US2540325A - Pessary and manipulating handle assembly - Google Patents

Description

G. l.. DE BRAY ET AL 2,540,325

PEssARY Filed Deo. 3l, 1946 INVENTORS Gar/wv L Ofeny BY ITW/a weeg/V Patented Feb. 6, 1951 ATENT OFFICE PES SARY AND MANIPULATIN G HANDLE ASSEMBLY Glenn L. De Bray and Atwill Morgan, Los Angeles, Calif.

Application December 31, 1946, Serial No. 719,464 Y 4 Claims. l

This invention relates to pessaries, and has particular reference to a pessary especially adapted for the treatment of uterine prolapse, in which the pessary is required to remain within the vaginal cavity over relatively long periods of time.

In the treatment of uterine prolapse, it is frequently desirable to provide an artificial support for the uterus which will hold the uterus in its normally retracted position for a suiiiciently long period of time to permit restoration of the muscles to a condition in which they can naturally support the uterus.

In other instances it is found that it is neces- .sar-y to maintain the artificial support for an rindefinite period of time where the muscular development and restoration are insuiiicient to provide the necessary normal support.

In the treatment of such cases, it has heretofore been the practice to utilize a pessary adapted to be inserted into the vaginal cavity a suicient distance to engage the exposed end of the uterus, the pessary then being pressed upwardly to position the uterus in its normal position, the pessary remainingin this position, engaging the vaginal walls with suiiicient force to prevent a falling of the uterus back to its abnormal position.

Where such pessaries are required to remain in place over-any appreciable period of time, it is desirable to remove the pessary from time to time l for the purpose of permitting the physician or surgeon to determine whether or not a cure has been eiected and considerable diiculty is encountered in removing pessaries of known construction due to the fact that body secretions tend'to cement the pessary to the uterus, such quent-ly occurs that the accumulation of body g secretions above the pessary is of such volume as .to require frequent irrigation, which is difficult,

if not impossible, with known types of pessaries employed for this purpose.

The present invention is an improvement upon the invention disclosed and claimed in earlier application Serial No. 655,109, now Patent 2,452,229, and the present application is a continuation-inpart of the earlier case. The present invention diiiers importantly from the earlier lconstruction (Cl. 12S- 127) in that the drainage passages are open in all relative positions of the partsy of the unit permitting irrigation to aid in the breaking of adhesions hydraulically. Y

It is therefore an` object of .this invention to provide a pessary` vof the character described, which may be readily inserted and removed, and which is provided with a positive means for separating the pessary from the tissues engaged there,- by prior to the exertion of any outward pull on the pessary, and which means also serves to provide an irrigation passage through which irrigating fluids may readily be passed from the exterior of the body to the portions of the pessary engaging the 'surrounding body tissue. v

It is also an object of the present invention to provide a pessary of thetype just notedwherein are provided permanent drain passages through which secretionsmay pass and thereby drain in a normal manner. v

Still'another object of the invention is to provide a pessary having a stem and an enlarged head that is concave on b'otlrupper and lower vsurfaces'so that the vaginalfwal'l may morepositively engage the pessary for retaining it in position.

Other objectsandadvan'tages of the invention will be apparent in the follbwing'description and claims,c'onsidered together With the accompanying drawings, in which:

Fig, 1Y is a sectional View 'thro-ugh a portion of 'the 'body of a woman showing the uterus supported by a pessary embodying the invention and disposed in andi retained bythe vagina;

Fig: 2 is an venlarged vertical sectionalr view through the pessary of Fig. 1 and illustrating the manner in which Aa manipulating' handlev may be adapted thereto;

Fig. 3- is` a view similar toFig. 2 but illustrating the handle in section and'. illustrating the. position. of the `pessary parts when the. partsv are in position for irrigation; Y l

Fig. 4 is a top planview of the pessary body with the valve removed; and

Fig. 5 is a detailedfragmentary sectionalview taken along line. V-Vof Fig. .3.

