US20030125768A1 - Impotence treatment apparatus with energy transforming means - Google Patents

Abstract

A male sexual impotence treatment apparatus includes or use an operable restriction device implantable in a male patient for engaging a tissue portion of the penile tissue to form a restrictable passageway for the penile exit blood flow. An energy transmission device is provided for wireless transmission of energy from outside the patient's body to inside the patient's body for use in connection with the operation of the restriction device, including temporarily contracting said tissue portion to restrict the penile exit blood flow in the blood flow passageway to achieve erection.

Description

• The present invention relates to a male sexual impotence treatment apparatus, comprising an operable restriction device implantable in an impotent patient for engaging a tissue portion of the normal penile tissue or the prolongation thereof to form a restrictable penile exit blood flow passageway.[0001]
• The expression “normal penile tissue or the prolongation thereof” should be understood to mean the penile tissue extended inside the human body and following the pathway of the blood flow leaving the penis i.e. one or more exit veins from the penis, the corpus cavernosum, crura or the prolongation thereof.[0002]
• Male sexual impotence is a widespread problem. Many different solutions to this problem have been tried. A solution currently practiced is to replace the corpus cavernosa in the penis with a hydraulic inflatable/contractable silicon prosthesis, thus implanted in the penis. In fluid connection with this prosthesis is a reservoir implanted in the scrotum. By manual pumping action the prosthesis is filled with fluid from the reservoir to effect errect penile condition or is emptied of fluid, which returns to the reservoir, to effect flaccid penile condition. However, there are several more or less severe disadvantages of this solution. Above all, the penis is more or less damaged by the operation and it is practically impossible to reverse the operation. Another disadvantage is that rather strong forces act against this implanted prosthesis resulting in a significant risk of the prosthesis being broken.[0003]
• Another solution to achieve erection is to restrict the blood flow leaving the penis. For example, U.S. Pat. Nos. 4,829,990, 4,958,630 and 5,048,511 disclose two hydraulically operated inflatable cuffs wrapped around respective crura or veins. A disadvantage of such a solution is that it involves complicated surgery. Another example on this solution is U.S. Pat. No. 4,828,544, which discloses an artificial fistula system surgically implanted and providing a primary fistula between the femoral artery and the femoral vein and a secondary fistula for leading blood from the the primary fistula to the penis. The inflatable balloon engages the primary fistula between the secondary fistula and the vein. The balloon is in fluid connection with a manually compressible reservoir implanted in the scrotum. Again, implantation of this artifical fistula system requires delicate surgery. Yet another solution is to inject a substance in the penile vein system to achieve erection. However, injections are painful and complicated for the patient.[0004]
• The object of the present invention is to provide a simple male sexual impotence treatment apparatus, which is conveniently controlled by the patient.[0005]
• This object is obtained by an apparatus of the kind stated initially characterised by an energy transmission device for wireless transmission of energy from outside the patient's body to inside the patient's body for use in connection with the operation of the restriction device, including temporarily contracting said tissue portion to restrict the penile exit blood flow in the blood flow passageway to achieve erection.[0006]
• As a result, the advantage is achieved that the impotence treatment apparatus of the invention provides simple and effective energy transmission which ensures an extended and reliable functionality of the apparatus, possibly for the rest of the patient's natural life, and at least many years.[0007]
• The restriction device preferably controls the cross-sectional area of the passageway through which blood flow leaves the penis, which gives the advantage that the patient is enabled to adjust the restriction device to acheive the desired erection without feeling pain. This advantage should not be underestimated, because fine adjustments to restrict the cross-sectional area of the passageway, will allow maximal erection with minimum of restriction.[0008]
• Generally, the apparatus comprises an energy transforming device implantable in the patient for transforming the energy wirelessly transmitted by the energy transmission device from a first form into a second form, preferably different than the first form.[0009]
• The energy transforming device may comprise at least one semiconductor type of component or a circuitry of such semiconductor components. The semiconductor component may comprise a transistor or microchip or similar electronic components. However, the semiconductor component may not comprise rectifying diodes.[0010]
• In accordance with a main embodiment of the invention, the energy transforming device comprises at least one element having a positive region and a negative region and adapted to create an energy field between the positive and negative regions when exposed to the energy of the first form transmitted by the energy transmission device, so that the energy field provides the energy of the second form. Typically, the above-mentioned semiconductor component may include such an element.[0011]
• In accordance with a preferred embodiment of the invention, the element comprises an electrical junction element capable of inducing an electric field between the positive and negative regions when exposed to the energy of the first form transmitted by the energy transmission device, whereby the energy of the second form comprises electric energy.[0012]
• Consequently, the restriction device suitably is electrically operated, whereby the positive and negative regions of the electrical junction element supply electric energy for the operation of the restriction device. The apparatus suitably comprises implantable electric conductors connected to the positive and negative regions of the electrical junction element, whereby the electrical junction element is capable of supplying an electric current, such as a direct current, a pulsating direct current, a combination of a direct and pulsating direct current, an alternating current or a combination of a direct and alternating current, via the conductors. Furthermore, the electrical junction element may be capable of supplying a frequency, amplitude, or frequency and amplitude modulated analog, digital, or a combination of analog and digital signal, which is used in connection with control of the restriction device.[0013]
• The element, preferably in the form of an electrical semiconductor junction element, should be designed to generate an output current exceeding 1 μA when exposed to the energy of the first form transmitted by the energy transmission device. Suitably the electrical junction element forms a flat and thin sheet and has a volume of less than 2000 cm[0014]³to be suited for subcutaneous implantation, so that the electrical junction element can be located just behind the skin of the patient. Alternatively, it would be possible to implant the element in the thorax or cephalic region of the patient, or in an orifice of the patient's body and under the mucosa or intraluminar outside the mucosa of the orifice. Of course, all the components of the energy transforming device including the electrical junction element in contact with the patient's body should be of biocompatible material.
