K Number
K190612
Device Name
EQUINOX Balloon Dilatation Catheter
Date Cleared
2019-12-06

(270 days)

Product Code
Regulation Number
876.5470
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Dornier EQUINOX Balloon Dilatation Catheter is indicated for dilation of the urinary tract.
Device Description
The Dornier EQUINOX Balloon Dilatation Catheter is a multiple lumen catheter with a dilatation balloon mounted at the distal tip. Dilatation balloon catheters are used to exert radial force to dilate narrow ureteral segments. The Dornier EQUINOX Balloon Dilatation Catheters are sterile, single-use devices. The EQUINOX Balloon Dilatation Catheters are available in 5.8 French (Fr) diameter, with a catheter length of 80 centimeters (cm). There will be three (3) balloon diameters, (4mm, 5mm and 6mm) and two (2) balloon lengths (4cm and 10cm) The Dornier EQUINOX Balloon Dilatation Catheters are constructed of a medical grade nylon material. This material has been USP Class VI tested. The base material is compounded with BaSO4 to render the Dornier EQUINOX Balloon Dilatation Catheter radiopaque under x-ray fluoroscopy. The catheter also has radio-opaque marker bands on the proximal and distal ends of the balloon for visualization during use. All colorants used are compliant with FDA standards.
More Information

Not Found

No
The device description and performance studies focus on the physical characteristics and mechanical performance of a balloon catheter, with no mention of AI or ML capabilities.

Yes
The device is intended for the "dilation of the urinary tract," which is a direct treatment or modification of a body function for therapeutic purposes.

No

Explanation: The device is indicated for "dilation of the urinary tract," which is a therapeutic intervention, not a diagnostic one. While it uses x-ray fluoroscopy for visualization, this is for guiding the dilation procedure, not for diagnosing a condition.

No

The device description clearly details a physical catheter with a balloon, constructed from medical-grade nylon and containing radiopaque materials. This indicates a hardware-based medical device, not a software-only one.

No, this device is not an IVD (In Vitro Diagnostic).

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, or tissue) to provide information for the diagnosis, treatment, or prevention of disease.
  • Device Function: The Dornier EQUINOX Balloon Dilatation Catheter is a surgical device used to physically dilate a part of the urinary tract. It is used within the body to perform a procedure, not to analyze a specimen taken from the body.
  • Intended Use: The intended use is "dilation of the urinary tract," which is a therapeutic procedure, not a diagnostic test performed on a sample.

The device description and performance studies focus on the physical properties and function of the catheter itself, not on the analysis of biological samples.

N/A

Intended Use / Indications for Use

The Dornier EQUINOX Balloon Dilatation Catheter is indicated for dilation of the urinary tract.

Product codes

EZN, KOE

Device Description

The Dornier EQUINOX Balloon Dilatation Catheter is a multiple lumen catheter with a dilatation balloon mounted at the distal tip. Dilatation balloon catheters are used to exert radial force to dilate narrow ureteral segments.

The Dornier EQUINOX Balloon Dilatation Catheters are sterile, single-use devices. The EQUINOX Balloon Dilatation Catheters are available in 5.8 French (Fr) diameter, with a catheter length of 80 centimeters (cm). There will be three (3) balloon diameters, (4mm, 5mm and 6mm) and two (2) balloon lengths (4cm and 10cm)

The Dornier EQUINOX Balloon Dilatation Catheters are constructed of a medical grade nylon material. This material has been USP Class VI tested. The base material is compounded with BaSO4 to render the Dornier EQUINOX Balloon Dilatation Catheter radiopaque under x-ray fluoroscopy. The catheter also has radio-opaque marker bands on the proximal and distal ends of the balloon for visualization during use. All colorants used are compliant with FDA standards.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

x-ray fluoroscopy

Anatomical Site

urinary tract

Indicated Patient Age Range

Not Found

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

The Dornier EQUINOX Balloon Dilatation Catheter was subjected to the following tests to assure design and performance under the specified testing parameters:

  • Sterility
  • Packaging
  • Biocompatibility
  • Balloon Burst Durability Test
  • Balloon Deflation Time
  • Balloon/Scope Compatibility
  • Radiopacity
  • Effective Working Length
  • Catheter Tip Length
  • Balloon Diameter @ RBP
  • Balloon Length @ OP
  • Catheter Shaft OD

All testing was found to be acceptable and substantially equivalent to those of the predicate device.

Key Metrics

Not Found

Predicate Device(s)

K130804

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 876.5470 Ureteral dilator.

(a)
Identification. A ureteral dilator is a device that consists of a specially shaped catheter or bougie and is used to dilate the ureter at the place where a stone has become lodged or to dilate a ureteral stricture.(b)
Classification. Class II (performance standards).

0

Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food and Drug Administration (FDA). On the left is the Department of Health & Human Services logo. To the right of that is the FDA logo, which is a blue square with the letters "FDA" in white. To the right of the blue square is the text "U.S. FOOD & DRUG ADMINISTRATION" in blue.

