

Image /page/2/Picture/1 description: The image shows a black and white logo of the Department of Health & Human Services. The logo features a stylized bird with three curved lines representing its wings, and the text "DEPARTMENT OF HEALTH & HUMAN SERVICES" is arranged in a circular pattern around the bird. The overall design is simple and symbolic, representing the department's mission related to health and human welfare.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

MAR 2 9 2006

Applied Medical Resources Corporation c/o Mr. Morten Simon Christensen Staff Engineer & FDA Office Coordinator Medical Device Services Underwriters Laboratories, Inc. 455 East Trimble Road SAN JOSE CA 95131-1230

Re: K060673

Trade/Device Name: Pediatric Ureteral Stent Regulation Number: 21 CFR §876.4620 Regulation Name: Ureteral stent Regulatory Class: II Product Code: FAD Dated: March 13, 2006 Received: March 14, 2006

Dear Mr. Christensen:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced we have revient of 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 the encreate, to e enactment date of the Medical Device Amendments, or to devices that have been Nury 20, 1770, and coance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the do not require approval or a 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 Applorary, to they of casyer of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that I toase of a rise a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the For at backed and registration and limited to registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) (2) CFR Parl 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

3

This letter will allow you to begin marketing your device as described in your Section 510(k) This letter will allow you to begin harketing your antial equivalence of your device to a legally premarket notification. The FDA miding of saostantial of a lovice 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), pleased If you desire specific advice for your device on our labeling - 5
contact the Office of Compliance at one of the following numbers, based on the regulation number at the top of this letter:

21 CFR 876.xxxx(Gastroenterology/Renal/Urology)240-276-0115
21 CFR 884.xxxx(Obstetrics/Gynecology)240-276-0115
21 CFR 892.xxxx(Radiology)240-276-0120
Other240-276-0100

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Also, please note the regulation entitled, "Misoration on your responsibilities under the Act from the 807.97). You may obtain other general information on your - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/industry/support/index.html.

Sincerely yours,

Nancy C. Brogdon Director, Division of Reproductive, Abdominal, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

Indications for Use

510(k) Number (if known): __

Device Name: ____Pediatric Ureteral

Stent

Indications for Use:

The Applied Medical Pediatric Ureteral Stent is indicated to relieve The Applied Medical Podiaths oienian and malignant conditions in the ureter obstruction from a vancity of bonly stone fragments, or other ureteral such as presence of stones andrer tone in ureteral stricture, carcinoma of abdominal organs, retroperitoneal fibrosis, or in association with abuominal organs, retropentonounlibrooms, in patients 2 years of age and extracorporeal shookwave illulompoy) (2017) 1) 1975 - 1995 - 1995 - 1995 - 1995 - 19 to edema or following accidental, or planned ureteral perforation/incision to to edema of following acclasion for the healing ureter. In the latter provide drainage and a ocallord for with a urethral drainage circumstance it is usually assum may be placed using retrograde catheter (C.g. I oney Outhotohio it it it it is a percutaneously using standard radiographic technique, or at open surgery.

The stent is also indicated for use as a temporary indwelling ureteral The Steff is also malouted for azge through obstructed or strictured ureters.

X Prescription Use (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 801 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER

PAGE OF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

David h. Larson

(Division Sign-Off) (Division of Reproductive, Abdominal, and Radiological Devices 510(k) Number ________________________________________________________________________________________________________________________________________________________________

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