• For in vitro appliances, a particular type of an electrical semiconductor junction element has been commonly used, namely a so-called p-n (positive/negative) junction element, typically in the form of solar cells. A solar cell transfers solar energy in the form of visible light into electric energy in the form of direct current. For example, a p-n junction element may comprise two layers of semiconductor, one p-type (positive) and the other n-type (negative), sandwiched together to form a “p-n junction”. This p-n junction induces an electric field across the element when absorbing quanta of light (photons).[0015]
• To be more precise, the quanta of light transfer their energy to some of the semiconductor's electrons, which are then able to move about through the material. For each such negatively charged electron, a corresponding positive charge—a “hole”—is created. In an ordinary semiconductor, these electrons and holes recombine after a short time and their energy is wasted as heat. However, when the electrons and holes are swept across the p-n junction in opposite directions by the action of the electric field, the separation of charge induces a voltage across the p-n junction element. By connecting the p-n junction element to an external circuit, the electrons are able to flow thereby creating a current.[0016]
• Surprisingly, it has been proved that although both the skin and subcutis absorb energy from an external light beam directed against the skin portion behind which a properly designed p-n junction element is located, the light energy transmitted through the skin can induce a current from the p-n junction element strong enough (minimum 1 μA) to enable the operation of the electrically operated restriction device. Thus, such a p-n junction element is now for the first time used for in vivo applications.[0017]
• The apparatus may comprise an implantable pulse generator for generating electrical pulses from the energy of the second form produced by the energy field.[0018]
• Generally, the energy transforming device is adapted to transform the energy of the first form directly or indirectly into the energy of the second form.[0019]
• In accordance with a preferred embodiment of the invention, the energy of the second form comprises electric energy and the energy transforming device comprises a capacitor, which may be adapted to produce electric pulses from the transformed electric energy. Preferably, the capacitor may be adapted to produce the pulses as the energy transforming device transforms the energy of the first form transmitted by the energy transmission device into the electric energy of the second form. The capacitor should be small to facilitate implantation thereof; i.e. its capacity may not be more than 0,1 μF.[0020]
• The apparatus may comprise an implantable stabiliser for stabilising the energy of the second form. Where the energy of the second form comprises electric current the stabiliser may comprise at least one capacitor of the type described above.[0021]
• In most embodiments of the invention, the apparatus comprises implantable electrical components. Where the electrical components include a capacitor of the type described above or an accumulator, at least one, preferably a single, voltage level guard may advantageously be provided, wherein the charge and discharge of the capacitor or accumulator is controlled by use of the voltage level guard. As a result, there is no need for any implanted current detector and/or charge level detector for the control of the capacitor, which makes the apparatus simple and reliable.[0022]
• In a particular embodiment of the invention, the wireless energy of the first form comprises sound waves and the energy of the second form comprises electric energy, wherein the energy transforming device is adapted to directly transform the sound waves into electric energy.[0023]
• The apparatus may comprise an implantable motor or pump for operating the restriction device, wherein the motor or pump is powered by the transformed energy.[0024]
• In accordance with a main aspect of the invention, the energy transmission device may be adapted to transmit wireless energy for direct use in connection with the operation of the restriction device, as the wireless energy is being transmitted. The advantage of directly using energy as it is transmitted is that the apparatus can be of a very simple design and the few components involved makes the apparatus extremely reliable. For example, the energy transmission device may be adapted to directly power the motor or pump with wireless energy. The wireless energy may comprise a magnetic field or electromagnetic waves, suitably in the form of a signal, for direct power of the motor or pump. All the various functions of the motor and associated components described in the present specification may be used where applicable.[0025]
• As an alternative to the above-noted main aspect of the invention, the energy transforming device may be adapted to supply the energy of the second form for direct use in connection with the operation of the restriction device, as the energy of the first form is being transformed into the energy of the second form. Consequently, the energy transforming device may be adapted to directly power the motor or pump with the energy of the second form.[0026]
• Generally, the energy transforming device directly operates the restriction device with the energy of the second form in a non-magnetic, non-thermal or non-mechanical manner.[0027]
• Where the apparatus comprises a motor, which may be adapted to directly or intermittently operate the restriction device, the energy transforming device may power the motor with the energy of the second form. Suitably, the restriction device is operable to perform a reversible function and the motor is capable of reversing said function.[0028]
