MAUDE Adverse Event Report: C.R. BARD, INC. (COVINGTON) -1018233 TEGRESS URETHRAL IMPLANT; TEGRESS¿ URETHRAL IMPLANT

Catalog Number 653001

Device Problem Adverse Event Without Identified Device or Use Problem (2993)

Patient Problems Unspecified Infection (1930); Irritation (1941); Prolapse (2475); Blood Loss (2597); Foreign Body In Patient (2687); Constipation (3274)

Event Type  Injury  

Manufacturer Narrative

The sample was not returned.The finished product met all specifications prior to being released for general distribution.The instructions for use which accompanies all devices currently addresses potential risks associated with surgically implanted materials.The instructions for use states in the adverse events: ¿the tegress¿ urethral implant clinical trial involved 374 tegress¿ implant treatment injections in 174 subjects (mean follow-up of approximately 14 months).There were no deaths among study patients.The following table lists the treatment related adverse events reported during the clinical study (incidence >2%).Treatment related events are those events that were deemed to be related to either the device or the procedure.All genitourinary events were classified as treatment related.Number (%) subjects reporting treatment related adverse events event category tegress¿ implant (n=174) urinary tract infection (uti) 50 (29%) delayed voiding 32 (18%) dysuria 31 (18%) exposed material 28 (16%) urinary urgency 24 (14%) urinary frequency 22 (13%) genitourinary (infection, tenderness) 20 (11%) hematuria 19 (11%) urge incontinence 16 ( 9%) worsening of incontinence (onset of urge) 14 ( 8%) outlet obstruction 13 ( 7%) pain at injection site 13 ( 7%) pelvic pain 13 ( 7%) yeast infection 12 ( 7%) leakage of urine/stress incontinence 9 ( 5%) bulking material injected into bladder 7 ( 4%) fatigue 3 ( 2%) abnormal urinalysis 3 ( 2%) bladder fullness 3 ( 2%) nocturia 3 ( 2%) pelvic heaviness 3 ( 2%) uterine fibroids 3 ( 2%) other (<2%)* 38 (n/a)* other treatment related adverse events in tegress¿ urethral implant patients, occurring at frequencies of < 2%, were as follows (listed alphabetically): abdominal upset, bladder spasms, bladder stones, body aches, burning pain, cold and shivering, cyst, cystitis, feeling of decreased sensation with urination, feeling of bladder not emptying, felt faint during bulking injection, fever, garlic odor, genital pain, kidney stones, labia with erythema, lower back pain, medicinal smell to urine, nausea, partial urinary retention due to dementia, pyuria, removal of tegress¿ implant, urethral burning sensation, urethral irritation, urethral redness, urethral soreness, urethral spasm, vaginal bleeding, and vulvar burning.Most treatment related adverse events occurred within 24 hours of treatment and subsequently resolved within 30 days.At the time of database closure, 92% of treatment related adverse events were resolved.The following events were persistent or resolution was unconfirmed at the time of database closure (the number of events is shown in parentheses): urge incontinence (6); leakage of urine/stress incontinence (5); worsening of incontinence (onset of urge) (5); exposed material (4); uterine fibroids (3); urinary tract infection (2); urinary frequency (2); urinary urgency (2) and one event each of genitourinary (infection/tenderness), kidney stones, nocturia, pelvic pain, urethral redness, and tegress¿ implant removal.Of the treatment related adverse events, 39% were classified as mild, 58% were classified as moderate, and 3% were classified as severe.The severe treatment related adverse events included: bladder spasms, bladder stones, bulking material injected into the bladder, delayed voiding, exposed bulking material, hematuria, pelvic pain, urge incontinence, and urinary frequency.The clinical study consisted of a pilot or feasibility phase (n=28), followed by the expanded study phase (n=146).There was higher overall rate of genitourinary adverse events in the feasibility phase of the study than in the expanded phase.In particular, the rate of ¿exposed material¿ was higher (32% vs.13%).This reduction in the rate of exposed material was achieved as a result of modifications to the tegress¿ implant injection instructions and investigator training.During the course of the clinical investigation (both study phases), 28 subjects (16%) receiving tegress¿ urethral implant treatment experienced exposed bulking material in the urethral mucosa.Patients experiencing exposed material often reported other events, particularly dysuria, delayed voiding, urinary tract infection, hematuria, urinary frequency, and urinary urgency.Exposed tegress¿ implant material was associated with shallow placement and injection too proximal to the bladder neck.Over time, the urethra healed spontaneously as the mucosal surface re-epithelialized.The physician may choose to remove exposed material cystoscopically with graspers or forceps to facilitate healing.The majority of patients were injected via the transurethral approach, while a small proportion of patients were injected periuretherally.There were significantly more adverse events among tegress¿ implant patients treated periuretherally; as a result, the tegress¿ urethral implant instructions for use are limited to transurethral administration.Potential adverse events: although not reported in the clinical study, other potential adverse events which may occur include erosion, erythema, embolic phenomena, and vascular occlusion." (b)(4).The information provided by bard represents all of the known information at this time.Despite good faith efforts to obtain additional information, the complainant / reporter was unable or unwilling to provide any further patient, product, or procedural details to bard.Sample not received.