Referring. to the drawings, there is illustrated in Fig. 1 apessary body Il) which is preferably constructed as asubstantially large vdiameter cup portion l l from which may extend a downwardly depending stem I2 of relatively small diameter. The upper surface of the cup. portion Il is concave as at I3 to conformwith the convexity of the protruding end or cervix of the uterus Mand is preferably polished to present a smooth, non-irritating surface to the engaged tissues. The cup portion Il is of sufficient diameter to spread the walls oi the vagina I6 as the body is inserted therein, the surrounding vagina walls tending to hold the body in place against the cervix, the protruding end of the uterus, and to hold the uterus in its retracted position against accidental prolapse.

Referring to the other drawings, the cup portion II is made particularly in accordance with the invention and includes an annular concave portion Il on the underside thereof which curves smoothly into the outer surface of the stem I2. The stem I2 is also preferably of sufcient diameter to provide a relatively great area of contact with the surrounding vagina walls. This gripping action of the vagina walls is shown particularly in Fig. 1, wherein it will be noted that the tissues mold themselves into the concave portion I'I to give a very firm and secure support to the entire pessary IB. This action induced by the concavity I1 is in contrast to the usual tapered walls which are generally straight and therefore offer but little resistance to sliding when forces are imposed that tend to move the pessary I downwardly.

The stem I2 may be provided with a central axial bore I8 terminating at its upper end in a conical enlargement i9 and terminating at its lower end in an enlarged counterbore portion 2|. As noted particularly in Figs. 4 and 5, the bore I8 is non-circular and includes circular portions 22 separated by two concentric enlargements 23 which define irrigation passages, as will be explained more fully hereinafter. The upper conical enlargement i9 of the bore I 8 is also formed particularly in accordance with the invention, and may include two drain notches 24 cut into the conical enlargement and aligned with the irrigation passages 23.

A closure member or cover 2B may be provided for the conical opening I9, and this cover may be guided for axial movement with respect to the bore I8 by a shaft 21 adapted to slide along the circular guide portions 22 of the bore I8. The upper surface of the cover 26 may be concave if desired to conform with the concave surface I3, or may be flat as illustrated in Fig. 2. In any event, the shape of the cover 2B should be such that it forms a smooth contact with the cup portion l l when it is in a closed condition, as shown in Fig. 2, so that there will be no irritating projections or lines, the surface being smooth and broken only by the small drain passages 24.

'I'he shaft 2l of the cover 2li is preferably sufficiently long to extend into the counterbore 2.! formed on the lower end of the stem I2. The lower end of the shaft 2T may be provided with coupling means such as threads 28 adapted to be engaged by a complementary coupling 23 formed upon and constituting the upper part of a manipulating handle 3l by which the pessary and valve assembly may be inserted into or removed from its position within the vaginal cavity and by which irrigation through the handle and pessary may be obtained.

The handle 3| is preferably constructed as an elongated tubular member having a bore 32 extending from its lower end to a position immediately below the coupling 29. The bore 32 constitutes a fluid passage which communicates with the counterbore 2l in any suitable manner, as by means of a plurality of angularly extending ports 33. The ports 33 are preferably formed with their outer ends immediately adjacent the coupling 29 in a tapered surface 34 formed on the upper end of the handle 3| about the coupling 29. This tapered surface Sli accordingly may seat against the lower end of the body stem I2 which may have a corresponding tapered surface 36, if desired. Irrigating fluids may be supplied by any desired mechanism, such as a syringe 3l threaded into the lower end of the handle 3I.

Referring now particularly to Figs. 3 and 5, it will be noted that the shaft 2 that guides the cover 25 may be provided with a lug 38 along one side thereof, and further that this lug may be of a size to fit within one of the irrigatng passages 23. Accordingly the shaft 2l may .be locked against rotation when the lug 38 is disposed within one of the irrigating passages 23 as shown in Fig. 2. This lock renders the shaft 21 stationary, which permits the threading and unthreading of the manipulating handle 3l. Further, the lug 3S, by engaging the top part of the circular portions 22 of the bore it, may act to hold the cover 25 in a raised position, as shown in Fig. 3. The length of the lug 38 and the length of the shaft 2l are preferably such that when the lug may be thus used to maintain the cover 23 in a raised position, the tapered surface 35 of the handle 3l will be seated to form a fluidtight engagement with the pessary I0.