• In accordance with another embodiment of the invention, the restriction device comprises a hydraulic restriction device, and the apparatus comprises an implantable pump for operating the hydraulic restriction device, wherein the energy transforming device supplies the energy of the second form for driving the pump. Preferably, the pump is not a plunger type of pump, but may comprise a peristaltic or membrane pump.[0029]
• The energy transforming device preferably is capable of generating as the energy of the second form a current exceeding 1 μA, when transferring the energy of the first form transmitted by the energy transmission device.[0030]
• The apparatus may comprise an implantable adjustment device for adjusting the restriction device to change the restriction of the faecal passageway. In accordance with a first alternative the adjustment device is adapted to mechanically adjust the restriction device. In accordance with a second alternative the adjustment device is adapted to hydraulically adjust the restriction device by using implanted hydraulic means. Such hydraulic means may not use hydraulic fluid of the kind having a viscosity that substantially increases when exposed to heat or a magnetic field.[0031]
• The apparatus of the present invention is not limited to the use of visible light for the wireless transmission of energy. Thus, in accordance with a broad aspect of the invention, the energy transmission device transmits energy by at least one wireless signal, preferably containing radiant energy.[0032]
• The wireless signal may comprises a wave signal, for example an electromagnetic wave signal, such as an infrared light signal, a visible light signal, an ultra violet light signal, a laser signal, a micro wave signal, a radio wave signal, an x-ray radiation signal, and a gamma radiation signal. Where applicable, one or more of the above signals may be combined. Alternatively, the wave signal may comprise a sound wave signal, such as an ultrasonic signal. Generally, the wireless signal may comprise a digital, analog or a digital and analog signal.[0033]
• The energy of the first form transmitted by the energy transmission device may comprise an electric or magnetic field transmitted in pulses, for example digital pulses. Furthermore, the energy transforming device may transform the energy of the first form, which may comprise polarised energy, into a direct current, pulsating direct current, a combination of a direct and pulsating direct current, an alternating current or a combination of a direct and alternating current. Alternatively, the energy of the first form may comprise kinetic energy.[0034]
• The energy of the second form may comprise a frequency, amplitude or frequency and amplitude modulated analog, digital or combined analog and digital signal.[0035]
• The restriction device may be non-inflatable, i.e. with no hydraulic fluid involved for the adjustments of the restriction device. This eliminates problems with fluid leaking from the restriction device.[0036]
• The apparatus suitably comprises implantable electric conductors connected to the energy transforming device, whereby the energy transforming device is capable of supplying an electric current, such as direct current, a pulsating direct current, a combination of a direct and pulsating direct current, an alternating current or a combination of a direct and alternating current, via the conductors. Furthermore, the energy transforming device may be capable of supplying a frequency, amplitude, or frequency and amplitude modulated analog, digital, or a combination of analog and digital signal, which is used in connection with control of the restriction device.[0037]
• In accordance with a main embodiment of the invention, the apparatus comprises an implantable operation device for operating the restriction device and a control device for controlling the operation device, wherein the energy transforming device powers the operation device with the energy of the second form. The operation device preferably comprises a motor, for example an electric linear motor or an electric rotary motor that is controlled by the control device to rotate a desired number of revolutions. Optionally, an implantable gearing may be connected to the motor. The electric motor may have electrically conductive parts made of plastics. Alternatively, the motor may comprise a hydraulic or pneumatic fluid motor, wherein the control device controls the fluid flow through the fluid motor. Motors currently available on the market are getting smaller and smaller. Furthermore, there is a great variety of control methods and miniaturised control equipment available. For example, the number of revolutions of a rotary motor may be analysed by a Hall-element just a few mm in size.[0038]
• In accordance with another embodiment of the invention, the restriction device comprises hydraulic means and the operation device is adapted to conduct a hydraulic fluid in the hydraulic means. The operation device comprises a fluid conduit connected to the hydraulic means of the restriction device, and a reservoir for fluid, wherein the reservoir forms part of the conduit. The reservoir may form a fluid chamber with a variable volume, and the operation device may be adapted to distribute fluid from the chamber to the hydraulic means of the restriction device by reduction of the volume of the chamber and to withdraw fluid from the hydraulic means to the chamber by expansion of the volume of the chamber. The operation device suitably comprises an implantable motor used for reducing and expanding the volume of the chamber. Also, the operation device may comprise a pump for pumping the hydraulic fluid in the hydraulic means of the restriction device. All of the hydraulic components involved are preferably devoid of any non-return valve. This is of great advantage, because with valves involved there is always a risk of malfunction due to improperly working valves, especially when long time periods passes between valve operations.[0039]
