80_FR_18372 80 FR 18307 - Medical Devices; Gastroenterology-Urology Devices; Classification of the Urethral Insert With Pump for Bladder Drainage

80 FR 18307 - Medical Devices; Gastroenterology-Urology Devices; Classification of the Urethral Insert With Pump for Bladder Drainage

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration

Federal Register Volume 80, Issue 65 (April 6, 2015)

Page Range18307-18310
FR Document2015-07815

The Food and Drug Administration (FDA) is classifying the urethral insert with pump for bladder drainage into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the urethral insert with pump for bladder drainage's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

Federal Register, Volume 80 Issue 65 (Monday, April 6, 2015)
[Federal Register Volume 80, Number 65 (Monday, April 6, 2015)]
[Rules and Regulations]
[Pages 18307-18310]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-07815]


=======================================================================
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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

21 CFR Part 876

[Docket No. FDA-2015-N-0804]


Medical Devices; Gastroenterology-Urology Devices; Classification 
of the Urethral Insert With Pump for Bladder Drainage

AGENCY: Food and Drug Administration, HHS.

ACTION: Final order.

-----------------------------------------------------------------------

SUMMARY: The Food and Drug Administration (FDA) is classifying the 
urethral insert with pump for bladder drainage into class II (special 
controls). The special controls that will apply to the device are 
identified in this order and will be part of the codified language for 
the urethral insert with pump for bladder drainage's classification. 
The Agency is classifying the device into class II (special controls) 
in order to provide a reasonable assurance of safety and effectiveness 
of the device.

DATES: This order is effective April 6, 2015. The classification was 
applicable on October 14, 2014.

FOR FURTHER INFORMATION CONTACT: John Baxley, Center for Devices and 
Radiological Health, Food and Drug Administration, 10903 New Hampshire 
Ave., Bldg. 66, Rm. G210, Silver Spring, MD 20993-0002, 301-796-6549.

SUPPLEMENTARY INFORMATION: 

I. Background

    In accordance with section 513(f)(1) of the Federal Food, Drug, and 
Cosmetic Act (the FD&C Act) (21 U.S.C. 360c(f)(1)), devices that were 
not in commercial distribution before May 28, 1976 (the date of 
enactment of the Medical Device Amendments of 1976), generally referred 
to as postamendments devices, are classified automatically by statute 
into class III without any FDA rulemaking process. These devices remain 
in class III and require premarket approval, unless and until the 
device is classified or reclassified into class I or II, or FDA issues 
an order finding the device to be substantially equivalent, in 
accordance with section 513(i) of the FD&C Act, to a predicate device 
that does not require premarket approval. The Agency determines whether 
new devices are substantially equivalent to predicate devices by means 
of premarket notification procedures in section 510(k) of the FD&C Act 
(21 U.S.C. 360(k)) and part 807 (21 CFR part 807) of the regulations.

[[Page 18308]]

    Section 513(f)(2) of the FD&C Act, as amended by section 607 of the 
Food and Drug Administration Safety and Innovation Act (Pub. L. 112-
144), provides two procedures by which a person may request FDA to 
classify a device under the criteria set forth in section 513(a)(1). 
Under the first procedure, the person submits a premarket notification 
under section 510(k) of the FD&C Act for a device that has not 
previously been classified and, within 30 days of receiving an order 
classifying the device into class III under section 513(f)(1) of the 
FD&C Act, the person requests a classification under section 513(f)(2). 
Under the second procedure, rather than first submitting a premarket 
notification under section 510(k) of the FD&C Act and then a request 
for classification under the first procedure, the person determines 
that there is no legally marketed device upon which to base a 
determination of substantial equivalence and requests a classification 
under section 513(f)(2) of the FD&C Act. If the person submits a 
request to classify the device under this second procedure, FDA may 
decline to undertake the classification request if FDA identifies a 
legally marketed device that could provide a reasonable basis for 
review of substantial equivalence with the device or if FDA determines 
that the device submitted is not of ``low-moderate risk'' or that 
general controls would be inadequate to control the risks and special 
controls to mitigate the risks cannot be developed.
    In response to a request to classify a device under either 
procedure provided by section 513(f)(2) of the FD&C Act, FDA will 
classify the device by written order within 120 days. This 
classification will be the initial classification of the device.
    On October 25, 2013, Vesiflo, Inc., submitted a request for 
classification of the inFlowTM Intraurethral Valve-Pump and 
Activator under section 513(f)(2) of the FD&C Act. The manufacturer 
recommended that the device be classified into class II (Ref. 1).
    In accordance with section 513(f)(2) of the FD&C Act, FDA reviewed 
the request in order to classify the device under the criteria for 
classification set forth in section 513(a)(1). FDA classifies devices 
into class II if general controls by themselves are insufficient to 
provide reasonable assurance of safety and effectiveness, but there is 
sufficient information to establish special controls to provide 
reasonable assurance of the safety and effectiveness of the device for 
its intended use. After review of the information submitted in the 
request, FDA determined that the device can be classified into class II 
with the establishment of special controls. FDA believes these special 
controls, in addition to general controls, will provide reasonable 
assurance of the safety and effectiveness of the device.
    Therefore, on October 14, 2014, FDA issued an order to the 
requestor classifying the device into class II. FDA is codifying the 
classification of the device by adding Sec.  876.5140.
    Following the effective date of this final classification order, 
any firm submitting a premarket notification (510(k)) for a urethral 
insert with pump for bladder drainage will need to comply with the 
special controls named in this final order. The device is assigned the 
generic name urethral insert with pump for bladder drainage, and it is 
identified as a catheter-like device with internal pump mechanism that 
is placed in the urethra. Under patient control the internal pump draws 
urine out of the bladder when voiding is desired, and blocks urine flow 
when continence is desired. The device is intended for use by women who 
cannot empty their bladder due to impaired detrusor contractility.
    FDA has identified the following risks to health associated 
specifically with this type of device, as well as the measures required 
to mitigate these risks in table 1.

