K Number
K982042
Device Name
ISLAND BIOSURGICAL BLADDER NECK BOLSTR MODEL IBIBOL.002
Date Cleared
1998-09-08

(90 days)

Product Code
Regulation Number
878.3300
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The Island Biosurgical, Inc. Bladder Neck Suspension Bolster is to be used by operating pelvic surgeons to surgically correct female stress urinary incontinence due to pelvic relaxation. This bolster is recommended where the possibility of reduced suture and mosh reaction is desired.
Device Description
A surgically implantable polypropylene mesh bolster with monofilament sutures.
More Information

Island Biosurgical Bladder Neck Suspension Bolster

Not Found

No
The 510(k) summary describes a surgically implantable mesh bolster and sutures, with no mention of AI, ML, image processing, or performance studies that would typically involve such technologies.

Yes
The device is used to surgically correct female stress urinary incontinence, which is a medical condition, making it a therapeutic device.

No
The device is described as "surgically implantable polypropylene mesh bolster" meant "to surgically correct female stress urinary incontinence." Its purpose is to treat a condition, not to diagnose it.

No

The device description explicitly states it is a "surgically implantable polypropylene mesh bolster with monofilament sutures," which are physical hardware components.

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

Here's why:

  • IVD Definition: In vitro diagnostics are tests performed on samples taken from the human body, such as blood, urine, or tissue, to detect diseases, conditions, or infections. They are used to provide information for diagnosis, monitoring, or screening.
  • Device Description and Intended Use: The provided information clearly describes a surgically implantable device (polypropylene mesh bolster with sutures) used to physically correct a condition (female stress urinary incontinence) by supporting the bladder neck. This is a surgical intervention, not a diagnostic test performed on a sample.

The device is a surgical implant, not a diagnostic tool.

N/A

Intended Use / Indications for Use

The Island Biosurgical Bladder Neck Suspension Bolster is to be used by operating pelvic surgeons to surgically correct female stress urinary incontinence due to pelvic relaxation.

Product codes

OTN

Device Description

A surgically implantable polypropylene mesh bolster with monofilament sutures.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

pelvic

Indicated Patient Age Range

Not Found

Intended User / Care Setting

operating pelvic surgeons

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

Performance testing was not included in this 510 (k).

Key Metrics

Not Found

Predicate Device(s)

Island Biosurgical Bladder Neck Suspension Bolster

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 878.3300 Surgical mesh.

(a)
Identification. Surgical mesh is a metallic or polymeric screen intended to be implanted to reinforce soft tissue or bone where weakness exists. Examples of surgical mesh are metallic and polymeric mesh for hernia repair, and acetabular and cement restrictor mesh used during orthopedic surgery.(b)
Classification. Class II.

0

SEP 8 1998

Image /page/0/Picture/1 description: The image shows the text "ISLAND BIOSURGICAL, INC." in all capital letters. The text is written in a simple, sans-serif font. The letters are evenly spaced and the text is horizontally aligned. The text appears to be part of a document or label.

15922042

Bladder Neck Suspension Bolster Island Biosurgical, Inc. 510(k) Notification

510(k) SUMMARY

Contact Person: Hunter A. McKay, M.D. Date: June 4, 1998 Trade Name: Island Biosurgical Bladder Neck Suspension Bolster #2

Common Name: Bladder Neck Suspension Bolster Classification Name: None available

Predicate device: Island Biosurgical Bladder Neck Suspension Bolster

Substantial Equivalence: Island Biosurgical Bladder Neck Suspension Bolster

Description: A surgically implantable polypropylene mesh bolster with monofilament sutures.

Intended use: The Island Biosurgical Bladder Neck Suspension Bolster is to be used by operating pelvic surgeons to surgically correct female stress urinary incontinence due to pelvic relaxation.

Technological characteristics: This implantable bolster is composed of polypropylene mesh and monofilament suture material.

Performance testing: Performance testing was not included in this 510 (k).

Ref: \A\P\FDA\BQlster\980604\Summary. 022

1-800-858-5359

1

Image /page/1/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo features a stylized caduceus symbol, which is a staff with two snakes coiled around it, often associated with medicine and healthcare. The text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" is arranged in a circular fashion around the caduceus symbol.

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

SEP 2 8 2012

Hunter A. McKay, M.D. President Island Biosurgical, Inc. 18 Meadow Lane MERCER ISLAND WA 98040

K982042 Re:

Trade/Device Name: Island Biosurgical, Inc. Bladder Neck Suspension Bolster Regulation Number: 21 CFR 878.3300 Regulation Name: Surgical mesh Regulatory Class: II Product Code: OTN Dated: June 4, 1998 Received: June 10, 1998

Dear Dr. McKay:

This letter corrects our substantially equivalent letter of September 8, 1998.

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 (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.

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

2

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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); good manufacturing practice requirements as set forth in the quality systems (QS) 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 go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH0ffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. 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 Small Manufacturers, International and Consumer Assistance 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,

Sincerely yours,

Benjamin R. Perkins

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

3

Sep-02-98 12:44P colvin/bovard Sep-01-98 19:21 IsTand Biosurgical

541-345-5431 206 232 6239

P.03 P.01

K982042

Bladder Neck Suspension Bolster Island Biosurgical, Inc. 510(k) Notification

APPENDIX C

INDICATIONS POR USE STATEMENT

The Island Biosurgical, Inc. Bladder Neck Suspension Bolster is to be used by operating pelvic surgeons to surgically correct female stress urinary incontinence due to pelvic relaxation. This bolster is recommended where the possibility of reduced suture and mosh reaction is desired.

Ref: \A\P\PDA\Bolstar\980604\Sec2C.013 (Modified)

Aocoeeto

ﻌﻬﺪ ﺍﻟﻤ

(Division Sign-Off) Division of General Restorative Devices 1982047 510(k) Number

Prescription Use
(Per 21 CFR 801.109)