• The control device may be adapted to reverse the operation device by shifting polarity of the energy of the second form. Where the operation device comprises an electric motor the energy of the second form suitably comprises electric energy.[0040]
• In accordance with yet another embodiment of the invention, the restriction device is operable to perform a reversible function, such as enlarging and restricting the blood flow passageway, and there is a reversing device implanted in the patient for reversing the function performed by the restriction device. Such a reversing function preferably involves enlarging and restricting the blood flow passageway by the restriction device, suitably in a stepless manner. In this connection, the control device suitably controls the reversing device, which may include a switch, to reverse the function performed by the restriction device. The reversing device may comprise hydraulic means including a valve for shifting the flow direction of a fluid in the hydraulic means. Alternatively, the reversing device may comprise a mechanical reversing device, such as a switch or a gearbox.[0041]
• Where the reversing device comprises a switch it may be operable by the energy of the second form. In this case, the control device suitably controls the operation of the switch by shifting polarity of the energy of the second form supplied to the switch. The switch may comprise an electric switch and the source of energy may supply electric energy for the operation of the switch.[0042]
• In accordance with an advantageous embodiment of the invention, the apparatus further comprises an energy storage device implanted in the patient for storing the energy of the second form and for supplying energy in connection with the operation of the restriction device. The implanted energy storage device preferably comprises an electric source of energy, such as an accumulator, a rechargeable battery or a combination of an accumulator and rechargeable battery.[0043]
• The apparatus may further comprise a switch implantable in the patient for switching the operation of the restriction device and a source of energy implantable in the patient. This embodiment is particularly suited for applications where the energy transmission efficiency of the apparatus is insufficient, i.e. where the implanted restriction device is to perform more advanced operations. Such a source of energy preferably is a battery. Alternatively, the source of energy is an accumulator that also may store the energy of the second form.[0044]
• In accordance with a first alternative, the switch is operated by the energy of the second form supplied by the energy storage device to switch from an off mode, in which the source of energy is not in use, to an on mode, in which the source of energy supplies energy for the operation of the restriction device. In this case, the implanted source of energy may comprise a battery, preferably having a lifetime of at least 10 years, or an accumulator. However, other kinds of sources are also conceivable, such as a nuclear source of energy or a chemical source of energy (fuel cells).[0045]
• In accordance with a second alternative, the apparatus further comprises a remote control for controlling the supply of energy of the implanted source of energy, wherein the switch is operated by the energy of the second form supplied by the energy storage device to switch from an off mode, in which the remote control is prevented from controlling the source of energy and the source of energy is not in use, to a standby mode, in which the remote control is permitted to control the source of energy to supply energy for the operation of the restriction device.[0046]
• In accordance with a third alternative, the energy storage device is omitted, wherein the switch is operated by the energy of the second form supplied by the energy transforming device to switch from an off mode, in which the remote control is prevented from controlling the source of energy and the source of energy is not in use, to a standby mode, in which the remote control is permitted to control the source of energy to supply energy for the operation of the restriction device.[0047]
• In accordance with a fourth alternative, also the remote control is omitted, wherein the switch is operated by the energy of the second form supplied by the energy transforming device to switch from an off mode, in which the source of energy is not in use, to an on mode, in which the source of energy supplies energy for the operation of the restriction device. Where applicable, in the described embodiments the switch may switch when the energy transmission device is transmitting wireless energy, preferably while the transferred energy of the second form is stabilised by an implanted capacitor, which may temporarily (for a few seconds) store the energy of the second form.[0048]
• In the above noted third and fourth alternatives, the energy transmission device may be substituted for the energy transforming device, whereby the switch is operated by the energy of the first form.[0049]
• The switch mentioned above may comprise an electronic switch or, where applicable, a mechanical switch.[0050]
• The advantage of using a switch above all is increased control safety; i.e. interfering signals in the patient's surroundings cannot affect the implanted restriction device. Furthermore, the lifetime of the implanted source of energy will be significantly prolonged, since the energy consumption of the apparatus will be reduced to a minimum. During the above-mentioned standby mode, the remote control uses energy from the implanted source of energy. By means of the energy transmission device energy may be transmitted to activate the switch to connect the implanted source of energy only when energy is required in connection with the operation of the restriction device.[0051]
