K Number
K233411
Device Name
Folysil Silicone Catheter
Manufacturer
Date Cleared
2024-04-15

(192 days)

Product Code
Regulation Number
876.5130
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
Folysil catheters are intended for use up to 30 days in adult and pediatric populations for: - Bladder drainage by urethral catheterization, - Bladder drainage by suprapubic catheter replacement only (for non-grooved, straight 2-way Folysil catheters with a maximum balloon volume of 15mL). - Bladder instillation of physiological saline solution.
Device Description
Folysil catheters are thin, hollow tubes equipped with a balloon, funnel and valve, to be inserted into the bladder by the urethral or supra-pubic approach to drain urine into a urine collection bag. Folysil catheters are held in place within the bladder by the balloon, which is filled with sterile water or with aqua-glycerin solution.
More Information

Not Found

No
The 510(k) summary describes a standard medical device (catheter) and its performance testing, with no mention of AI, ML, image processing, or data-driven algorithms.

Yes

The device, a Folysil catheter, is used for "bladder drainage" and "bladder instillation," which are therapeutic interventions aimed at treating or alleviating a medical condition (urinary retention or for diagnostic/therapeutic instillation).

No

Explanation: The device description clearly states that Folysil catheters are used for "bladder drainage" and "bladder instillation." These are therapeutic or maintenance functions, not diagnostic ones. Diagnostic devices are used to identify or detect a disease, condition, or its characteristics.

No

The device description clearly outlines a physical medical device (catheter) with hardware components (tube, balloon, funnel, valve) and describes physical testing (biocompatibility, bench testing) related to these components. There is no mention of software as the primary or sole component.

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

Here's why:

  • Intended Use: The intended use is for bladder drainage and instillation, which are direct interventions on the body. IVDs are used to examine specimens from the body (like blood, urine, tissue) to provide information about a person's health.
  • Device Description: The description details a physical device (catheter) inserted into the body for drainage and instillation. This is a therapeutic or diagnostic device used in vivo, not in vitro.
  • Lack of IVD Characteristics: There is no mention of analyzing samples, reagents, or providing diagnostic information based on laboratory testing.

The device is a medical device used for direct patient care, not for in vitro diagnostic testing.

N/A

Intended Use / Indications for Use

Folysil catheters are intended for use up to 30 days in adult and pediatric populations for:

  • Bladder drainage by urethral catheterization,
  • Bladder drainage by suprapubic catheter replacement only (for non-grooved, straight 2-way Folysil catheters with a maximum balloon volume of 15mL).
  • Bladder instillation of physiological saline solution.

Product codes

EZL

Device Description

Folysil catheters are thin, hollow tubes equipped with a balloon, funnel and valve, to be inserted into the bladder by the urethral or supra-pubic approach to drain urine into a urine collection bag. Folysil catheters are held in place within the bladder by the balloon, which is filled with sterile water or with aqua-glycerin solution.

Folysil Silicone catheters are provided in a variety of configurations as shown in Table 1.

Pediatric UseAdult Use
2-way2-way2-way
Size, Fr6 Fr - 10 Fr12 Fr - 24 Fr
Tip ShapesStraight round, Tiemann, StraightStraight round, Tiemann, Straight
OpenOpen
Balloon Volume, mL1.5mL - 3.0mL10 mL - 30 mL
Drainage eyes21-6
Catheter Total Length, cm26 cm - 32 cm25 cm - 41 cm
Tube SurfaceSmoothSmooth and grooved

Table 1: Folysil Silicone Catheter Range

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Bladder, urethral, supra-pubic

Indicated Patient Age Range

Adult and pediatric populations

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)

Biocompatibility Testing
Biocompatibility testing was conducted based upon ISO 10993-1 (2018): Biological evaluation of medical devices - Part 1: "Evaluation and testing within a risk management process" and FDA Guidance document (2023). "Use of International Standard ISO 10993-1, "Biological evaluation of medical devices - Part 1: Evaluation and testing within a risk management process" | FDA". The subject device is an externally communicating device in contact with mucosal tissue for 30 days or more and following tests were conducted in accordance with the relevant ISO 10993 standards:

  • Cytotoxicity
  • Irritation
  • Sensitization
  • Acute Systemic Toxicity
  • Material-mediated Pyrogenicity
  • Genotoxicity Ames and Mouse Lymphoma
  • Implantation 4 and 13 weeks
  • Systemic toxicity 13 weeks
    The results of these tests demonstrate that the subject device is biocompatible.

