K Number
K183468
Device Name
Revive Reusable Bladder Support
Date Cleared
2019-01-25

(42 days)

Product Code
Regulation Number
884.3575
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Revive bladder support is intended for temporary management of urine leakage caused by stress urinary incontinence (SUI) in women, 18 years and older.
Device Description
The Revive bladder support reduces bladder leaks in women who are suffering from SUI by preventing or reducing unwanted urinary leakage. Use of the device is applicable for women who experience leakage when laughing, coughing, exercising, sneezing, etc. The device is not intended to treat women with urge incontinence. The shape of the Revive bladder support is designed to fit in the vaginal tract, and there is no sizing required. The device fits most users. The device can be worn daily for up to 12 hours. The Revive bladder support can be reused (and cleaned) for up to 31 times. Each packaged Revive bladder support device comes with the following: - · 1 Reusable Bladder Support - · 1 Reusable Applicator - · 1 Month Strings Supply - · Travel Case - · Instructions for Use
More Information

No
The device description and performance studies focus on a physical, reusable bladder support and its clinical efficacy, with no mention of AI or ML components.

Yes
The device is intended for the temporary management of urine leakage caused by stress urinary incontinence, reducing leaks and improving quality of life, which aligns with treating a medical condition.

No

This device is intended for the management (treatment/prevention) of urine leakage caused by SUI, not for diagnosing it. Its purpose is to prevent or reduce leakage, as described in the "Intended Use / Indications for Use" and "Device Description" sections.

No

The device description explicitly lists physical components such as a reusable bladder support, reusable applicator, month strings supply, and travel case. This indicates it is a physical medical device, not software-only.

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

Here's why:

  • IVD Definition: In Vitro Diagnostics are devices intended for use in the collection, preparation, and examination of specimens taken from the human body (such as blood, urine, tissue) to provide information for the diagnosis, monitoring, or treatment of a disease or condition.
  • Revive's Function: The Revive bladder support is a physical device inserted into the vaginal tract to provide mechanical support and reduce urine leakage. It does not analyze or test any bodily specimens.
  • Intended Use: The intended use is for the "temporary management of urine leakage caused by stress urinary incontinence (SUI)," which is a physical intervention, not a diagnostic process.
  • Device Description: The description focuses on the physical design and function of the device within the body, not on any laboratory or analytical procedures.
  • Lack of IVD Indicators: The document does not mention any aspects related to specimen collection, analysis, reagents, or laboratory procedures, which are characteristic of IVD devices.

Therefore, the Revive bladder support is a medical device, but it falls under a different classification than In Vitro Diagnostics.

N/A

Intended Use / Indications for Use

The Revive bladder support is intended for temporary management of urine leakage caused by stress urinary incontinence (SUI) in women, 18 years and older.

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

HHW

Device Description

The Revive bladder support reduces bladder leaks in women who are suffering from SUI by preventing or reducing unwanted urinary leakage. Use of the device is applicable for women who experience leakage when laughing, coughing, exercising, sneezing, etc. The device is not intended to treat women with urge incontinence. The shape of the Revive bladder support is designed to fit in the vaginal tract, and there is no sizing required. The device fits most users. The device can be worn daily for up to 12 hours. The Revive bladder support can be reused (and cleaned) for up to 31 times. Each packaged Revive bladder support device comes with the following:

  • 1 Reusable Bladder Support
  • 1 Reusable Applicator
  • 1 Month Strings Supply
  • Travel Case
  • Instructions for Use

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

vaginal tract

Indicated Patient Age Range

18 years and older

Intended User / Care Setting

Home Use

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)

A safety and efficacy study of the Revive Bladder Support was conducted. This clinical study was conducted as a non-IDE, Non-Significant Risk study, and was registered with clinicaltrials gov. In this interventional, multicenter study, women underwent a baseline phase, as well as a treatment phase where they wore the investigational product. Device efficacy was evaluated through pad weight gain reduction, leakage reduction, and improvement in quality of life analysis. Safety was assessed by an evaluation of adverse events and other safety outcomes, such as vaginal swab and urinalysis results.
This study showed that the Revive bladder support was effective, well tolerated, and safe for use with no serious adverse events reported. During the clinical study, there was a total of 40 adverse events reported. Thirty-six were classified as mild. The most common adverse events that participants experienced throughout this study was vaginal pain and vaginal spotting. All adverse events were reviewed by a third-party adjudicator for consistent reporting and classification using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Vaginal swabs and urinalyses were also performed to evaluate if the product caused any significant negative changes in the vaqinal microflora or urinary tract health, respectively. Only one participant tested positive for yeast cells after the treatment phase and was asymptomatic and not treated. Two participants screened positive in the urinalysis at final visit, however both participants were asymptomatic.
Statistically significant improvement in leakage volume and number of leakage episodes while wearing the Revive device was observed. 53% of the participants showed a >50% improvement in pad weight gain compared to baseline phase. Additionally, participants experienced an average 56.7% reduction in the number of leakage episodes per day. Compared to baseline, women reported a significant improvement in their quality of life. The study also showed that women were able to appropriately identify symptoms of SUI and determine in the device was a proper fit.
A responder analysis was performed, where a responder was defined as achieving >50% reduction in pad weight gain and/or >50% reduction in leakage episodes. Results indicated that 71% of participants achieved a clinically meaningful reduction in leakage episodes, pad weight gain, or both. The percentage of responders is greater as compared to the predicate device.