• All of the above embodiments may be combined with at least one implantable sensor for sensing at least one physical parameter of the patient, wherein the control device may control the restriction device in response to signals from the sensor. Advantageously, the sensor may sense ejaculation, and the restriction device may release said tissue portion in response to the sensor sensing ejaculation.[0052]
• The control device may comprise an internal control unit implantable in the patient for, preferably directly, controlling the restriction device in response to signals from the sensor. In response to signals from the sensor, for example signals related to pressure, the patient's position or any other important physical parameter, the internal control unit may send information thereon to outside the patient's body. The control device may also automatically control the restriction device in response to signals from the sensor. For example, the control device may control the restriction device to further restrict the blood flow passageway in response to the sensor sensing that the patients blood flow and blood pressure are increasing, or enlarge the blood flow passageway in response to the sensor sensing an abnormally high pressure against the restriction device or sensing ejaculation.[0053]
• Alternatively, the control device may comprise an external control unit outside the patient's body for, suitably directly, controlling the restriction device in response to signals from the sensor. The external control unit may store information on the physical parameter sensed by the sensor and may be manually operated to control the restriction device based on the stored information. In addition, there may be at least one implantable sender for sending information on the physical parameter sensed by the sensor.[0054]
• An external data communicator may be provided outside the patient's body and an internal data communicator may be implanted in the patient for communicating with the external communicator. The internal communicator may feed data related to the patient, or related to the restriction device, back to the external communicator. Alternatively or in combination, the external communicator may feed data to the internal communicator. The internal communicator may suitably feed data related to at least one physical signal of the patient.[0055]
• The apparatus may further comprise an implantable programmable control unit for controlling the restriction device, preferably over time in accordance with an activity schedule program. This will advance the apparatus and make possible an adaptation of the apparatus to the individual patients.[0056]
• Many of the above embodiments are suitably remote controlled. Thus, the apparatus advantageously comprises a wireless remote control transmitting at least one wireless control signal for controlling the restriction device. With such a remote control it will be possible to adapt the function of the apparatus to the patient's need. The control signal may comprise a frequency, amplitude or frequency or amplitude modulated signal. Furthermore, the control signal may comprise an analog or a digital signal, or a combination of an analog and digital signal.[0057]
• The wireless remote control may be capable of obtaining information on the condition of the implanted restriction device and of controlling the restriction device in response to the information. Also, The remote control may be capable of sending information related to the restriction device from inside the patient's body to the outside thereof.[0058]
• In a particular embodiment of the invention, the wireless remote control comprises at least one external signal transmitter or transceiver and at least one internal signal receiver or transceiver implantable in the patient. In another particular embodiment of the invention, the wireless remote control comprises at least one external signal receiver or transceiver and at least one internal signal transmitter or transceiver implantable in the patient.[0059]
• The wireless remote control may transmit a carrier signal for carrying the control signal, wherein the carrier signal is frequency, amplitude or frequency and amplitude modulated. The carrier signal may also comprise digital, analog or a combination of digital and analog signals. Such signals may comprise wave signals. Also the control signal used with the carrier signal may be frequency, amplitude or frequency and amplitude modulated, and be digital, analog or combined digital and analog.[0060]
• The control signal may comprise a wave signal, for example, a sound wave signal, such as an ultrasound wave signal, an electromagnetic wave signal, such as an infrared light signal, a visible light signal, an ultra violet light signal, a laser signal, a micro wave signal, a radio wave signal, an x-ray radiation signal, or a gamma radiation signal. Where applicable, two or more of the above signals may be combined.[0061]
• The control signal may be digital or analog, and may comprise an electric or magnetic field. Suitably, the wireless remote control may transmit an electromagnetic carrier wave signal for carrying the digital or analog control signal. For example, use of an analog carrier wave signal carrying a digital control signal would give safe communication. The control signal may be transmitted in pulses by the wireless remote control.[0062]
