K Number
K141643
Device Name
YARLAP
Date Cleared
2015-04-24

(309 days)

Product Code
Regulation Number
876.5320
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The device is intended to provide electrical stimulation and neuromuscular re-education for the purpose of rehabilitation of weak pelvic floor muscles for the treatment of stress, urge and mixed urinary incontinence in women and to maintain urinary continence in women.
Device Description
The Applicant device, YARLAP, is a precision Class II device housed in a sturdy lightweight cabinet. The device is battery powered with a backlit Liquid Crystal Display (LCD) and offers the user a choice of six (6) pre-set Neuromuscular Electrical Stimulation (NMES) programs. The NMES programs are Work/Rest modes of operation. The Applicant device has no TENS programs. The Applicant device is supplied with a vaginally inserted electrode specifically designed in 2003 for the hardware, circuit and software used in device to stimulate the female pubococcvgeus (PC) muscle. The Applicant device control unit connects directly to the design-specific electrode by cable and plug (extant for the industry). Sold as a kit, the YARLAP kit consists of: One (1) Battery Powered Muscle Stimulator (Control Unit), One (1) vaginally inserted electrode specifically designed for the hardware. circuit and software used in the Control Unit to stimulate the female pubococcvgeus (PC) muscle, One (1) user's manual, One (1) case.
More Information

K-081480, K-083704

Not Found

No
The device description and performance studies focus on pre-set electrical stimulation programs and usability, with no mention of adaptive algorithms, learning from data, or AI/ML terminology.

Yes
The device is described as providing "electrical stimulation and neuromuscular re-education for the purpose of rehabilitation of weak pelvic floor muscles for the treatment of stress, urge and mixed urinary incontinence in women and to maintain urinary continence in women," indicating its therapeutic purpose.

No

The device is intended to provide electrical stimulation for the purpose of rehabilitation of weak pelvic floor muscles, which is a therapeutic rather than a diagnostic function.

No

The device description explicitly states it is a "precision Class II device housed in a sturdy lightweight cabinet" and includes a "Battery Powered Muscle Stimulator (Control Unit)" and a "vaginally inserted electrode specifically designed for the hardware, circuit and software used in the Control Unit". This indicates significant hardware components beyond just software.

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

Here's why:

  • Intended Use: The intended use is to provide electrical stimulation and neuromuscular re-education for the treatment of urinary incontinence and to maintain urinary continence. This is a therapeutic purpose, not a diagnostic one.
  • Device Description: The device is a muscle stimulator that uses electrical pulses to stimulate muscles. This is a physical intervention, not a test performed on a sample of biological material.
  • Lack of IVD Characteristics: The description does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Detecting or measuring substances in biological samples
    • Providing information for diagnosis, monitoring, or screening of diseases or conditions

In summary, the device is a therapeutic device used for physical rehabilitation, not a diagnostic device used for testing biological samples.

N/A

Intended Use / Indications for Use

The device is intended to provide electrical stimulation and neuromuscular re-education for the purpose of rehabilitation of weak pelvic floor muscles for the treatment of stress, urge and mixed urinary incontinence in women and to maintain urinary continence in women.

Product codes (comma separated list FDA assigned to the subject device)

KPI

Device Description

The Applicant device, YARLAP, is a precision Class II device housed in a sturdy lightweight cabinet. The device is battery powered with a backlit Liquid Crystal Display (LCD) and offers the user a choice of six (6) pre-set Neuromuscular Electrical Stimulation (NMES) programs. The NMES programs are Work/Rest modes of operation. The Applicant device has no TENS programs. The Applicant device is supplied with a vaginally inserted electrode specifically designed in 2003 for the hardware, circuit and software used in device to stimulate the female pubococcvgeus (PC) muscle. The Applicant device control unit connects directly to the design-specific electrode by cable and plug (extant for the industry).

Sold as a kit, the YARLAP kit consists of:

  • One (1) Battery Powered Muscle Stimulator (Control Unit)
  • One (1) vaginally inserted electrode specifically designed for the hardware. circuit and software used in the Control Unit to stimulate the female pubococcvgeus (PC) muscle.
  • One (1) user's manual
  • One (1) case

Individual components that may be lost (e.g., battery compartment door) or which must be replaced throughout normal usage (e.g., battery and electrode(s) can be re-ordered individually (see User's Manual).