              Table 1--Urethral Insert With Pump for Bladder Drainage Risks and Mitigation Measures
----------------------------------------------------------------------------------------------------------------
               Identified risk                                        Mitigation measure
----------------------------------------------------------------------------------------------------------------
Adverse Tissue Reaction.....................  Biocompatibility Testing.
Infection...................................  Sterilization Validation.
                                              Clinical Testing.
                                              Labeling.
Reflux or Renal Damage......................  Non-Clinical (Bench) Testing.
                                              Clinical Testing.
                                              Labeling.
Urethral/Bladder Wall Trauma................  Clinical Testing.
                                              Labeling.
Urinary Frequency/Urgency...................  Clinical Testing.
                                              Labeling.
Device Encrustation.........................  Non-Clinical (Bench) Testing.
                                              Labeling.
Device Migration............................  Non-Clinical (Bench) Testing.
                                              Clinical Testing.
Device Malfunction..........................  Non-Clinical (Bench) Testing.
                                              Labeling.
Urine Leakage...............................  Non-Clinical (Bench) Testing.
                                              Labeling.
Discomfort..................................  Clinical Testing.
                                              Labeling.
----------------------------------------------------------------------------------------------------------------

    FDA believes that the following special controls, in combination 
with the general controls, address these risks to health and provide 
reasonable assurance of the safety and effectiveness:
     The elements of the device that may contact the urinary 
tract must be demonstrated to be biocompatible.
     Performance data must demonstrate the sterility of the 
device components that contact the urinary tract.
     Performance data must support shelf life by demonstrating 
continued sterility of the device (or the sterile components), package 
integrity, and device functionality over the requested shelf life.

[[Page 18309]]

     Non-clinical testing data must demonstrate that the device 
performs as intended under anticipated conditions of use. The following 
performance characteristics must be tested:
    [cir] Urine flow rate testing.
    [cir] Valve integrity testing.
    [cir] Bladder neck retention force testing.
    [cir] Pump/valve endurance testing.
    [cir] Encrustation testing.
    [cir] Remote control reliability, mechanical integrity, and battery 
life testing.
     Clinical testing must demonstrate safe and effective use, 
document the device acceptance rate and the adverse event profile 
associated with clinical use, and demonstrate that the device performs 
as intended under anticipated conditions of use.
     Labeling must include:
    [cir] Specific instructions, contraindications, warnings, cautions, 
limitations, and the clinical training needed for the safe use of the 
device.
    [cir] Statement of the maximum insert indwelling period.
    [cir] Information on the patient education and support program 
prior to and during initial device use.
    [cir] Information on the patient population for which the device 
has been demonstrated to be safe and effective.
    [cir] Information on how the device operates and the recommended 
treatment regimen.
    [cir] A detailed summary of the device- and procedure-related 
complications or adverse events pertinent to use of the device.
    [cir] An expiration date/shelf life.
     Patient labeling must be provided and must include:
    [cir] Relevant contraindications, warnings, precautions, and 
adverse events/complications.
    [cir] Information on how the device operates and the recommended 
treatment regimen.
    [cir] Information on the patient education and support program 
prior to and during initial device use.
    [cir] Information on the patient population for which there is 
clinical evidence of safety and effectiveness.
    [cir] The potential risks and benefits associated with the use of 
the device.
    [cir] Post-insertion care instructions.
    [cir] Alternative treatments.
    Urethral inserts with pump for bladder drainage are prescription 
devices restricted to patient use only upon the authorization of a 
practitioner licensed by law to administer or use the device; see 
section 520(e) of the FD&C Act (21 U.S.C. 360j(e)) and 21 CFR 801.109 
(Prescription devices). Prescription-use restrictions are a type of 
general controls as defined in section 513(a)(1)(A)(i) of the FD&C Act.
    Section 510(m) of the FD&C Act provides that FDA may exempt a class 
II device from the premarket notification requirements under section 
510(k), if FDA determines that premarket notification is not necessary 
to provide reasonable assurance of the safety and effectiveness of the 
device. For this type of device, FDA has determined that premarket 
notification is necessary to provide reasonable assurance of the safety 
and effectiveness of the device. Therefore, this device type is not 
exempt from premarket notification requirements. Persons who intend to 
market this type of device must submit to FDA a premarket notification, 
prior to marketing the device, which contains information about the 
urethral inserts with pump for bladder drainage they intend to market.

II. Environmental Impact

    The Agency has determined under 21 CFR 25.34(b) that this action is 
of a type that does not individually or cumulatively have a significant 
effect on the human environment. Therefore, neither an environmental 
assessment nor an environmental impact statement is required.

III. Paperwork Reduction Act of 1995

    This final order establishes special controls that refer to 
previously approved collections of information found in other FDA 
regulations. These collections of information are subject to review by 
the Office of Management and Budget (OMB) under the Paperwork Reduction 
Act of 1995 (44 U.S.C. 3501-3520). The collections of information in 21 
CFR part 807, subpart E, regarding premarket notification submissions 
have been approved under OMB control number 0910-0120, and the 
collections of information in 21 CFR part 801, regarding labeling have 
been approved under OMB control number 0910-0485.