When it is desired to insert the pessary into the vagina, the handle SI may be assembled thereto by threadedly engaging the lower end of the cover shaft 2. The shaft will be restrained against rotation during this threading operation by the lug 38 tting within one of the irrigatin'g passages 23. When the threaded coupling is made, the handle 3| may be positioned upwardly against the pessary I0 until the tapered surface 34 abuts against the lower end of the pessary Iii, and the two thereafter move as a unit. The pessary is then moved to its proper location, for example that shown in Fig. l, and the handle may then be rotated so that the lug 38 will flt within one of the passages 23 and the handle 3l may then be withdrawn outwardly, causing the cover 26 to close. The lug 38 will hold the shaft 2l against rotation, and the handle 3I may then be unthreaded from the shaft.

Thus the pessary l0 may be positioned with a relatively simple movement, and the manipulating handle 3l may be detached therefrom. The walls of the vagina I6 will tend to engage the under surfaces of the pessary closely and fit within the concavity Il on its lower surfaces. This tends to give great support to the pessary, holding it tightly against the cervix I4 so that the uterus as a whole may be properly supported.

While the pessary is retained within the body, drainage of the usual secretions is accomplished in a normal manner because the passages 24 always remain open. Accordingly the secretions may pass down the passages 24 and into the irrigating passages 23 and out the counterbore 2|. The pessary therefore offers no obstacle to normal drainage while it is performing its vital support function. The provision of a drainage means in the pessary also tends to reduce the cementing effect of secretions, which effect is normally present, and tends to cause the tissues of the cervix or uterus to adhere tightly to the concave upper surface I8 and to the upper surface of the cover 2E.

If it is desired to supply irrigating fluids to the -cervix and 4the adjoining vaginal cavity, the handle 3| may be re-attached to the pessary l0 by threadedly engaging the. shaft 2l. The syringe 31 may then be secured to the lower end of the handle 3|. The assembly of the handle 3| and syringe 3l may next be moved upwardly, lifting the cover 26 and at the same Vtime forming a seal at the tapered surface 34. The irrigating fluids may then be forced through the bore 32 in the handle 3|, thence through the ports 3 3 into the counterbore 2| and-up the irrigating passages 23 to the upper surface of the cup shape i3. rlfhese irrigating fluids may be allowed to drain Vout immediately by maintaining the cover 2G in a raised condition as shown in Fig. 3, or they may be allowed to drain out slowly by closing the cover 25 and restricting the opening to the drain passages 24 only. This irrigating action may be facilitated by rotating the cover 25 slightly until the lug 38 holds itin the extended position as shown in Fig. 3. From the foregoing it is evident that a pessary made in accordance with the invention may permit irrigation of the vagina and cervix without removal of the pessary.

If it is desired to remove the pessary, as is necessary for inspection purposes, it is desirable that the adhesion between the pessary and the surrounding tissues be broken, since otherwise the withdrawal of the pessary would tend to pull the cervix I4 downwardly and thus undo any benefits obtained by having the pessary in posi-- tion. Accordingly, therefore, the handle 3| may be threadedly attached to the stem 2l and the cover 25 may be moved upwardly as shown in Fig. 3. rlhis upward movement raises the ad joining tissues of the cervix, breaking them free from contact with the cup-shaped portion i3 of the pessary. The contact of the cervix with the cover 25 may be broken by rotating the cover 26 when in this raised condition. The shaft 2l may then be rotated until the lug 38 again aligns with an irrigating passage 23 and drops therein. The entire pessary It may then be rotated to break any possible remaining adhesion between the pessary and the surrounding tissues. The entire pessary may then be removed by a downward movement of the handle 3| and the cover 2B engaging the conical enlargement i9 moves the entire pessary.

The passages 24 also permit the utilization of a novel procedure for breaking adhesions; namely the use of fluid or hydraulic pressure. If it is desired to remove the pessary, for example to permit examination, the handle 3| and the syringe 31 may be attached as previously described in connection with the irrigating operation. The syringe may then be operated by maintaining contact between the vagina and the handle, and forcing fluid into the vagina, Part of this fluid will work upwardly through the passages 24 to develop a pressure between the tissue and the pessary. This pressure will break adhesions and accordingly this procedure may be used independently or in combination with the mechanical technique for breaking adhesions.