• The energy transmission device may function different from or similar to the energy transforming device. For example, the energy transmission and transforming devices function differently when the energy transmission device comprises a coil used for transmitting the energy of the first form and the energy transforming device comprises an electrical junction element for transforming the transmitted energy into the energy of the second form. The energy transmission and transforming devices function similar to each other when the energy transmission device comprises a coil used for transmitting the energy of the first form and the energy transforming device also comprises a coil for transforming the transmitted energy into the energy of the second form.[0063]
• In accordance with an alternative embodiment of the invention, the apparatus comprises an activatable source of energy implantable in the patient, wherein the source of energy is activated by wireless energy transmitted by the energy transmission device, to supply energy which is used in connection with the operation of the restriction device.[0064]
• The implantable restriction device suitably is embedded in a soft or gel-like material. For example, a silicone material having hardness less than 20 Shore.[0065]
• All the above described various components, such as the motor, pump and capacitor, may be combined in the different embodiments where applicable. Also the various functions described in connection with the above embodiments of the invention may be used in different applications, where applicable.[0066]
• All the various ways of transferring, transforming and controlling energy presented in the present specification may be practised by using all of the various components and solutions described.[0067]
• The present invention also provides methods for implanting the apparatus of the invention, and for treating impotence.[0068]
• Accordingly, there is provided an implanting method, comprising the steps of: providing an impotence treatment apparatus as described above, cutting an opening in a patient's mucosa in the orifice of the patient's body, and implanting the energy transforming means in the patient's body through the opening. Alternatively, the cutting step may comprise cutting the opening in the patient's skin and the implanting step may comprise implanting the energy transforming means in the patient's body through the opening.[0069]
• There is also provided a laparascopical implanting method, comprising the steps of: providing the impotence treatment apparatus as desribed above, placing at least two laparascopic cannula within a patient's body, and implanting the energy transforming means in the patient's body by using the at least two laparascopic cannula.[0070]
• In accordance with another alternative there is provided a laparascopical surgical method of implanting the impotence treatment apparatus, comprising the steps of: a) Providing the impotence treatment apparatus as desribed above. b) Placing at least two laparoscopic trocars within the patient's body. c) Using a dissecting tool inserted through the laparoscopic trocars, dissecting the region of the penile tissue or the prolongation thereof. d) Introducing the operable restriction device of the apparatus through the trocars. e) Placing the restriction device in engagement with the penile tissue or the prolongation thereof to create a stoma through which blood flow leaves the penis. And f) implanting the energy transforming means of the apparatus in the patient for transforming wireless energy into energy of a form suited for operating the restriction device to reduce the stoma to restrict the blood flow therethrough. The method as recited in (a)-(f) may further comprise adjusting the reduced stoma in a non-invasive procedure.[0071]
• There is also provided a method of treating an impotent male comprising: (a) Surgically implanting in a male patient a restriction device engaging the male's penile tissue or the prolongation thereof to form a restrictable passageway in which blood flow leaves the penis. (b) Surgically implanting in the male the operation device which can adjust the restricted passageway in response to supplied energy. And (c) in a non-invasive post-operative procedure, from time to time, supplying energy to the operation device so as to restrict the passageway to reduce the blood flow leaving the male's penis to achieve erection. In the method (c) may be practised by the patient whenever he desires.[0072]
• The invention is described in more detail in the following with reference to the accompanying drawings, in which[0073]
• FIGS.[0074]1 to12 are schematic block diagrams illustrating twelve embodiments, respectively, of the male sexual impotence treatment apparatus of the invention, in which wireless energy is transmitted from outside a patient's body to energy consuming components of the apparatus implanted in the patient;
• FIG. 13 is a schematic block diagram illustrating conceivable combinations of implanted components for achieving various communication options;[0075]
• FIG. 14 illustrates an electrical junction element for use in the apparatus of the present invention; and[0076]
• FIG. 15 illustrates the apparatus in accordance with the invention implanted in a patient.[0077]
• FIG. 16 is a block diagram illustrating remote control components of an embodiment of the invention, in which wireless energy is transmitted by the use of electromagnetic signals; and[0078]
• FIG. 17 is a schematic view of exemplary circuitry used for the components of the block diagram of FIG. 16.[0079]
• Referring to the drawing figures, like reference numerals designate identical or corresponding elements throughout the several figures.[0080]
• FIG. 1 schematically shows a very simple embodiment of the impotence apparatus of the invention having some parts implanted in a patient and other parts located outside the patient's body. Thus, in FIG. 1 all parts placed to the right of the patient's[0081]skin2 are implanted and all parts placed to the left of theskin2 are located outside the patient's body.