IV. Reference

    The following reference has been placed on display in the Division 
of Dockets Management (HFA-305), Food and Drug Administration, 5630 
Fishers Lane, Rm. 1061, Rockville, MD 20852, and may be seen by 
interested persons between 9 a.m. and 4 p.m., Monday through Friday, 
and is available electronically at http://www.regulations.gov.

1. DEN130044: De Novo Request per 513(f)(2) from Vesiflo, Inc., 
dated October 25, 2013.

List of Subjects in 21 CFR Part 876

    Medical devices.

    Therefore, under the Federal Food, Drug, and Cosmetic Act and under 
authority delegated to the Commissioner of Food and Drugs, 21 CFR part 
876 is amended as follows:

PART 876--GASTROENTEROLOGY-UROLOGY DEVICES

0
1. The authority citation for 21 CFR part 876 continues to read as 
follows:

    Authority:  21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371.

0
2. Add Sec.  876.5140 to subpart F to read as follows:


Sec.  876.5140  Urethral insert with pump for bladder drainage.

    (a) Identification. A urethral insert with pump for bladder 
drainage is a catheter-like device with internal pump mechanism that is 
placed in the urethra. Under patient control the internal pump draws 
urine out of the bladder when voiding is desired, and blocks urine flow 
when continence is desired. The device is intended for use by women who 
cannot empty their bladder due to impaired detrusor contractility.
    (b) Classification. Class II (special controls). The special 
controls for this device are:
    (1) The elements of the device that may contact the urinary tract 
must be demonstrated to be biocompatible.
    (2) Performance data must demonstrate the sterility of the device 
components that contact the urinary tract.
    (3) Performance data must support shelf life by demonstrating 
continued sterility of the device (or the sterile components), package 
integrity, and device functionality over the requested shelf life.
    (4) Non-clinical testing data must demonstrate that the device 
performs as intended under anticipated conditions of use. The following 
performance characteristics must be tested:
    (i) Urine flow rate testing.
    (ii) Valve integrity testing.
    (iii) Bladder neck retention force testing.
    (iv) Pump/valve endurance testing.
    (v) Encrustation testing.
    (vi) Remote control reliability, mechanical integrity, and battery 
life testing.
    (5) Clinical testing must demonstrate safe and effective use, 
document the device acceptance rate and the adverse event profile 
associated with clinical use, and demonstrate that the device performs 
as intended under anticipated conditions of use.

[[Page 18310]]

    (6) Labeling must include:
    (i) Specific instructions, contraindications, warnings, cautions, 
limitations, and the clinical training needed for the safe use of the 
device.
    (ii) Statement of the maximum insert indwelling period.
    (iii) Information on the patient education and support program 
prior to and during initial device use.
    (iv) Information on the patient population for which the device has 
been demonstrated to be safe and effective.
    (v) Information on how the device operates and the recommended 
treatment regimen.
    (vi) A detailed summary of the device- and procedure-related 
complications or adverse events pertinent to use of the device.
    (vii) An expiration date/shelf life.
    (7) Patient labeling must be provided and must include:
    (i) Relevant contraindications, warnings, precautions, and adverse 
events/complications.
    (ii) Information on how the device operates and the recommended 
treatment regimen.
    (iii) Information on the patient education and support program 
prior to and during initial device use.
    (iv) Information on the patient population for which there is 
clinical evidence of safety and effectiveness.
    (v) The potential risks and benefits associated with the use of the 
device.
    (vi) Post-insertion care instructions.
    (vii) Alternative treatments.

    Dated: March 31, 2015.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2015-07815 Filed 4-3-15; 8:45 am]
 BILLING CODE 4164-01-P



                                                                  Federal Register / Vol. 80, No. 65 / Monday, April 6, 2015 / Rules and Regulations                                         18307