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

pelvic floor muscles, female pubococcvgeus (PC) muscle

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Prescription Use, Over-The-Counter Use. The device can be used by a layperson without medical professional oversight on an OTC basis for the rehabilitation of weak pelvic floor muscles to treat stress, urge and mixed urinary incontinence in women and to maintain urinary continence in women.

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)

Usability Study to Support OTC Use: Safety and efficacy of the device among racially diverse incontinent adult females unfamiliar with the device was collected demonstrating that users were able to use the device correctly (successful task completion) and in a manner that produced strong tolerable pelvic floor contractions. Both the observer and subject participants were charged with annotating possible improvements to the device itself or its labelling as well as documenting any specified or unspecified actual or potential hazard(s) concerning use, including, but not limited to the user's understanding of the device from the packaging, the user's comprehension of the instructions, the user's selection of an appropriate intensity level, or cleaning and storage.

All aspects of OTC usability were positive including, but not limited to the user's operative understanding of the device, the user's comprehension of the labelling, including the packaging and instructions, the user's selection of an appropriate intensity level and storing the device after completion of treatment. No adverse events were observed nor were potentially hazardous situations observed or prognosticated when the participants followed the provided labelling on an OTC basis.

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

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K-081480, K-083704

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 876.5320 Nonimplanted electrical continence device.

(a)
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).(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/1 description: The image shows the seal of the U.S. Department of Health and Human Services. The seal features a stylized caduceus-like symbol with three human profiles facing right, representing health and well-being. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" is arranged in a circular pattern around the symbol.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-0002

April 24, 2015

International Trade Group, Inc. Brent C. Reider President 4663 Katie Lane, Suite O Oxford, OH 45056

Re: K141643 Trade/Device Name: Yarlap Regulation Number: 21 CFR 876.5320 Regulation Name: Nonimplanted electrical continence device Regulatory Class: II Product Code: KPI Dated: March 31, 2015 Received: April 1, 2015

Dear Brent C. Reider,

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and 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) that do not require approval of a premarket approval application (PMA). 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. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code 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 FDA has made 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 Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical devicerelated adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in

1

the quality systems (OS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Industry and Consumer Education at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Joyce M. Whang -S

for Benjamin R. Fisher, Ph.D. Director Division of Reproductive, Gastro-Renal, and Urological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

Indications for Use

510(k) Number (if known) K141643

Device Name

YARLAP

Indications for Use (Describe)

The device is intended to provide electrical stimulation and neuromuscular re-education for the purpose of rehabilitation of weak pelvic floor muscles for the treatment of stress, urge and mixed urinary incontinence in women and to maintain urinary continence in women.

Type of Use (Select one or both, as applicable)

[X] Prescription Use (Part 21 CFR 801 Subpart D)
[X] Over-The-Counter Use (21 CFR 801 Subpart C)

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3

510(k) Summary

General InformationAs Required by 21 CFR 807.92(c)
Date Prepared31 March 2015
Applicant & Spec. Dev. Name:
Applicant & Spec. Dev. Address:International Trade Group, Incorporated
4663 Katie Lane, Suite “O”
Oxford, OH 45056 USA
Applicant & Spec. Dev. Tele.:
Applicant & Spec. Dev. FAX:
Applicant & Spec. Dev. Contact:
Applicant & Spec. Dev. e-mail:614-568-7000
614-568-7001
Brent C. Reider, President
info@internationaltradegroup.info
Trade Name of Device:YARLAP
510(k):K141643
Common/Usual Name:Battery Powered Muscle Stimulator with Vaginal
Electrode, Non-Implantable,
For Pelvic Floor Muscle Conditioning, Prescription
and Over-The-Counter (OTC).
Classification Group:KPI
Classification Name:Stimulator, Electrical, Non-Implanted for
incontinence.
Classification regulation:21 CFR 876.5320

Predicate Devices:

Per 21 CFR 807.92(a)(3), the two predicate (ProCode: KPI) devices are:

  • Kegel8 Pelvic Muscle Exerciser Model OPH 400 by N.E. Services, Limited o K-081480
  • . NuTrac Pelvator Model PEL 200 by Verity Scientific Limited o K-083704

Applicant Device Description:

The Applicant device, YARLAP, is a precision Class II device housed in a sturdy lightweight cabinet. The device is battery powered with a backlit Liquid Crystal Display (LCD) and offers the user a choice of six (6) pre-set Neuromuscular Electrical Stimulation (NMES) programs. The NMES programs are Work/Rest modes of operation. The Applicant device has no TENS programs. The Applicant device is supplied with a vaginally inserted electrode specifically designed in 2003 for the hardware, circuit and software used in device to stimulate the female pubococcvgeus (PC) muscle. The Applicant device control unit connects directly to the design-specific electrode by cable and plug (extant for the industry).