Bench Testing
The following tests were performed per FDA recognized standard ASTM F623-19, ISO 20696:2018 and FDA guidance document (2020), "Conventional Foley Catheters - Performance Criteria for Safety and Performance Based Pathway | FDA".

  • Visual tests
  • Catheter integrity test
  • Balloon size and shaft size
  • Flow rate through drainage lumen
  • Balloon integrity (resistance to rupture)
  • Inflated balloon response to traction
  • Balloon volume maintenance
  • Deflation reliability test (failure to deflate)
  • Funnel security of fit test
  • Tensile test on funnel junction
  • Tensile test on tip
  • Simulation of use test
  • Kink resistance test
  • Radiopacity test
  • Tensile test on valve junction
    All pre-determined acceptance criteria were met for 14-24 Fr. catheters. The performance testing on the catheter sizes 6-12 Fr. was conducted according to the sponsor's internal test protocols as these catheter sizes are not covered under the above referenced standards. The protocol and acceptance criteria for these tests were scientifically adequate and clinically relevant, and the acceptance criteria were met for these tests as well.

Sterility, Packaging and Distribution
The Folysil® Silicone Catheters were validated to be sterilized using ethylene oxide in accordance with ANSVAAMI/ISO 11135:2014. To support the claimed shelf life, the Folysil Silicone Catheters were subjected to bench performance testing, transportation testing and package integrity testing to demonstrate that the product and package would be undamaged throughout the product life and maintain device sterility.

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

Not Found

Predicate Device(s)

Folysil® Silicone Catheter (K013174), Modified Pediatric Silicone Foley Catheter (K900031)

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 876.5130 Urological catheter and accessories.

(a)
Identification. A urological catheter and accessories is a flexible tubular device that is inserted through the urethra and used to pass fluids to or from the urinary tract. This generic type of device includes radiopaque urological catheters, ureteral catheters, urethral catheters, coudé catheters, balloon retention type catheters, straight catheters, upper urinary tract catheters, double lumen female urethrographic catheters, disposable ureteral catheters, male urethrographic catheters, and urological catheter accessories including ureteral catheter stylets, ureteral catheter adapters, ureteral catheter holders, ureteral catheter stylets, ureteral catheterization trays, and the gastro-urological irrigation tray (for urological use).(b)
Classification. (1) Class II (performance standards).(2) Class I for the ureteral stylet (guidewire), stylet for gastrourological catheter, ureteral catheter adapter, ureteral catheter connector, and ureteral catheter holder. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.

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Image /page/0/Picture/0 description: The image contains the logo of the U.S. Food & Drug Administration (FDA). On the left, there is a seal with the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged in a circular pattern around a stylized image. To the right of the seal, there is a blue square with the letters "FDA" in white. Next to the square, the words "U.S. FOOD & DRUG" are written in blue, with the word "ADMINISTRATION" written in a smaller font size below.

April 15, 2024

Coloplast Corp % Kristen Swanson Regulatory Consultant Kompass Regulatory Consulting 1583 Northrop St. Falcon Heights, Minnesota 55108

Re: K233411

Trade/Device Name: Folysil® Silicone Catheter Regulation Number: 21 CFR 876.5130 Regulation Name: Urological Catheter and accessories Regulatory Class: II Product Code: EZL Dated: October 6, 2023 Received: October 6, 2023

Dear Kristen Swanson:

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 (the 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 available 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.

1

Additional information about changes that may require a new premarket notification are provided in the FDA guidance documents entitled "Deciding When to Submit a 510(k) for a Change to an Existing Device" (https://www.fda.gov/media/99812/download) and "Deciding When to Submit a 510(k) for a Software Change to an Existing Device" (https://www.fda.gov/media/99785/download).

Your device is also subject to, among other requirements, the Quality System (QS) regulation (21 CFR Part 820), which includes, but is not limited to, 21 CFR 820.30. Design controls; 21 CFR 820.90. Nonconforming product; and 21 CFR 820.100, Corrective and preventive action. Please note that regardless of whether a change requires premarket review, the QS regulation requires device manufacturers to review and approve changes to device design and production (21 CFR 820.30 and 21 CFR 820.70) and document changes and approvals in the device master record (21 CFR 820.181).

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 of medical device-related adverse events) (21 CFR Part 803) for devices or postmarketing safety reporting (21 CFR Part 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 Part 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR Parts 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 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 mediation-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

2

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,

Sharon M. Andrews -S

for Jessica K. Nguyen, Ph.D. 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

3

Indications for Use

510(k) Number (if known) K233411

Device Name Folysil® Silicone Catheter

Indications for Use (Describe)

Folysil catheters are intended for use up to 30 days in adult and pediatric populations for:

  • Bladder drainage by urethral catheterization,

  • Bladder drainage by suprapubic catheter replacement only (for non-grooved, straight 2-way Folysil catheters with a maximum balloon volume of 15mL).