                                             the ground or flight path in normal taxi                products and issues that will be brought              DEPARTMENT OF HEALTH AND
                                             and flight attitudes of the airplane. This              to the committee. The change became                   HUMAN SERVICES
                                             means must be designed to function,                     effective March 4, 2015.
                                             without continuous attention on the                                                                           Food and Drug Administration
                                                                                                        Therefore, the Agency is amending 21
                                             part of the flightcrew, in conditions                   CFR 14.100(c) as set forth in the
                                             from light misting precipitation to heavy                                                                     21 CFR Part 876
                                                                                                     regulatory text of this document.
                                             rain, at speeds from fully stopped in                                                                         [Docket No. FDA–2015–N–0804]
                                             still air, to 1.5 VSR1 with lift and drag                  Under 5 U.S.C. 553(b)(3)(B) and (d)
                                             devices retracted.                                      and 21 CFR 10.40(d) and (e), the Agency               Medical Devices; Gastroenterology-
                                               Issued in Renton, Washington, on March
                                                                                                     finds good cause to dispense with notice              Urology Devices; Classification of the
                                             27, 2015.                                               and public comment procedures and to                  Urethral Insert With Pump for Bladder
                                             Michael Kazycki,                                        proceed to an immediate effective date                Drainage
                                             Acting Manager, Transport Airplane                      on this rule. Notice and public comment
                                                                                                     and a delayed effective date are                      AGENCY:    Food and Drug Administration,
                                             Directorate, Aircraft Certification Service.
                                                                                                     unnecessary and are not in the public                 HHS.
                                             [FR Doc. 2015–07713 Filed 4–3–15; 8:45 am]
                                                                                                     interest as this final rule merely                    ACTION:   Final order.
                                             BILLING CODE 4910–13–P
                                                                                                     removes the name of the Anti-Infective
                                                                                                                                                           SUMMARY:    The Food and Drug
                                                                                                     Drugs Advisory Committee from the list
                                                                                                                                                           Administration (FDA) is classifying the
                                             DEPARTMENT OF HEALTH AND                                of standing advisory committees in 21
                                                                                                                                                           urethral insert with pump for bladder
                                             HUMAN SERVICES                                          CFR 14.100 and replaces it with the                   drainage into class II (special controls).
                                                                                                     Antimicrobial Drugs Advisory                          The special controls that will apply to
                                             Food and Drug Administration                            Committee.                                            the device are identified in this order
                                                                                                     List of Subjects in 21 CFR Part 14                    and will be part of the codified language
                                             21 CFR Part 14                                                                                                for the urethral insert with pump for
                                             [Docket No. FDA–2009–N–0443]                              Administrative practice and                         bladder drainage’s classification. The
                                                                                                     procedure, Advisory committees, Color                 Agency is classifying the device into
                                             Advisory Committee; Anti-Infective                      additives, Drugs, Radiation protection.               class II (special controls) in order to
                                             Drugs Advisory Committee                                                                                      provide a reasonable assurance of safety
                                                                                                       Therefore, under the Federal Food,                  and effectiveness of the device.
                                             AGENCY:    Food and Drug Administration,                Drug, and Cosmetic Act and under
                                             HHS.                                                                                                          DATES: This order is effective April 6,
                                                                                                     authority delegated to the Commissioner
                                                                                                                                                           2015. The classification was applicable
                                             ACTION:   Final rule.                                   of Food and Drugs, 21 CFR part 14 is
                                                                                                                                                           on October 14, 2014.
                                                                                                     amended as follows:
                                             SUMMARY:  The Food and Drug                                                                                   FOR FURTHER INFORMATION CONTACT: John
                                             Administration (FDA) is amending the                    PART 14—PUBLIC HEARING BEFORE                         Baxley, Center for Devices and
                                             standing advisory committees’                           A PUBLIC ADVISORY COMMITTEE                           Radiological Health, Food and Drug
                                             regulations to change the name of the                                                                         Administration, 10903 New Hampshire
                                             Anti-Infective Drugs Advisory                           ■ 1. The authority citation for 21 CFR                Ave., Bldg. 66, Rm. G210, Silver Spring,
                                             Committee. This action is being taken to                part 14 continues to read as follows:                 MD 20993–0002, 301–796–6549.
                                             change the name of this committee on                                                                          SUPPLEMENTARY INFORMATION:
                                             the Agency’s list of standing advisory                    Authority: 5 U.S.C. App. 2; 15 U.S.C.
                                             committees.                                             1451–1461; 21 U.S.C. 41–50, 141–149, 321–             I. Background
                                                                                                     394, 467f, 679, 821, 1034; 28 U.S.C. 2112; 42            In accordance with section 513(f)(1) of
                                             DATES:  This rule is effective April 6,                 U.S.C. 201, 262, 263b, 264; Pub. L. 107–109;
                                             2015. The name change became                                                                                  the Federal Food, Drug, and Cosmetic
                                                                                                     Pub. L. 108–155; Pub. L. 113–54.
                                             applicable March 4, 2015.                                                                                     Act (the FD&C Act) (21 U.S.C.
                                                                                                                                                           360c(f)(1)), devices that were not in
                                             FOR FURTHER INFORMATION CONTACT:                        ■ 2. Amend § 14.100 by revising
                                                                                                                                                           commercial distribution before May 28,
                                             Michael Ortwerth, Advisory Committee                    paragraph (c)(2) introductory text to                 1976 (the date of enactment of the
                                             Oversight and Management Staff, Food                    read as follows:                                      Medical Device Amendments of 1976),
                                             and Drug Administration, 10903 New                                                                            generally referred to as postamendments
                                             Hampshire Ave., Bldg. 32, Rm. 5129,                     § 14.100 List of standing advisory
                                                                                                     committees.                                           devices, are classified automatically by
                                             Silver Spring, MD 20993–0002, FAX:                                                                            statute into class III without any FDA
                                             301–847–8640, or Michael.Ortwerth@                      *     *    *    *     *
                                                                                                                                                           rulemaking process. These devices
                                             fda.hhs.gov.                                              (c) * * *                                           remain in class III and require
                                             SUPPLEMENTARY INFORMATION:     The Anti-                  (2) Antimicrobial Drugs Advisory                    premarket approval, unless and until
                                             Infective Drugs Advisory Committee                      Committee.                                            the device is classified or reclassified
                                             (the Committee) was established on                                                                            into class I or II, or FDA issues an order
                                                                                                     *     *    *    *     *
                                             October 7, 1980 (45 FR 79025). The                                                                            finding the device to be substantially
                                             Committee reviews and evaluates                           Dated: March 27, 2015.                              equivalent, in accordance with section
                                             available data concerning the safety and                Leslie Kux,                                           513(i) of the FD&C Act, to a predicate
                                             effectiveness of marketed and                           Associate Commissioner for Policy.                    device that does not require premarket
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                                             investigational human drug products for                 [FR Doc. 2015–07789 Filed 4–3–15; 8:45 am]            approval. The Agency determines
                                             use in the treatment of infectious                                                                            whether new devices are substantially
                                                                                                     BILLING CODE 4164–01–P
                                             diseases and disorders.                                                                                       equivalent to predicate devices by
                                                The Committee name has been                                                                                means of premarket notification
                                             changed to the following: Antimicrobial                                                                       procedures in section 510(k) of the
                                             Drugs Advisory Committee. The Agency                                                                          FD&C Act (21 U.S.C. 360(k)) and part
                                             changed the name to better reflect the                                                                        807 (21 CFR part 807) of the regulations.