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

  • 53% of the participants showed a >50% improvement in pad weight gain compared to baseline phase.
  • participants experienced an average 56.7% reduction in the number of leakage episodes per day.
  • 71% of participants achieved a clinically meaningful reduction in leakage episodes, pad weight gain, or both.

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.

K151413

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.

K131198

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

§ 884.3575 Vaginal pessary.

(a)
Identification. A vaginal pessary is a removable structure placed in the vagina to support the pelvic organs and is used to treat conditions such as uterine prolapse (falling down of uterus), uterine retroposition (backward displacement), or gynecologic hernia.(b)
Classification. Class II (performance standards).

0

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January 25, 2019

Rinovum Subsidiary 2, LLC Shaylee Masilunas, RAC Director of Regulatory, Clinical and Quality Affairs 300 Oxford Drive, Suite 330 Monroeville, PA 15146

Re: K183468 Trade/Device Name: Revive Reusable Bladder Support Regulation Number: 21 CFR§ 884.3575 Regulation Name: Vaginal Pessary Regulatory Class: II Product Code: HHW Dated: December 14, 2018 Received: December 14, 2018

Dear Shaylee Masilunas:

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. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. 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.

1

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 of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see

https://www.fda.gov/CombinationProducts/GuidanceRegulatoryInformation/ucm597488.html; good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

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 comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/) and CDRH Learn (http://www.fda.gov/Training/CDRHLearn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (http://www.fda.gov/DICE) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

Glenn B. Bell -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

| DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration
Indications for Use
510(k) Number (if known)K183468
Device NameRevive Reusable Bladder Support
Indications for Use (Describe)The Revive bladder support is intended for temporary management of urine leakage caused by stress urinary incontinence (SUI) in women, 18 years and older.
Type of Use (Select one or both, as applicable)
Prescription Use (Part 21 CFR 801 Subpart D)
Over-The-Counter Use (21 CFR 801 Subpart C)

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3

510(k) SUMMARY

Rinovum Subsidiary 2, LLC's Revive™ Reusable Bladder Support

Submitter/Sponsor:

Rinovum Subsidiary 2, LLC 300 Oxford Drive Suite 330 Monroeville, PA 15146 Phone: 412-200-7996 Facsimile: 724-204-8141

Contact Person:

Shaylee Masilunas, RAC Director of Regulatory, Clinical, and Quality Affairs smasilunas@rinovum.com

Date Prepared:

December 14, 2018

General Device Information

Generic Device Name

Intra-vaginal Stress Urinary Incontinence Device

Device Tradename

Revive Reusable Bladder Support

Product Classification Codes:

  • Device Classification Name - Pessary, Vaginal
  • . Product Code - HHW
  • Classification Panel Obstetrical/Gynecological .
  • Device Class 2 ●
  • Regulation Number - 21 CFR § 884.3575

Predicate Device

Proctor & Gamble Always/Tampax bladder supports (K151413)

Reference Device

ConTIPI Ltd. Improve Bladder Supports (K131198)

4

Intended Use/Indications for Use

The Revive bladder support is intended for temporary management of urine leakage caused by stress urinary incontinence (SUI) in women, 18 years and older.