• The apparatus of FIG. 1 comprises an implanted[0082]operable restriction device4, which engages penile tissue or the prolongation thereof to form a restrictable passageway for blood flow leaving the penis. Therestriction device4 is capable of performing a reversible function, i.e. to enlarge and restrict the passageway, so that therestriction device4 works as an artificial sphincter. The implantedenergy transforming means6 is adapted to supply energy consuming components of therestriction device4 with energy via a power supply line12. The external energy transmission means10 includes a wireless remote control transmitting a wireless signal which is received by a signal receiver incorporated in the implantedenergy transforming means6. The implantedenergy transforming means6 transforms energy from the signal into electric energy which is supplied via the power supply line12 to therestriction device4, which energy causes portions of thedevice4 to move and thus adjust the opening.
• FIG. 2 shows an embodiment of the invention identical to that of FIG. 1, except that a reversing device in the form of an electric switch[0083]14 also is implanted in the patient for reversing therestriction device4. The wireless remote control of the external energy transmission means10 transmits a wireless signal that carries energy and the implantedenergy transforming means6 transforms the wireless energy into a current for operating the switch14. When the polarity of the current is shifted by theenergy transforming means6 the switch14 reverses the function performed by therestriction device4.
• FIG. 3 shows an embodiment of the invention identical to that of FIG. 1, except that the operation device in the form of a[0084]motor15 for operating therestriction device4 also is implanted in the patient. Themotor15 is powered with energy from theenergy transforming means6, as the remote control of the external energy transmission means10 transmits a wireless signal to the receiver of theenergy transforming means6.
• FIG. 4 shows an embodiment of the invention identical to that of FIG. 1, except that an[0085]assembly16 including a motor/pump unit18 and afluid reservoir20 also is implanted in the patient. In this case therestriction device4 is hydraulically operated, i.e. hydraulic fluid is pumped by the motor/pump unit18 from thereservoir20 through a conduit22 to therestriction device4 to restrict the passageway, and hydraulic fluid is pumped by the motor/pump unit18 back from therestriction device4 to thereservoir20 to enlarge the cross-sectional area. The implantedenergy transforming means6 transforms wireless energy into a current, for powering the motor/pump unit18 via the electric power supply line24.
• FIG. 5 shows an embodiment of the invention comprising the external energy transmission means[0086]10 with its wireless remote control, therestriction device4, in this case hydraulically operated, and the implantedenergy transforming means6, and further comprising an implantedhydraulic fluid reservoir30, an implanted motor/pump unit32 and an implanted reversing device in the form of a hydraulicvalve shifting device34. The motor of the motor/pump unit32 is the electric motor. In response to a control signal from the wireless remote control of the external energy transmission means10, the implanted energy transforming means6 powers the motor/pump unit32 with energy from the energy carried by the control signal, whereby the motor/pump unit32 distributes hydraulic fluid between thereservoir30 and therestriction device4. The remote control of the energy transmission means10 controls the shiftingdevice34 to shift the hydraulic fluid flow direction between one direction in which the fluid is pumped by the motor/pump unit32 from thereservoir30 to therestriction device4 to reduce the passageway, and another opposite direction in which the fluid is pumped by the motor/pump unit32 back from therestriction device4 to thereservoir30 to enlarge the cross-sectional area.
• FIG. 6 shows an embodiment of the invention identical to that of FIG. 1, except that a[0087]control unit36 controlled by the wireless remote control of the external energy transmission means10, anaccumulator38 and acapacitor40 also are implanted in the patient. Thecontrol unit36 stores electric energy received from the energy transforming means6 in theaccumulator38, which supplies energy to therestriction device4. In response to a control signal from the wireless remote control of the energy transmission means10, thecontrol unit6 either releases electric energy from theaccumulator38 and transfers the released energy viapower lines42 and44, or directly transfers electric energy from the energy transforming means6 via a power line46, thecapacitor40, which stabilises the electric current, apower line48 and thepower line44, for the operation of therestriction device4.
• In accordance with one alternative, the[0088]capacitor40 in the embodiment of FIG. 6 may be omitted. In accordance with another alternative, theaccumulator38 in this embodiment may be omitted.
• FIG. 7 shows an embodiment of the invention identical to that of FIG. 1, except that a[0089]battery50 for supplying energy for the operation of therestriction device4 and anelectric switch52 for switching the operation of therestriction device4 also are implanted in the patient. Theswitch52 is operated by the energy supplied by the energy transforming means6 to switch from an off mode, in which thebattery50 is not in use, to an on mode, in which thebattery50 supplies energy for the operation of therestriction device4.