                                        VerDate Sep<11>2014   15:01 Apr 03, 2015   Jkt 235001   PO 00000   Frm 00003   Fmt 4700   Sfmt 4700   E:\FR\FM\06APR1.SGM   06APR1


                                             18308                        Federal Register / Vol. 80, No. 65 / Monday, April 6, 2015 / Rules and Regulations

                                                Section 513(f)(2) of the FD&C Act, as                                    device submitted is not of ‘‘low-                                             establishment of special controls. FDA
                                             amended by section 607 of the Food and                                      moderate risk’’ or that general controls                                      believes these special controls, in
                                             Drug Administration Safety and                                              would be inadequate to control the risks                                      addition to general controls, will
                                             Innovation Act (Pub. L. 112–144),                                           and special controls to mitigate the risks                                    provide reasonable assurance of the
                                             provides two procedures by which a                                          cannot be developed.                                                          safety and effectiveness of the device.
                                             person may request FDA to classify a                                           In response to a request to classify a                                        Therefore, on October 14, 2014, FDA
                                             device under the criteria set forth in                                      device under either procedure provided                                        issued an order to the requestor
                                             section 513(a)(1). Under the first                                          by section 513(f)(2) of the FD&C Act,                                         classifying the device into class II. FDA
                                             procedure, the person submits a                                             FDA will classify the device by written                                       is codifying the classification of the
                                             premarket notification under section                                        order within 120 days. This                                                   device by adding § 876.5140.
                                             510(k) of the FD&C Act for a device that                                    classification will be the initial
                                             has not previously been classified and,                                     classification of the device.                                                    Following the effective date of this
                                             within 30 days of receiving an order                                           On October 25, 2013, Vesiflo, Inc.,                                        final classification order, any firm
                                             classifying the device into class III                                       submitted a request for classification of                                     submitting a premarket notification
                                             under section 513(f)(1) of the FD&C Act,                                    the inFlowTM Intraurethral Valve-Pump                                         (510(k)) for a urethral insert with pump
                                             the person requests a classification                                        and Activator under section 513(f)(2) of                                      for bladder drainage will need to
                                             under section 513(f)(2). Under the                                          the FD&C Act. The manufacturer                                                comply with the special controls named
                                             second procedure, rather than first                                         recommended that the device be                                                in this final order. The device is
                                             submitting a premarket notification                                         classified into class II (Ref. 1).                                            assigned the generic name urethral
                                             under section 510(k) of the FD&C Act                                           In accordance with section 513(f)(2) of                                    insert with pump for bladder drainage,
                                             and then a request for classification                                       the FD&C Act, FDA reviewed the                                                and it is identified as a catheter-like
                                             under the first procedure, the person                                       request in order to classify the device                                       device with internal pump mechanism
                                             determines that there is no legally                                         under the criteria for classification set                                     that is placed in the urethra. Under
                                             marketed device upon which to base a                                        forth in section 513(a)(1). FDA classifies                                    patient control the internal pump draws
                                             determination of substantial                                                devices into class II if general controls                                     urine out of the bladder when voiding
                                             equivalence and requests a classification                                   by themselves are insufficient to                                             is desired, and blocks urine flow when
                                             under section 513(f)(2) of the FD&C Act.                                    provide reasonable assurance of safety                                        continence is desired. The device is
                                             If the person submits a request to                                          and effectiveness, but there is sufficient                                    intended for use by women who cannot
                                             classify the device under this second                                       information to establish special controls                                     empty their bladder due to impaired
                                             procedure, FDA may decline to                                               to provide reasonable assurance of the                                        detrusor contractility.
                                             undertake the classification request if                                     safety and effectiveness of the device for                                       FDA has identified the following risks
                                             FDA identifies a legally marketed device                                    its intended use. After review of the                                         to health associated specifically with
                                             that could provide a reasonable basis for                                   information submitted in the request,                                         this type of device, as well as the
                                             review of substantial equivalence with                                      FDA determined that the device can be                                         measures required to mitigate these
                                             the device or if FDA determines that the                                    classified into class II with the                                             risks in table 1.

                                                               TABLE 1—URETHRAL INSERT WITH PUMP FOR BLADDER DRAINAGE RISKS AND MITIGATION MEASURES
                                                                                                                 Identified risk                                                                                         Mitigation measure

                                             Adverse Tissue Reaction .........................................................................................................................                Biocompatibility Testing.
                                             Infection ....................................................................................................................................................   Sterilization Validation.
                                                                                                                                                                                                              Clinical Testing.
                                                                                                                                                                                                              Labeling.
                                             Reflux or Renal Damage .........................................................................................................................                 Non-Clinical (Bench) Testing.
                                                                                                                                                                                                              Clinical Testing.
                                                                                                                                                                                                              Labeling.
                                             Urethral/Bladder Wall Trauma .................................................................................................................                   Clinical Testing.
                                                                                                                                                                                                              Labeling.
                                             Urinary Frequency/Urgency .....................................................................................................................                  Clinical Testing.
                                                                                                                                                                                                              Labeling.
                                             Device Encrustation .................................................................................................................................            Non-Clinical (Bench) Testing.
                                                                                                                                                                                                              Labeling.
                                             Device Migration ......................................................................................................................................          Non-Clinical (Bench) Testing.
                                                                                                                                                                                                              Clinical Testing.
                                             Device Malfunction ...................................................................................................................................           Non-Clinical (Bench) Testing.
                                                                                                                                                                                                              Labeling.
                                             Urine Leakage ..........................................................................................................................................         Non-Clinical (Bench) Testing.
                                                                                                                                                                                                              Labeling.
                                             Discomfort ................................................................................................................................................      Clinical Testing.
                                                                                                                                                                                                              Labeling.



