K Number
K972054
Device Name
INNOVA RECTAL REUSABLE ELECTRODE/COMFORTPULSE REGULAR OR SMALL REUSABLE ELECTRODE
Manufacturer
Date Cleared
1997-08-14

(73 days)

Product Code
Regulation Number
876.5320
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
Indication for Use - Stimulation: The electrode is indicated for use in the treatment of urinary incontinence. The electrode is reusable if reuse instructions are followed. Indication for Use - Sensing: The electrode monitors and allows assessment of the EMG activity of the pelvic floor muscles. The electrode is reusable if reuse instructions are followed.
Device Description
The Reusable Vaginal and Rectal Electrodes are identical to the predicate devices except for the addition of "multi-patient use" and reuse instructions. There were no design changes required or made to allow for this change.
More Information

Not Found

No
The summary describes a reusable electrode for stimulation and sensing of pelvic floor muscles. There is no mention of AI, ML, or any computational analysis beyond basic EMG monitoring. The changes from the predicate devices are related to reuse instructions, not technological advancements in data processing.

Yes.
The device is indicated for use in the treatment of urinary incontinence, which is a therapeutic purpose.

Yes
The device is indicated for "Sensing: The electrode monitors and allows assessment of the EMG activity of the pelvic floor muscles," which is a diagnostic function.

No

The device description explicitly states it is a "Reusable Vaginal and Rectal Electrodes," which are physical hardware components. The summary focuses on the reuse instructions and sterilization validation, further indicating a hardware device.

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

Here's why:

  • Intended Use: The intended uses are for the treatment of urinary incontinence (stimulation) and the monitoring and assessment of pelvic floor muscle EMG activity (sensing). These are direct interactions with the patient's body for therapeutic and physiological monitoring purposes.
  • Device Description: The device is an electrode, which is a component used to apply electrical stimulation or detect electrical signals from the body.
  • Lack of IVD Characteristics: An IVD is a medical device used to perform tests on samples taken from the human body (like blood, urine, tissue) to provide information about a physiological state, disease, or congenital abnormality. This device does not perform such tests on samples.

The device is clearly intended for direct patient contact and interaction for therapeutic and diagnostic (in the sense of monitoring physiological activity) purposes, not for testing samples in vitro.

N/A

Intended Use / Indications for Use

Indication for Use - Stimulation: The electrode is indicated for use in the treatment of urinary incontinence. The electrode is reusable if reuse instructions are followed.

Indication for Use - Sensing: The electrode monitors and allows assessment of the EMG activity of the pelvic floor muscles. The electrode is reusable if reuse instructions are followed.

Product codes

78 KPI

Device Description

The Reusable Vaginal and Rectal Electrodes are identical to the predicate devices except for the addition of "multi-patient use" and reuse instructions. There were no design changes required or made to allow for this change.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

pelvic floor muscles

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

Non-clinical tests were performed to validate the sterilization process and instructions.

Key Metrics

Not Found

Predicate Device(s)

K970307, K964577, K952688, K954272

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

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

K9172054

SUMMARY OF SAFETY AND EFFECTIVENESS Reusable Vaginal and Rectal Electrodes Date of Summary May 30, 1997

AUG 1 4 1997

Page 1 of 1

General Provisions A.

Submitter's Name:Empi, Inc.
Submitter's Address:599 Cardigan Road
St. Paul, Minnesota 55126-3965
Contact Person:Carolyn M. Steele Husten
Regulatory Affairs Manager
Classification Name:Non-Implanted Electrical Continence Device
21 CFR Part 876.5320
Proprietary Name:Innova® ComfortPulse Vaginal Electrodes (Small
and Standard)
Innova® Rectal Electrode
Common Name:Pelvic Floor Stimulation Device

Name of Predicate Devices B.

• Empi, Inc. Minnova Pelvic Floor Stimulation SystemK970307
• Empi, Inc. ComfortPulse Regular and Small ElectrodeK964577
• Empi, Inc. Innova Rectal or Small Vaginal EMG Sensing ElectrodeK952688
• Empi, Inc. Innova Rectal Stimulation ElectrodeK954272

C. Device Description

The Reusable Vaginal and Rectal Electrodes are identical to the predicate devices except for the addition of "multi-patient use" and reuse instructions. There were no design changes required or made to allow for this change.

Intended Use D.

Indication for Use - Stimulation:

The electrode is indicated for use in the treatment of urinary incontinence. The electrode is reusable if reuse instructions are followed.

Indication for Use - Sensing:

The electrode monitors and allows assessment of the EMG activity of the pelvic floor muscles. The electrode is reusable if reuse instructions are followed.

Non-Clinical and Clinical Test Summary E.

Non-clinical tests were performed to validate the sterilization process and instructions.

1

Image /page/1/Picture/0 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features the department's name arranged in a circular fashion around a stylized emblem. The emblem consists of a symbol that resembles a human figure in profile, with three parallel lines extending from the head, representing the department's focus on health and well-being.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

AUG 1 4 1997

Ms. Carolyn M. Steele Husten Regulatory Affairs Manager EMPI, Inc. 599 Cardigan Road … St.Paul, Minnesota 55126-3965 Re : K972054

Innova® ComfortPulse Vaginal Electrodes (Small and Standard) Innova® Rectal Electrode ` Dated: May 30, 1997 Received: June 2, 1997 Requlatory Class: II 21 CFR §876.5320/Product Code: 78 KPI

Dear Ms. Husten:

We have reviewed your Section 510(k) notification of intent to market the device referenced above and we have determined the device is substantially equivalent (for the inclosure) to 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). You may, therefore, 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.

If your device is classified (see above) into either class III (Premarket Approval), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 895. A substantially equivalent determination assumes compliance with the Current Good Manufacturing Practice requirement, as set forth in the Quality System Regulation (QS) for Medical Devices: General regulation (21 CFR Part 820) and that, through periodic QS inspections, the Food and Drug Administration (FDA) will verify such assumptions. Failure to comply with the GMP regulation may result in regulatory action. In addition. FDA may publish further announcements concerning your device in the Federal Register. Please note: this response to your premarket notification submission does not affect any obligation you might have under sections 531 through 542 of the Act for devices under Radiation Control provisions, or other Federal laws or regulations.

This letter will allow you to begin marketing your device as described in your 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 and additionally 809.10 for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4613. Additionally, for question and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsmamain.html".

Sincerely yours.

h. William Lyr

Lillian Yin, Ph.D. Director, Division of Reproductive, Abdominal, Ear, Nose and Throat, and Radiological Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

2

K972054--

510(k) Number: (if known): Unknown at time of submission Device Name: Reusable Vaginal and Rectal Electrodes Indications for Use:

Indication for Use - Stimulation:

The electrode is indicated for use in the treatment of urinary incontinence. The electrode is reusable if reuse instructions are followed. .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Indication for Use - Sensing:

The electrode monitors and allows assessment of the EMG activity of the pelvic floor muscles. The electrode is reusable if reuse instructions are followed.

PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Daniel H.P.

(Division Sign-Off) (Division Sigil-Krif)
Division of Reproductive, Abdominai, ENT, and Radiological Devices 510(k) Number .

OR

P Prescription Use (Per 21 CFR 801.109)

Over-The Counter Use ________