December 6, 2019

Dornier MedTech America Inc John Hoffer Vice President Quality, Regulatory, Clinical 1155 Roberts Blvd, Suite 100 Kennesaw, GA 30144

Re: K190612 Trade/Device Name: EQUINOX Balloon Dilatation Catheter Regulation Number: 21 CFR 876.5470 Regulation Name: Ureteral dilator Regulatory Class: II Product Code: EZN, KOE Dated: October 22, 2019 Received: October 22, 2019

Dear John Hoffer:

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. 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

1

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/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); 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 https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about medical devices and radiation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). 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 (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

Jessica K. Nguyen, Ph.D. Acting Assistant Director DHT3B: Division of Reproductive, Gynecology and Urology Devices OHT3: Office of GastroRenal, ObGyn, General Hospital and Urology Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

2

DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration Indications for Use

Form Approved: OMB No. 0910-0120 Expiration Date: January 31, 2017 See PRA Statement on last page

510(k) Number (if known)

K190612

Device Name

Dornier EQUINOX Balloon Dilatation Catheter

Indications for Use (Describe)

The Dornier EQUINOX Balloon Dilatation Catheter is indicated for dilation of the urinary tract.

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

区 Prescription Use (Part 21 CFR 801 Subpart D) Subpart C)

□ Over-The-Counter Use (21 CFR 801

PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON A SEPARATE PAGE IF NEEDED.

FOR FDA USE ONLY

Concurrence of Center for Devices and Radiological Health (CDRH) (Signature)

This section applies only to requirements of the Paperwork Reduction Act of 1995. DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW. The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to: Department of Health and Human Services Food and Drug Administration

Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number.

3

510(k) SUMMARY Dornier EQUINOX Balloon Dilatation Catheter

Submitter's Name, Address, Telephone Number, Contact Person and Date Prepared

Dornier MedTech America, Inc. 1155 Roberts Blvd., Suite 00 Kennesaw, GA 30144

Date Prepared: October 18, 2019

Contact Person: John Hoffer

Phone: 770-514- 6163

Name of Device and Name/Address of Sponsor

Dornier EQUINOX Balloon Dilatation Catheter

Dornier MedTech America, Inc. 1155 Roberts Blvd. Kennesaw, GA 30144

Common or Usual Name

Ureteral Balloon Dilatation Catheter

Classification Name

According to 21 C.F.R. § 876.5470, the Food and Drug Administration ("FDA" or "the agency") has classified Ureteral Dilators as Class II devices (performance standards). The Product Code for these Dilators is EZN.

Predicate Device

Boston Scientific's Uromax Ultra Balloon Dilatation Catheter (K130804)

Purpose of the 510(k) Notice

The purpose of this submission is to obtain marketing clearance for the Dornier EQUINOX Balloon Dilatation Catheter product line.

Intended Use/Indications for Use

The Dornier EQUINOX Balloon Dilatation Catheter is indicated for dilation of the urinary tract.

4

Device Description

The Dornier EQUINOX Balloon Dilatation Catheter is a multiple lumen catheter with a dilatation balloon mounted at the distal tip. Dilatation balloon catheters are used to exert radial force to dilate narrow ureteral segments.

The Dornier EQUINOX Balloon Dilatation Catheters are sterile, single-use devices. The EQUINOX Balloon Dilatation Catheters are available in 5.8 French (Fr) diameter, with a catheter length of 80 centimeters (cm). There will be three (3) balloon diameters, (4mm, 5mm and 6mm) and two (2) balloon lengths (4cm and 10cm)

The Dornier EQUINOX Balloon Dilatation Catheters are constructed of a medical grade nylon material. This material has been USP Class VI tested. The base material is compounded with BaSO4 to render the Dornier EQUINOX Balloon Dilatation Catheter radiopaque under x-ray fluoroscopy. The catheter also has radio-opaque marker bands on the proximal and distal ends of the balloon for visualization during use. All colorants used are compliant with FDA standards.

Technological Characteristics

The Dornier EQUINOX Balloon Dilatation Catheters have the same basic technological characteristics as the predicate device, Boston Scientific's Uromax Ultra Balloon Dilatation Catheter. They both are a multiple lumen catheter with a dilatation balloon mounted at the distal tip. They are both manufactured using PET for the inflation balloon which is the primary functional component of the devices. At the proximal end, they both have leur lock connectors that will attach to the inflation device to inflate the balloon during use. As noted above, both devices are compounded with Barium sulfate and radiopaque marking bands to allow visualization under fluoroscopy.

Performance Data

The Dornier EQUINOX Balloon Dilatation Catheter was subjected to the following tests to assure design and performance under the specified testing parameters:

  • Sterilitv Packaging Biocompatibility Balloon Burst Durability Test Balloon Deflation Time Balloon/Scope Compatibility Radiopacity Effective Working Length Catheter Tip Length Balloon Diameter @ RBP Balloon Length @ OP Catheter Shaft OD

5

All testing was found to be acceptable and substantially equivalent to those of the predicate device.

Substantial Equivalence

A comparison of design characteristics has been performed and demonstrates that the proposed Dornier EQUINOX Balloon Dilatation Catheter is substantially equivalent to the predicate device in terms of intended use, technological characteristics, type of materials and performance characteristics. Therefore, the proposed Dornier EQUINOX Balloon Dilatation Catheter is as safe, as effective, and performs as well as the predicate device.

Conclusion

Based on the data and information comparing the Dornier EQUINOX Balloon Dilatation Catheter and the predicate device we conclude they are substantially equivalent as they have the same intended use, basic design, principle of operation, technology, materials, and performance to the predicate. Any minor differences between the subject and predicate devices do not raise any concerns regarding the overall safety or effectiveness. Thus, the Dornier EQUINOX Balloon Dilatation Catheter is substantially equivalent to its predicate device.