                                                FDA believes that the following                                            • The elements of the device that may                                         • Performance data must support
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                                             special controls, in combination with                                       contact the urinary tract must be                                             shelf life by demonstrating continued
                                             the general controls, address these risks                                   demonstrated to be biocompatible.                                             sterility of the device (or the sterile
                                             to health and provide reasonable                                              • Performance data must demonstrate                                         components), package integrity, and
                                             assurance of the safety and                                                 the sterility of the device components                                        device functionality over the requested
                                             effectiveness:                                                              that contact the urinary tract.                                               shelf life.




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                                                                  Federal Register / Vol. 80, No. 65 / Monday, April 6, 2015 / Rules and Regulations                                            18309

                                                • Non-clinical testing data must                     Prescription-use restrictions are a type              List of Subjects in 21 CFR Part 876
                                             demonstrate that the device performs as                 of general controls as defined in section               Medical devices.
                                             intended under anticipated conditions                   513(a)(1)(A)(i) of the FD&C Act.
                                             of use. The following performance                                                                               Therefore, under the Federal Food,
                                                                                                        Section 510(m) of the FD&C Act                     Drug, and Cosmetic Act and under
                                             characteristics must be tested:                         provides that FDA may exempt a class
                                                Æ Urine flow rate testing.                                                                                 authority delegated to the Commissioner
                                                                                                     II device from the premarket notification             of Food and Drugs, 21 CFR part 876 is
                                                Æ Valve integrity testing.                           requirements under section 510(k), if
                                                Æ Bladder neck retention force                                                                             amended as follows:
                                                                                                     FDA determines that premarket
                                             testing.                                                notification is not necessary to provide              PART 876—GASTROENTEROLOGY-
                                                Æ Pump/valve endurance testing.
                                                                                                     reasonable assurance of the safety and                UROLOGY DEVICES
                                                Æ Encrustation testing.
                                                Æ Remote control reliability,                        effectiveness of the device. For this type
                                                                                                     of device, FDA has determined that                    ■ 1. The authority citation for 21 CFR
                                             mechanical integrity, and battery life                                                                        part 876 continues to read as follows:
                                             testing.                                                premarket notification is necessary to
                                                • Clinical testing must demonstrate                  provide reasonable assurance of the                     Authority: 21 U.S.C. 351, 360, 360c, 360e,
                                             safe and effective use, document the                    safety and effectiveness of the device.               360j, 360l, 371.
                                             device acceptance rate and the adverse                  Therefore, this device type is not                    ■ 2. Add § 876.5140 to subpart F to read
                                             event profile associated with clinical                  exempt from premarket notification                    as follows:
                                             use, and demonstrate that the device                    requirements. Persons who intend to
                                                                                                     market this type of device must submit                § 876.5140 Urethral insert with pump for
                                             performs as intended under anticipated                                                                        bladder drainage.
                                             conditions of use.                                      to FDA a premarket notification, prior to
                                                • Labeling must include:                             marketing the device, which contains                     (a) Identification. A urethral insert
                                                Æ Specific instructions,                             information about the urethral inserts                with pump for bladder drainage is a
                                             contraindications, warnings, cautions,                  with pump for bladder drainage they                   catheter-like device with internal pump
                                             limitations, and the clinical training                  intend to market.                                     mechanism that is placed in the urethra.
                                             needed for the safe use of the device.                                                                        Under patient control the internal pump
                                                                                                     II. Environmental Impact                              draws urine out of the bladder when
                                                Æ Statement of the maximum insert
                                             indwelling period.                                         The Agency has determined under 21                 voiding is desired, and blocks urine
                                                Æ Information on the patient                         CFR 25.34(b) that this action is of a type            flow when continence is desired. The
                                             education and support program prior to                  that does not individually or                         device is intended for use by women
                                             and during initial device use.                          cumulatively have a significant effect on             who cannot empty their bladder due to
                                                Æ Information on the patient                         the human environment. Therefore,                     impaired detrusor contractility.
                                             population for which the device has                     neither an environmental assessment                      (b) Classification. Class II (special
                                             been demonstrated to be safe and                        nor an environmental impact statement                 controls). The special controls for this
                                             effective.                                              is required.                                          device are:
                                                Æ Information on how the device                                                                               (1) The elements of the device that
                                                                                                     III. Paperwork Reduction Act of 1995                  may contact the urinary tract must be
                                             operates and the recommended
                                             treatment regimen.                                                                                            demonstrated to be biocompatible.
                                                                                                       This final order establishes special                   (2) Performance data must
                                                Æ A detailed summary of the device-                  controls that refer to previously
                                             and procedure-related complications or                                                                        demonstrate the sterility of the device
                                                                                                     approved collections of information                   components that contact the urinary
                                             adverse events pertinent to use of the                  found in other FDA regulations. These
                                             device.                                                                                                       tract.
                                                                                                     collections of information are subject to                (3) Performance data must support
                                                Æ An expiration date/shelf life.                     review by the Office of Management and
                                                • Patient labeling must be provided                  Budget (OMB) under the Paperwork
                                                                                                                                                           shelf life by demonstrating continued
                                             and must include:                                                                                             sterility of the device (or the sterile
                                                                                                     Reduction Act of 1995 (44 U.S.C. 3501–                components), package integrity, and
                                                Æ Relevant contraindications,                        3520). The collections of information in
                                             warnings, precautions, and adverse                                                                            device functionality over the requested
                                                                                                     21 CFR part 807, subpart E, regarding                 shelf life.
                                             events/complications.                                   premarket notification submissions have
                                                Æ Information on how the device                                                                               (4) Non-clinical testing data must
                                                                                                     been approved under OMB control                       demonstrate that the device performs as
                                             operates and the recommended                            number 0910–0120, and the collections
                                             treatment regimen.                                                                                            intended under anticipated conditions
                                                                                                     of information in 21 CFR part 801,                    of use. The following performance
                                                Æ Information on the patient                         regarding labeling have been approved
                                             education and support program prior to                                                                        characteristics must be tested:
                                                                                                     under OMB control number 0910–0485.                      (i) Urine flow rate testing.
                                             and during initial device use.
                                                Æ Information on the patient                         IV. Reference                                            (ii) Valve integrity testing.
                                             population for which there is clinical                                                                           (iii) Bladder neck retention force
                                             evidence of safety and effectiveness.                     The following reference has been                    testing.
                                                Æ The potential risks and benefits                   placed on display in the Division of                     (iv) Pump/valve endurance testing.
                                             associated with the use of the device.                  Dockets Management (HFA–305), Food                       (v) Encrustation testing.
                                                Æ Post-insertion care instructions.                  and Drug Administration, 5630 Fishers                    (vi) Remote control reliability,
                                                Æ Alternative treatments.                            Lane, Rm. 1061, Rockville, MD 20852,                  mechanical integrity, and battery life
                                                Urethral inserts with pump for                       and may be seen by interested persons                 testing.
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                                             bladder drainage are prescription                       between 9 a.m. and 4 p.m., Monday                        (5) Clinical testing must demonstrate
                                             devices restricted to patient use only                  through Friday, and is available                      safe and effective use, document the
                                             upon the authorization of a practitioner                electronically at http://                             device acceptance rate and the adverse
                                             licensed by law to administer or use the                www.regulations.gov.                                  event profile associated with clinical
                                             device; see section 520(e) of the FD&C                  1. DEN130044: De Novo Request per 513(f)(2)           use, and demonstrate that the device
                                             Act (21 U.S.C. 360j(e)) and 21 CFR                          from Vesiflo, Inc., dated October 25,             performs as intended under anticipated
                                             801.109 (Prescription devices).                             2013.                                             conditions of use.