Traditional 510(K) Notification of a New Device: YARLAP Model Number: ECS 323

4

Sold as a kit, the YARLAP kit consists of:

  • One (1) Battery Powered Muscle Stimulator (Control Unit)
  • One (1) vaginally inserted electrode specifically designed for the hardware. circuit and software used in the Control Unit to stimulate the female pubococcvgeus (PC) muscle.
  • One (1) user's manual

One (1) case

Individual components that may be lost (e.g., battery compartment door) or which must be replaced throughout normal usage (e.g., battery and electrode(s) can be re-ordered individually (see User's Manual).

Indications for Use:

The device is intended to provide electrical stimulation and neuromuscular re-education for the purpose of rehabilitation of weak pelvic floor muscles for the treatment of stress, urge and mixed urinary incontinence in women and to maintain urinary continence in women.

Differences in Indications for Use Discussion:

A comparison of the applicant and predicate(s) stated Indications for Use (IFU) is below:

Table of Comparative Indications for Use
Predicate Device(s)Applicant Device
The device is intended to provide electrical
stimulation and neuromuscular re-education for
the purpose of rehabilitation of weak pelvic floor
muscles for the treatment of treat stress, urge and
mixed incontinence in women.The device is intended to provide electrical
stimulation and neuromuscular re-education for the
purpose of rehabilitation of weak pelvic floor
muscles for the treatment of stress, urge and mixed
urinary incontinence in women and to maintain
urinary continence in women.

The indications for use treat stress, urge and mixed incontinence in women and to maintain urinary continence in women may be considered reasonably consistent with the use described under 21 CFR 876.5320 in maintaining "continence" because in the conveyance of electrical stimulation to treat stress. urge and mixed incontinence in women and the mutual promotion continence by posture of the visceral organs and response to inter-abdominal pressure are concordant and do not introduce "different technological characteristics," and demonstrates with reasonable assurance based on established controls that the device is at least as safe and effective as a legally marketed device (see below). "

Device Substantial Equivalence and Safety

The primary function of the PC muscle is postural (i.e., muscle tone affects postural control - keeping the visceral organs in position [see stress incontinence below] and postural stability). Additionally, the PC muscle responds to inter abdominal (urinary) cues (e.g., start and stop).

1 "While a new device must have the same intended use as a predicate device in order to be SE, the Centre does not require that a new device be labelled with precise therapeutic statements identical to those that appear on predicate device labelling in order for the new device to have the same intended use" 21 U.S.C. §§ 360(n), 360c(f)(1) & 360c(i); 21 CFR 807.92(a)(3)) per extant Guidance on the CDRH Premarket Notification Review Program, 510(k) Memorandum K86-3.

5

The FDA has cleared many substantially equivalent devices for the treatment of stress, urge and mixed urinary incontinence in women using the NMES modes with a vaginally inserted electrode. This is the exact mode of action in the applicant device and of the Predicate (1) device: KEGEL8 Pelvic Muscle Exerciser Model OPH 400 (K081480) and Predicate (II) device: NuTrac Pelvator Model PEL 200 (K083704).

The biocompatible materials, circuit, hardware, software, construction and vaginally inserted electrode in the Applicant device. YARLAP, are identical to those used in the Predicate (I) device, KEGEL8 (K081480). As such, the Applicant device, "YARLAP," is substantially equivalent to:

  • . Kegel8 Pelvic Muscle Exerciser Model OPH 400 by N.E. Services, Limited o K-081480
    • o Product Code: KPI

The biocompatible materials, safety features and vaginally inserted electrode in the Applicant device. YARLAP, are identical to those used in the Predicate (II) device. NuTrac Pelvator Model PEL 200 (K083704). The hardware, software and construction are substantially similar. As such, the Applicant device, "YARLAP," is substantially equivalent:

  • NuTrac Pelvator Model PEL 200 by Verity Scientific Limited . o K-083704
    • o Product Code: KPI

The applicant device uses only pre-set substantially equivalent programs at only the most common (and intermediate) out-put levels of the cited predicates (see tables 1 & 2 below).