Device Description

The Revive bladder support reduces bladder leaks in women who are suffering from SUI by preventing or reducing unwanted urinary leakage. Use of the device is applicable for women who experience leakage when laughing, coughing, exercising, sneezing, etc. The device is not intended to treat women with urge incontinence. The shape of the Revive bladder support is designed to fit in the vaginal tract, and there is no sizing required. The device fits most users. The device can be worn daily for up to 12 hours. The Revive bladder support can be reused (and cleaned) for up to 31 times. Each packaged Revive bladder support device comes with the following:

  • · 1 Reusable Bladder Support
  • · 1 Reusable Applicator
  • · 1 Month Strings Supply
  • · Travel Case
  • · Instructions for Use

Technological Characteristics

The Revive Reusable Bladder Support is a reusable and cleanable system that includes a silicone bladder support and a tampon-like reloadable applicator. A single-use disposable cotton string is assembled to the bladder support for easy, tampon-like removal from the vaginal cavity. The package will also include a set of 30 replacement strings, detailed Instructions for Use, and a device storage case. The bladder support and applicator components are to be cleaned after each use. The device is available in only one size and is sold over the counter.

Performance Data

Summary of non-clinical tests

Removal string to pessary retention force

This method determines the force required to separate the string from the pessary. The product is confirmed to meet specification.

Pessary from applicator extraction force

This method determines the force required to extract the pessary from the applicator. The product is confirmed to meet specification.

Tensile strength of string

This method determines the force required to break the withdrawal removal string. The product is confirmed to meet specification.

Retraction force of pessary removal

This method determines the force required to remove the pessary, using the withdrawal removal string, from the vaginal cavity. The product is confirmed to meet specification.

5

Revive™ Reusable Bladder Support

Dimension verification

Specified product dimensions are confirmed to meet finished product specifications.

Biocompatibility Assessment

| Revive
Component | ISO
Standard | Test | Results |
|---------------------------------|-----------------|----------------------------------------------------|-------------------------------------------|
| Pessary
String
Applicator | 10993-5 | Cytotoxicity Study Using the ISO
Elution Method | Non-cytotoxic |
| Pessary
String
Applicator | 10993-10 | ISO Guinea Pig Maximization
Sensitization Test | Non-sensitizer |
| Pessary
String
Applicator | 10993-10 | ISO Vaginal Irritation Study in
Rabbits | Non-irritant |
| Pessary
String | 10993-11 | Material Mediated Pyrogenicity in
Rabbits | Non-pyrogenic |
| Pessary
String | 10993-3 | Genotoxicity: Bacterial Reverse
Mutation Study | Non-mutagenic |
| Pessary
String | 10993-3 | Genotoxicity: Mouse Lymphoma
Assay | Non-mutagenic |
| Pessary
String | 10993-18 | Chemical Characterization | Outlined in Biological Risk
Assessment |

A biological risk assessment was completed and indicated that the likelihood of a toxic effect is neqligible and that the Revive™ device can be considered safe for use as intended. No further testing was recommended.

Evaluation of Toxic Shock Syndrome Risk

The device was evaluated to determine that is does not enhance the growth of Staphylococcus aureus and does not increase the production of Toxic Syndrome Toxin-1 (TSST-1). Under the test conditions, the Revive bladder support did not promote or enhance the bacterial growth or toxin production.

Summary of Clinical Testing

A safety and efficacy study of the Revive Bladder Support was conducted. This clinical study was conducted as a non-IDE, Non-Significant Risk study, and was registered with clinicaltrials gov. In this interventional, multicenter study, women underwent a baseline phase, as well as a treatment phase where they wore the investigational product. Device efficacy was evaluated through pad weight gain reduction, leakage reduction, and improvement in quality of life analysis. Safety was assessed by an evaluation of adverse events and other safety outcomes, such as vaginal swab and urinalysis results.

6

This study showed that the Revive bladder support was effective, well tolerated, and safe for use with no serious adverse events reported. During the clinical study, there was a total of 40 adverse events reported. Thirty-six were classified as mild. The most common adverse events that participants experienced throughout this study was vaginal pain and vaginal spotting. All adverse events were reviewed by a third-party adjudicator for consistent reporting and classification using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Vaginal swabs and urinalyses were also performed to evaluate if the product caused any significant negative changes in the vaqinal microflora or urinary tract health, respectively. Only one participant tested positive for yeast cells after the treatment phase and was asymptomatic and not treated. Two participants screened positive in the urinalysis at final visit, however both participants were asymptomatic.

Statistically significant improvement in leakage volume and number of leakage episodes while wearing the Revive device was observed. 53% of the participants showed a >50% improvement in pad weight gain compared to baseline phase. Additionally, participants experienced an average 56.7% reduction in the number of leakage episodes per day. Compared to baseline, women reported a significant improvement in their quality of life. The study also showed that women were able to appropriately identify symptoms of SUI and determine in the device was a proper fit.

A responder analysis was performed, where a responder was defined as achieving >50% reduction in pad weight gain and/or >50% reduction in leakage episodes. Results indicated that 71% of participants achieved a clinically meaningful reduction in leakage episodes, pad weight gain, or both. The percentage of responders is greater as compared to the predicate device.