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                                             18310                Federal Register / Vol. 80, No. 65 / Monday, April 6, 2015 / Rules and Regulations

                                                (6) Labeling must include:                           vessel San Salvador located in the                    Table of Acronyms
                                                (i) Specific instructions,                           Captain of the Port San Diego Zone on                 DHS Department of Homeland Security
                                             contraindications, warnings, cautions,                  San Diego Bay. This action is necessary               FR Federal Register
                                             limitations, and the clinical training                  to provide for the safety of life and                 NPRM Notice of Proposed Rulemaking
                                             needed for the safe use of the device.                  property on navigable waters during this
                                                (ii) Statement of the maximum insert                 event. This special local regulation will             A. Public Participation and Comments
                                             indwelling period.                                      establish restrictions upon, and control                 We encourage you to submit
                                                (iii) Information on the patient                     movement of, vessels in a portion of San              comments (or related material) on this
                                             education and support program prior to                  Diego Bay during the initial launch and               temporary final rule. We will consider
                                             and during initial device use.                          subsequent procession of the San                      all submissions and may adjust our final
                                                (iv) Information on the patient                      Salvador around a portion of San Diego                action based on your comments.
                                             population for which the device has                     Bay. Unauthorized persons and vessels                 Comments should be marked with
                                             been demonstrated to be safe and                        are prohibited from entering into,                    docket number USCG–2015–0138 and
                                             effective.                                              transiting through or anchoring within                should provide a reason for each
                                                (v) Information on how the device                    this regulated area unless authorized by              suggestion or recommendation. You
                                             operates and the recommended                            the Captain of the Port, or his                       should provide personal contact
                                             treatment regimen.                                      designated representative. The Coast                  information so that we can contact you
                                                (vi) A detailed summary of the device-               Guard requests public comments on the                 if we have questions regarding your
                                             and procedure-related complications or                  temporary special local regulation.                   comments; but please note that all
                                             adverse events pertinent to use of the                  DATES: This rule is effective from 8:00               comments will be posted to the online
                                             device.                                                 a.m. to 1:00 p.m. on April 19, 2015.                  docket without change and that any
                                                (vii) An expiration date/shelf life.                 Public comments must be received by                   personal information you include can be
                                                (7) Patient labeling must be provided                April 15, 2015.                                       searchable online (see the Federal
                                             and must include:                                                                                             Register Privacy Act notice regarding
                                                                                                     ADDRESSES: Submit comments using one
                                                (i) Relevant contraindications,                                                                            our public dockets, 73 FR 3316, Jan. 17,
                                                                                                     of the listed methods, and see
                                             warnings, precautions, and adverse                                                                            2008).
                                                                                                     SUPPLEMENTARY INFORMATION for more
                                             events/complications.                                                                                            Mailed or hand-delivered comments
                                                                                                     information on public comments.                       should be in an unbound 81⁄2 x 11 inch
                                                (ii) Information on how the device                      • Online—http://www.regulations.gov
                                             operates and the recommended                                                                                  format suitable for reproduction. The
                                                                                                     following Web site instructions.
                                             treatment regimen.                                         • Fax—202–493–2251.                                Docket Management Facility will
                                                (iii) Information on the patient                        • Mail or hand deliver—Docket                      acknowledge receipt of mailed
                                             education and support program prior to                  Management Facility (M–30), U.S.                      comments if you enclose a stamped,
                                             and during initial device use.                          Department of Transportation, West                    self-addressed postcard or envelope
                                                (iv) Information on the patient                      Building Ground Floor, Room W12–140,                  with your submission.
                                                                                                                                                              Documents mentioned in this notice
                                             population for which there is clinical                  1200 New Jersey Avenue SE.,
                                                                                                                                                           and all public comments, are in our
                                             evidence of safety and effectiveness.                   Washington, DC 20590–0001. Hand