Additional Information Request Table 1
Basic Unit
CharacteristicsPredicate (II) Device
NuTrac PelvatorPredicate (I) Device
Kegel 8Applicant Device
YARLAP
510(k)K083704K081480K141643
Maximum Output Current
pulse peak @ 500 Ohms90mA +0/- 8%90mA +0/- 8%80mA +0/- 8%
Maximum Output Current
pulse peak @ 2K Ohms50mA +/-10%50mA +/-10%50mA +/-10%
Maximum Output Current
pulse peak @ 10K Ohms19mA +/-10%
And thus shuts off19mA +/-10%
And thus shuts off19mA +/-10%
And thus shuts off
Pulse Width (µS)50 µS – 330 µS,
program dependent50 µS – 450 µS,
program dependent200 µS – 250 µS,
program dependent
Frequency (Hz)2 Hz - 100 Hz, program
dependent2 Hz - 100 Hz, program
dependent10 Hz - 35Hz, program
dependent
Net Charge @ 500 ohms
(µC per pulse)
(If zero, state method of
achieving zero net
charge.)Zero- positive pulse is
equal and opposite to
negative pulse.
Symmetrical DC zero
(Transformer output)Zero- positive pulse is
equal and opposite to
negative pulse.
Asymmetrical DC zero
(Transformer output)Zero- positive pulse is
equal and opposite to
negative pulse.
Asymmetrical DC zero
(Transformer output)
Maximum (Peak) Phase
Charge, (µC) at 500 ohms$90mA x 330 µS = 27.9 µC$
This corresponds to the
longest pulse at the
highest current.$90mA x 450 µS = 40.5 µC$
This corresponds to the
longest pulse at the
highest current.$80mA x 250 µS = 20 µC$
This corresponds to the
longest pulse at the
highest current.

Traditional 510(K) Notification of a New Device: YARLAP Model Number: ECS 323

Submission: S003 Per 21 CFR 807.92(a)(3)(4)(5)(6)(b(1)(2)(3)(c)(d)

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SECTION 5.0 510(k) Summary

| Maximum (peak) Current
Density, (mA/cm²)
Vaginal | 14.1 mA/sq. cm
Surface = 6.4 cm² | 14.1 mA/sq. cm
Surface = 6.4 cm² | 12.5 mA/sq. cm
Surface = 6.4 cm² |
|--------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------|
| Maximum (peak) Current
Density, (mA/cm²) 2 X 2 | 3.6 mA/sq. cm
Surface = 25 cm² (2X2) | 3.6 mA/sq. cm
Surface = 25 cm² (2X2) | 3.2 mA/sq. cm
Surface = 25 cm² (2X2) |
| Maximum Power Density,
(W/cm²)
at 500 ohms | 41.8 mW/sqcm
At maximum frequency
of 100Hz, pulse width
330µS and current of
90mA (Custom: PC1,
PC2, & PC3)
PC Electrode area: 6.4
cm² | 28 mW/sqcm
At maximum frequency
of 100Hz, pulse width
450µS and current of
90mA (Custom: PC1,
PC2, & PC3)
PC Electrode area: 6.4
cm² | 3.5 mW/sqcm
At maximum frequency
of 35Hz pulse width
200µS and current of
80mA.
(P06)
PC Electrode area: 6.4
cm² |

So, while Maximum Power Density is a near ten fold difference (tables above) the true comparative Maximum Power Density for the Applicant device is established by comparing the out-put of the pre-set intermediate programs of the predicate with the corresponding pre-set programs of the applicant device. As the table below demonstrates, the values are substantially equivalent when comparing the power density of the pre-set programs at the recommended starting/ beginners intensity level of 30mA, as well as at the user intensity level of 45mA or at the maximum possible intensity level of each comparative program (see the three columns to the far right of the Table 2 below).