Event Description

It was reported in the patient¿s medical records that as a result of having the product implanted, the patient has experienced prolapse surgery, chronic vaginal irritation, chronic infections, persistent urinary incontinence, persistent mesh exposure, urgency, dysuria, grade four cystocele, grade one rectocele, vaginal discharge, voiding dysfunction from transobturator sling, recurrent infections in her vagina and bladder most likely related to the exposed mesh, shortened urethra which may be contributing to her incontinence, cystourethrocele, recurrent urinary tract infections, extrusion of tegress material, small fleck of calculi which broke off from the area of the tegress erosion, grade two wall prolapse, grade two enterocele, large scar and deformity of vaginal wall, granulation tissue, severe vaginal prolapse, urethral hypermobility, vaginal vault prolapse, perineal separation, persistent nausea and symptoms of abdominal pain status post pelvic organ prolapse repair, retention after coaptite and intermittent lower quadrant pain.Excision of anterior vaginal wall mesh and reconstruction of the anterior vaginal wall ((b)(6) 2008).Placement of suprapubic catheter, sling procedure using soft prolene mesh, transvaginal and paravaginal repair of grade four cystocele, transvaginal repair of enterocele, vaginal vault prolapse repair, modified sacrospinal fixation and repair of rectocele using a soft prolene mesh ((b)(6) 2008).Excision of eroded posterior apical mesh, vaginal reconstruction after mesh excision ((b)(6) 2017), cystourethroscopy, multiple cystoscopies and transurethral implants of coaptite (x2) ((b)(6) 2009 and (b)(6) 2012).

Manufacturer Narrative

(b)(4).

Event Description

Per additional information received, the patient has experienced vaginal vault mesh erosion, pelvic pain, painful intercourse, vaginal bleeding (blood loss), stress urinary incontinence, diminished physical capacity, constipation, vaginal pain, intrinsic sphincter deficiency, foreign body in patient, dyspareunia, unspecified urinary problems, unspecified bowel problems and additional surgical intervention.

• Brand Name: TEGRESS URETHRAL IMPLANT
• Type of Device: TEGRESS¿ URETHRAL IMPLANT
• Manufacturer (Section D): C.R. BARD, INC. (COVINGTON) -1018233; 8195 industrial blvd; covington GA 30014
• MDR Report Key: 7183580
• MDR Text Key: 97056541
• Report Number: 1018233-2018-00108
• Device Sequence Number: 1
• Product Code: LNM
• Combination Product (y/n): N
• PMA/PMN Number: P030030 S005
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: other
• Type of Report: Initial,Followup,Followup
• Report Date: 04/12/2018

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Device Operator: Health Professional
• Device Expiration Date: 01/31/2009
• Device Catalogue Number: 653001
• Device Lot Number: 43AQH002
• Was Device Available for Evaluation?: No
• Was the Report Sent to FDA?: No
• Device Age: 23 MO
• Event Location: Hospital
• Initial Date Manufacturer Received: 12/21/2017
• Initial Date FDA Received: 01/11/2018
• Supplement Dates Manufacturer Received: 02/06/2018; 03/20/2018
• Supplement Dates FDA Received: 02/13/2018; 04/12/2018
• Is This a Reprocessed and Reused Single-Use Device?: No
• Patient Sequence Number: 1
• Patient Outcome(s): Required Intervention
• Patient Age: 64 YR
• Patient Weight: 61