  • Bladder instillation of physiological saline solution.

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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4

K233411 Page 1 of 5 Coloplast 1601 West River Road North Minneapolis, MN 55411

TRADITIONAL 510(k) SUMMARY

SUBMITTER INFORMATION I.

ApplicantColoplast A/S
Legal Manufacturer Address:Holtedam 1
3050 Humlebaek, Denmark
Official Correspondent:Kristen Swanson
Regulatory Consultant
1583 Northrop St.
Falcon Heights, MN 55108
Phone: 651-245-2678
Email: uskrs@coloplast.com)
Date Prepared:April 12, 2024

II. DEVICE NAME

Trade or Proprietary Name:Folysil® Silicone Catheter
Common or Usual Name:Foley Catheter
Classification Regulation:21 CFR 876.5130
Device Class:II
Product Code:EZL (Catheter, Retention Type, Balloon)
Panel:Gastroenterology/Urology

III. PREDICATE DEVICES IDENTIFICATION

Primary Predicate device:Folysil® Silicone Catheter (K013174)
Secondary Predicate device:Modified Pediatric Silicone Foley Catheter (K900031)

5

IV. DEVICE DESCRIPTION

Folysil catheters are thin, hollow tubes equipped with a balloon, funnel and valve, to be inserted into the bladder by the urethral or supra-pubic approach to drain urine into a urine collection bag. Folysil catheters are held in place within the bladder by the balloon, which is filled with sterile water or with aqua-glycerin solution.

Folysil Silicone catheters are provided in a variety of configurations as shown in Table 1.

Pediatric UseAdult Use
2-way2-way2-way
Size, Fr6 Fr - 10 Fr12 Fr - 24 Fr
Tip ShapesStraight round, Tiemann, StraightStraight round, Tiemann, Straight
OpenOpen
Balloon Volume, mL1.5mL - 3.0mL10 mL - 30 mL
Drainage eyes21-6
Catheter Total Length, cm26 cm - 32 cm25 cm - 41 cm
Tube SurfaceSmoothSmooth and grooved

Table 1: Folysil Silicone Catheter Range

INDICATIONS FOR USE V.

Folysil catheters are intended for use up to 30 days in adult and pediatric populations for: Bladder drainage by urethral catheterization, -

  • Bladder drainage by suprapubic catheterization for catheter replacement only (for non-grooved, straight 2-way Folysil catheters with a maximum balloon volume of 15mL).
  • -Bladder instillation of physiological saline solution.

VI. COMPARISON OF TECHNOLOGICAL CHARACTERISTICS WITH THE PREDICATE DEVICE

| Comparison
Element | Device
Folysil® Silicone Catheters | Primary Predicate Device
Porges Folysil Silicone Foley
Catheters
K013174 | Secondary Predicate
Device
Modified Pediatric
Silicone Foley Catheters
K900031 |
|------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------|
| Indications for
Use | Folysil catheters are intended
for use up to 30 days in adult
and pediatric populations for:

  • Bladder drainage by
    urethral catheterization,
  • Bladder drainage by
    suprapubic catheterization
    for catheter replacement
    only (for non-grooved,
    straight 2-way Folysil
    catheters with a maximum
    balloon volume of 15mL). | The 2-way PORGES Folysil
    silicone Foley catheter is used
    for urethral urinary
    catheterization for short-term
    drainage of vesical urines.
    Only straight 2-way PORGES
    Folysil silicone Foley catheter
    with a maximum 15 ml
    balloon volume may be used
    in a supra-pubic way (except
    the grooved catheters). | The PORGES paediatric
    silicone Foley catheter is
    used to pass fluids or from
    the urinary tract for
    children. |

Table 2: Comparison between Subject Device and Predicate Device

6

Image /page/6/Picture/1 description: The image shows the logo for Coloplast. The logo consists of a blue circle with horizontal lines on the left side and the word "Coloplast" in blue on the right side. The font of the word "Coloplast" is bold and sans-serif.