Additional Information Request Table 2
UtilityK141643
Applicant
80mAK081480
Predicate
90mARatePulseWorkRestTimeMax.
W/cm²
80 vs 90Ave.
W/cm²
30mAAve.
W/cm²
45mA
MixedProgram 11220055151.20.170.38
Program 51020055201.30.140.32
MixedProgram 22025088202.50.350.79
Program 92025055203.20.350.79
UrgeProgram 312200510151.20.170.38
Program 21025055201.60.180.39
UrgeProgram 410200612201.00.140.32
Program 51020055201.30.140.32
StressProgram 512250515151.50.210.47
Program 21025055201.60.180.40
StressProgram 635200618203.50.501.11
Program 340200615205.10.561.26
For the Applicant [K141643] programs chart see page 14 of the Yarlap manual.
For the Predicate [K081480] programs chart see page 12 of the Kege8 manual.

As such:

  1. the applicant device has the same technological characteristics as the predicate; and 2. the information submitted to the FDA for the applicant device does not raise new questions about safety or effectiveness and demonstrates with reasonable assurance based on established controls that the device is at least as safe and effective as a legally marketed device.

7

The predicates provide safe and effective stimulation to treat stress, mixed and urge incontinence in women using pre-set and custom [programmable] settings. The custom [programmable] settings in the predicate have broad out-put capabilities and as such the Maximum Power Density for the predicates reflect this fact (i.e., for the K081480; 28 mW/cm² at a maximum frequency of 100Hz, pulse width 450uS and current of 90mA). While all the programs of the predicate are unquestionably safe and effective; the higherlevel power out-puts of the predicate custom [programmable] settings are rarely used. Indeed, the most widely used programs in the predicate are the pre-set intermediate output level programs. So, limiting the out-put levels in the applicant [OTC] device to the most widely used intermediate levels found in the pre-set programs of the predicate device(s) gives the applicant device the same technological characteristics as the predicate with commensurate efficacy, safety and reduced risk.

Vaginal Electrodes Substantial Equivalence and Safety:

The vaginally inserted electrode cited with both Applicant and Predicate devices was designed specifically for these devices. As such the electrode does not introduce "different technological characteristics" when used for treating urinary incontinence or when avoiding it.

Usability Study to Support OTC Use

Safety and efficacy of the device among racially diverse incontinent adult females unfamiliar with the device was collected demonstrating that users were able to use the device correctly (successful task completion) and in a manner that produced strong tolerable pelvic floor contractions. Both the observer and subject participants were charged with annotating possible improvements to the device itself or its labelling as well as documenting any specified or unspecified actual or potential hazard(s) concerning use, including, but not limited to the user's understanding of the device from the packaging, the user's comprehension of the instructions, the user's selection of an appropriate intensity level, or cleaning and storage.

All aspects of OTC usability were positive including, but not limited to the user's operative understanding of the device, the user's comprehension of the labelling, including the packaging and instructions, the user's selection of an appropriate intensity level and storing the device after completion of treatment. No adverse events were observed nor were potentially hazardous situations observed or prognosticated when the participants followed the provided labelling on an OTC basis.

Conclusion

  • . The applicant device is substantially equivalent to the predicate because it has the same intended use as the predicate:
  • The applicant device has the same technological characteristics as the predicate;
  • . The labelling of the applicant device is concordant with the predicate and FDA compliant and
  • . The information submitted to the FDA for the applicant device does not raise new questions about safety or effectiveness and demonstrates with reasonable assurance based on established controls that the device is at least as safe and effective as a legally marketed device.

Traditional 510(K) Notification of a New Device: YARLAP Model Number: ECS 323

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  • . The results of the Usability Study demonstrate the device can be used by a layperson without medical professional oversight on an OTC basis for the rehabilitation of weak pelvic floor muscles to treat stress, urge and mixed urinary incontinence in women and to maintain urinary continence in women.
    The YARLAP device meets the FDA's definition of Substantial Equivalency under the relationships cited above (21 U.S.C. §§ 360(n), 360c(f)(1) & 360c(i); 21 CFR 807.92(a)(3) and the indications suggest, when obtained over-the-counter and used by a layperson without oversight by a healthcare practitioner in a non-clinical environment, the applicant device can be used correctly, safely and in a manor that produces strong tolerable pelvic floor muscle contractions appropriate for the user's condition to treat stress, urge or mixed incontinence in women and/or to maintain urinary continence in women.