                                                                                                                                                           online docket at http://
                                                (v) The potential risks and benefits                 delivery hours: 9 a.m. to 5 p.m., Monday
                                                                                                                                                           www.regulations.gov and can be viewed
                                             associated with the use of the device.                  through Friday, except Federal holidays
                                                                                                                                                           by following the Web site’s instructions.
                                                (vi) Post-insertion care instructions.               (telephone 202–366–9329).
                                                                                                                                                           You can also view the docket at the
                                                (vii) Alternative treatments.                           Documents mentioned in this
                                                                                                                                                           Docket Management Facility (see the
                                               Dated: March 31, 2015.                                preamble are part of docket [USCG–
                                                                                                                                                           mailing address under ADDRESSES)
                                                                                                     2015–0138]. To view documents
                                             Leslie Kux,                                                                                                   between 9 a.m. and 5 p.m., Monday
                                                                                                     mentioned in this preamble as being
                                             Associate Commissioner for Policy.                                                                            through Friday, except Federal holidays.
                                                                                                     available in the docket, go to http://
                                             [FR Doc. 2015–07815 Filed 4–3–15; 8:45 am]              www.regulations.gov, type the docket                  B. Regulatory History and Information
                                             BILLING CODE 4164–01–P                                  number in the ‘‘SEARCH’’ box and click                   The San Salvador Launch and
                                                                                                     ‘‘SEARCH.’’ Click on Open Docket                      Procession is a onetime marine event
                                                                                                     Folder on the line associated with this               with no regulatory history. The Coast
                                             DEPARTMENT OF HOMELAND                                  rulemaking. You may also visit the                    Guard is issuing this temporary final
                                             SECURITY                                                Docket Management Facility in Room                    rule without prior notice and
                                                                                                     W12–140 on the ground floor of the                    opportunity to comment pursuant to
                                             Coast Guard                                             Department of Transportation West                     authority under section 4(a) of the
                                                                                                     Building, 1200 New Jersey Avenue SE.,                 Administrative Procedure Act (APA) (5
                                             33 CFR Part 100                                         Washington, DC 20590, between 9 a.m.                  U.S.C. 553(b)). This provision
                                             [Docket Number USCG–2015–0138]                          and 5 p.m., Monday through Friday,                    authorizes an agency to issue a rule
                                                                                                     except Federal holidays.                              without prior notice and opportunity to
                                             RIN 1625–AA08                                           FOR FURTHER INFORMATION CONTACT: If                   comment when the agency for good
                                                                                                     you have questions on this rule, call or              cause finds that those procedures are
                                             Special Local Regulation; San                           email Petty Officer Randolph Pahilanga,
                                             Salvador Launch and Procession; San                                                                           ‘‘impracticable, unnecessary, or contrary
                                                                                                     Waterways Management, U.S. Coast                      to the public interest.’’
                                             Diego Bay, San Diego, CA                                Guard Sector San Diego; telephone (619)                  Under 5 U.S.C. 553(b)(B), the Coast
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                                             AGENCY:Coast Guard, DHS.                                278–7656, email D11-PF-                               Guard finds that good cause exists for
                                                   Temporary final rule; request for
                                             ACTION:
                                                                                                     MarineEventsSanDiego@uscg.mil. If you                 not publishing a notice of proposed
                                             comments.                                               have questions on viewing or submitting               rulemaking (NPRM) with respect to this
                                                                                                     material to the docket, call Cheryl                   rule because publishing an NPRM
                                             SUMMARY:   The Coast Guard is                           Collins, Program Manager, Docket                      would be impracticable since immediate
                                             establishing a marine event special local               Operations, telephone (202) 366–9826.                 action is needed to minimize potential
                                             regulation for the launch of the historic               SUPPLEMENTARY INFORMATION:                            danger to the participants and the


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Document Created: 2015-12-18 11:18:03
Document Modified: 2015-12-18 11:18:03
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionRules and Regulations
ActionFinal order.
DatesThis order is effective April 6, 2015. The classification was applicable on October 14, 2014.
ContactJohn Baxley, Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 66, Rm. G210, Silver Spring, MD 20993-0002, 301-796-6549.
FR Citation80 FR 18307 

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