1601 West River Road North

Minneapolis, MN 55411
Comparison
ElementDevice
Folysil® Silicone CathetersPrimary Predicate Device
Porges Folysil Silicone Foley
Catheters
K013174Secondary Predicate
Device
Modified Pediatric
Silicone Foley Catheters
K900031
Bladder instillation of
physiological saline
solution.The 3-way PORGES Folysil
silicone Foley catheter is used
for urethral urinary
catheterization to allow short
term drainage of the vesical
urines, irrigation/injection
following surgery.
Target
PopulationPediatric and Adult, male and
femalePediatric and Adult, male and
femalePediatric patients.
Duration
of
Use/Indwell timeUp to 30 days.Up to 30 days.Up to 30 days.
Common NameCatheter, Retention Type,
BalloonCatheter, Retention Type,
BalloonCatheter, Retention Type,
Balloon
French Size6 - 24 Fr12 - 24 Fr6-10 Fr
Length25 - 41 cm25 - 41 cm30 — 35 cm
Lumen2-way2-way or 3-way2-way
BalloonYesYesYes
Balloon Size1.5mL-30mL10mL-30mL1.5 - 3mL
Single UseYesYesYes
SterileYes, via EOYes, via EOYes, via EO
Main
Shaft
MaterialSiliconeSiliconeSilicone
Shelf Life5 years5 years5 years
Radiopaque lineYesYes, (only for neobladder
catheters)-
EyesUp to 6Up to 6up to 6
Tip ShapesTiemann (coude tip), straight
cylindrical," Over the guide"
(straight open), straight roundTiemann (coude tip), straight
cylindrical, "Over the guide"
(straight open), straight roundTiemann (coude tip),
straight cylindrical," Over
the guide" (straight open),
straight round
Stylet/IntroducerYes (for pediatric sizes),
Looped styletNot for adult sizesYes (for pediatric sizes),
Straight stylet

As evidenced by the above table, both the subject and the predicate devices have same intended use, but the subject and predicate devices have different technological characteristics. The differences in technological characteristics between the subject and the predicate does not raise different questions of safety or effectiveness.

VII. PERFORMANCE DATA

Device performance data was provided in support of the substantial equivalence determination.

7

Biocompatibility Testing

Biocompatibility testing was conducted based upon ISO 10993-1 (2018): Biological evaluation of medical devices - Part 1: "Evaluation and testing within a risk management process" and FDA Guidance document (2023). "Use of International Standard ISO 10993-1, "Biological evaluation of medical devices - Part 1: Evaluation and testing within a risk management process" | FDA". The subject device is an externally communicating device in contact with mucosal tissue for 30 days or more and following tests were conducted in accordance with the relevant ISO 10993 standards:

  • Cytotoxicity
  • Irritation ●
  • Sensitization ●
  • Acute Systemic Toxicity ●
  • Material-mediated Pyrogenicity ●
  • Genotoxicity Ames and Mouse Lymphoma ●
  • Implantation 4 and 13 weeks ●
  • Systemic toxicity 13 weeks ●

The results of these tests demonstrate that the subject device is biocompatible.

Bench Testing

The following tests were performed per FDA recognized standard ASTM F623-19, ISO 20696:2018 and FDA guidance document (2020), "Conventional Foley Catheters - Performance Criteria for Safety and Performance Based Pathway | FDA".

  • Visual tests ●
  • Catheter integrity test
  • Balloon size and shaft size ●
  • Flow rate through drainage lumen ●
  • Balloon integrity (resistance to rupture)
  • Inflated balloon response to traction
  • . Balloon volume maintenance
  • Deflation reliability test (failure to deflate) ●
  • Funnel security of fit test
  • Tensile test on funnel junction ●
  • Tensile test on tip
  • Simulation of use test
  • Kink resistance test
  • Radiopacity test
  • Tensile test on valve junction .

All pre-determined acceptance criteria were met for 14-24 Fr. catheters. The performance testing on the catheter sizes 6-12 Fr. was conducted according to the sponsor's internal test protocols as these catheter sizes are not covered under the above referenced standards. The protocol and acceptance criteria for these tests were scientifically adequate and clinically relevant, and the acceptance criteria were met for these tests as well.

8

Image /page/8/Picture/0 description: The image shows the Coloplast logo and address. The logo is a blue circle with white lines inside. The text above the logo says "K233411 Page 5 of 5". The address is "1601 West River Road North Minneapolis, MN 55411".

Sterility, Packaging and Distribution

The Folysil® Silicone Catheters were validated to be sterilized using ethylene oxide in accordance with ANSVAAMI/ISO 11135:2014. To support the claimed shelf life, the Folysil Silicone Catheters were subjected to bench performance testing, transportation testing and package integrity testing to demonstrate that the product and package would be undamaged throughout the product life and maintain device sterility.

VIII. CONCLUSIONS

Based on the information presented in this submission, it can be concluded that the subject device is substantially equivalent to the predicates.