From the foregoing description of a presently preferred embodiment of the invention it is obvious that the improvement provides natural drainage for pessaries of the type having movable and rotatable covers. Additionally, the passages permit the flow of air through the pessary in the event that the cover becomes closed during insertion of the pessary into the vagina. Further, the passages make possible the use of rrigating fluid that may be used to break adhesions by fluid pressure developed between the pessaryand the adhering tissue. Also, the present invention results in a more favorable shape of pessary cup portion, allowing it to be more securely engaged by the vaginal tissues and thus perform more effectively its purpose of holding the uterus in its normal position.

Any suitable material may be used for forming the pessary, and at present a plastic molding is preferred. Methyl methacrylate has proved quite satisfactory, particularly since it is light in weight. A cup diameter of about two inches has been found satisfactory, with a stem length of a Corresponding dimension.

Although theinvention has been described with reference to a presently preferred embodiment thereof, it willbe apparent to those skilled in the art that various modifications and substitutions may be made in this structure without departing from the true spirit and scope of the invention. For example, various thicknesses of cup portion for .the pessary could be used and still eifectively employ the concavity l1. Likewise different shapes of cover 25 could well be employed without departing from the teaching of forming permanent drain apertures. Also it is obvious that the drain apertures could be separately drilled holes and are not necessarily notches in a conical enlargement of a bore. Accordingly the invention is not limited to the specific description, nor otherwise, except by the terms of the following claims.

What is claimed is:

l. A. pessary comprising a body terminating in a cup shape, a bore extending through the body and opening into the cup shape, a shaft disposed within the bore and defining irrigation passages between it and the bore, a cover secured to the upper end of the shaft and adapted to close the opening of the -bore into the cup shape, and notches formed in the bore adjacent to the Cup shape to denne permanent drain passages communicating the cup shape with the irrigation passages in all positions of said cover.

2. A pessary comprising a body having a cupshaped portion of large diameter and a lower stem of relatively small diameter and having a thick bead formed on the outer edge of the cup shape so that an annular concave surface is formed on the lower surface of the cup shape adjacent to the stem, a bore passing through the stem and opening conically outwardly into the cup-shaped portion and having circular guide portions along the length thereof, a shaft disposed within the bore and guided on the circular portions thereof and dening irrigation passages between it and the other portions of the bore, a conical cover secured to the upper end of the shaft and adapted to seat on the conical enlargement of the bore to substantially close the bore, and notches cut in the conical enlargementl of the bore in alignment with the irrigation pasf sages to define drain passages between the interior of the cup shape and the bore so that a communication is maintained at all times between the interior of the cup and the bore.

3. A pessary comprising a body having a cupshaped portion of large diameter concave upon its under side and having a lower stem of smaller diameter extended therefrom, a bore passing through said stem and cup-shaped portion, a valve including a head adapted to seat in said bore at said cup-shaped portion and a shaft extended through said stem and having handleengaging means at its end, cooperating means on said valve and body member to prevent rotation of said valve when seated to close said bore and to retain said valve in open position, a liquidconducting handle to conduct liquid to said bore including cooperating engaging means to engage said valve shaft with said valve in its closed position and adapted to raise it to open position, and cooperating means on said handle and on said body member to close the lower end of said bore with said valve raised, characterized in that said cooperating means on said valve and body member function, when retaining said valve in open position, to hold said last-mentioned cooperating means in their non-closing relationship.

4. A pessary comprising an enlarged disc-like body formed with a thickened rounded rim and with apposed concave sides, an integral stem of lesser size than said body extending centrally o from one side thereof, said body and said stem being formed with a continuous bore, a headed lvalve including a shaft positioned in said bore and a head adapted to close said bore at the side of said body spaced from said stem, passage means connecting said bore with the concave side of said body spaced from said stem and at a point spaced from said valve to provide for uninterrupted drainage and to prevent the creation of a vacuum in all positions of said Valve, said shaft being slidable in said stem to open and close said bore, and means to prevent the rotation of said valve in its closed position but offering no opposition thereto with said valve in its open position.

GLENN L. DE BRAY.

ATWILL MORGAN.

REFERECES CITED The following references are of record in the le of this patent:

UNITED STATES PATENTS Number Name Date 3,289 White et al Sept. 24, 1843 395,008 Sharp Dec. 25, 1888 1,230,112 Carey June 19, 1917

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