Self-Selection, Labeling Comprehension, and Simulated Use

As mentioned above, the clinical safety and efficacy study was conducted to support an OTC indication for use, as well as contribute to labeling comprehension. Self-selection was evaluated through the completion of a "Fit Test" during the screening process, in which the participants independently inserted a device using the Instructions for Use without physician quidance. Self-selection was also evaluated by participants' ability to identify with SUI symptoms without a formal diagnosis prior to enrolling in the study. Additionally, this study contributed to labeling comprehension as participants used the Instructions for Use throughout the duration of the treatment phase.

Multiple rounds of summative testing were completed in the form of Labeling Comprehension, Selection and Simulated Use studies. This testing was performed to evaluate the appropriateness of the Instructions for Use and package labeling to support an OTC indication for use. The last round of summative testing was also used to validate the usability of the reusable device design. A diverse population of women in race, ethnicity age, and literacy rates participated.

Substantial Equivalence

7

The Revive Reusable Bladder Support has the following similarities to the previously cleared predicate device Always/Tampax bladder supports (K151413) and reference device Improve Bladder Support (K131198):

  • Same general intended use ●
  • . Similar indications for use
  • Same operating principle ●
  • Similar materials ●
  • . Similar performance characteristics

The following modifications have been made to the Revive Reusable Bladder Support compared to the predicate device:

  • . The Revive bladder support and applicator are designed and validated to be reusable.
  • . The Revive bladder support does not include a fabric or mesh overwrap.
PREDICATE DEVICE:REFERENCE DEVICE:SUBJECT DEVICE:
Comparison ElementTampax/Always Bladder
Supports K151413Improve Bladder Support
(Poise Impressa) K131198Revive Bladder Support
Stress Incontinence
Device
INTENDED
USE/INDICATIONS FOR
USE STATEMENTFor the temporary
management of stress-
urinary incontinence in
women.The IMPROVE BLADDER
SUPPORT is an over-the-
counter device intended for
the temporary management
of stress urinary
incontinence (SUI) in
women.The Revive bladder support
is intended for temporary
management of urine
leakage caused by stress
urinary incontinence (SUI)
in women, 18 years and
older.
(Unchanged from K151413
and K131198)
PATIENT POPULATIONWomen ≥18 with SUI
symptomsWomen ≥21 with SUIWomen ≥18 with SUI
symptoms (Unchanged from
K151413)
INTENDED ENVIRONMENT
FOR USEHome UseHome UseUnchanged from K151413
and K131198
SINGLE USE?YesYesNo. The Revive Bladder
Support is reusable for 31
days.
WEAR TIMEUp to 12-hours in a 24-hour
periodUp to 8-hours in a 24-hour
periodUp to 12-hours in a 24-hour
period (Unchanged from
K151413)
DEVICE DESIGNThe Tampax/Always Bladder
Support consists of a
shaped high-density
polyethylene core covered
by a non-woven wrap with a
tampon-like withdrawal cord,
loaded into an applicator.The Improve Bladder
Support consists of a flexible
silicone rubber core covered
with mesh with a removal
string, loaded into an
applicator.The Revive™ system
consists of a reusable
silicone bladder support
(does not include an
overwrap), with a removal
string and a reusable,
tampon-like applicator. The
string is single-use
disposable. Replacement
strings are provided.

8

PREDICATE DEVICE:REFERENCE DEVICE:SUBJECT DEVICE:
Comparison ElementTampax/Always Bladder Supports K151413Improve Bladder Support (Poise Impressa) K131198Revive Bladder Support Stress Incontinence Device
MECHANISM OF ACTIONIncreases pressure through the anterior wall onto the urethra.Tension free, mid-urethral support for the temporary management of stress urinary incontinence (SUI).Tension-free, mid-urethral support for the temporary management of stress urinary incontinence (SUI).
SIZES1 size3 size1 size (Unchanged from K151413)
MATERIALBladder support - High-density polyethylene core with a non-woven overwrap
String - cotton-like
Applicator - plasticBladder support - Silicone rubber core covered with a non-woven mesh
String - cotton-like
Applicator - plasticBladder support - Silicone rubber
String - Cotton
Applicator - low-density polyethylene

Conclusion

The performance and technological characteristics of the Revive Reusable Bladder Support are substantially equivalent to the predicate device Always/Tampax bladder supports (K151413) and reference device Improve Bladder Support (K131198). The differences described above do not raise new issues of safety or effectiveness.