• FIG. 8 shows an embodiment of the invention identical to that of FIG. 7, except that a[0090]control unit36 controllable by the wireless remote control of the external energy transmission means10 also is implanted in the patient. In this case, theswitch52 is operated by the energy supplied by the energy transforming means6 to switch from an off mode, in which the wireless remote control is prevented from controlling thecontrol unit36 and thebattery50 is not in use, to a standby mode, in which the remote control is permitted to control thecontrol unit36 to release electric energy from thebattery50 for the operation of therestriction device4.
• FIG. 9 shows an embodiment of the invention identical to that of FIG. 8, except that the[0091]accumulator38 is substituted for thebattery50 and the implanted components are interconnected differently. In this case, theaccumulator38 stores energy from theenergy transforming means6. In response to a control signal from the wireless remote control of the external energy transmission means10, the implantedcontrol unit36 controls theswitch52 to switch from an off mode, in which theaccumulator38 is not in use, to an on mode, in which theaccumulator38 supplies energy for the operation of therestriction device4.
• FIG. 10 shows an embodiment of the invention identical to that of FIG. 9, except that the[0092]battery50 also is implanted in the patient and the implanted components are interconnected differently. In response to a control signal from the wireless remote control of the external energy transmission means10, the implantedcontrol unit36 controls theaccumulator38 to deliver energy for operating theswitch52 to switch from an off mode, in which thebattery50 is not in use, to an on mode, in which thebattery50 supplies electric energy for the operation of therestriction device4.
• Alternatively, the[0093]switch52 may be operated by energy supplied by theaccumulator38 to switch from an off mode, in which the wireless remote control is prevented from controlling thebattery50 to supply electric energy and thebattery50 is not in use, to a standby mode, in which the wireless remote control is permitted to control thebattery50 to supply electric energy for the operation of therestriction device4.
• FIG. 11 shows an embodiment of the invention identical to that of FIG. 7, except that a[0094]motor15, a mechanical reversing device in the form of a gearbox54 and acontrol unit36 for controlling the gearbox54 also are implanted in the patient. The implantedcontrol unit36 controls the gearbox54 to reverse the function performed by the restriction device4 (mechanically operated).
• FIG. 12 shows an embodiment of the invention identical to that of FIG. 10 except that the implanted components are interconnected differently. Thus, in this case the[0095]battery50 powers thecontrol unit36 when theaccumulator38, suitably a capacitor, activates theswitch52 to switch to an on mode. When theswitch52 is in its on mode thecontrol unit36 is permitted to control thebattery50 to supply, or not supply, energy for the operation of therestriction device4.
• FIG. 13 schematically shows conceivable combinations of implanted components of the apparatus for achieving various communication options. Basically, there are the implanted[0096]restriction device4,control unit36 and motor/pump unit18, and the external energy transmission means10 including the external wireless remote control. As already described above the wireless remote control transmits a control signal which is received by the implantedcontrol unit36, which in turn controls the various implanted components of the apparatus.
• A[0097]sensor56 may be implanted in the patient for sensing a physical parameter of the patient, such as the pressure in the passageway. The implantedcontrol unit36, or alternatively the external wireless remote control of the energy transmission means10, may control therestriction device4 in response to signals from thesensor56. A transceiver may be combined with thesensor56 for sending information on the sensed physical parameter to the external wireless remote control. The wireless remote control may comprise a signal transmitter or transceiver and the implantedcontrol unit36 may comprise a signal receiver or transceiver. Alternatively, the wireless remote control may comprise a signal receiver or transceiver and the implantedcontrol unit36 may comprise a signal transmitter or transceiver. The above transceivers, transmitters and receivers may be used for sending information or data related to therestriction device4 from inside the patient's body to the outside thereof.
• Where the motor/[0098]pump unit18 andbattery50 for powering the motor/pump unit18 are implanted, thebattery50 may be equipped with a transceiver for sending information on the condition of thebattery50.
• Those skilled in the art will realise that the above various embodiments according to FIGS.[0099]1-13 could be combined in many different ways. For example, the energy operated switch14 could be incorporated in any of the embodiments of FIGS.3,6-12, thehydraulic shifting device34 could be incorporated in the embodiment of FIG. 4, and the gearbox54 could be incorporated in the embodiment of FIG. 3.
• FIG. 14 shows the energy transforming means in the form of an[0100]electrical junction element58 for use in any of the above embodiments according to FIGS.1-13. Theelement58 is a flat p-n junction element comprising a p-type semiconductor layer60 and an n-type semiconductor layer62 sandwiched together. Alight bulb64 is electrically connected to opposite sides of theelement58 to illustrate how the generated current is obtained. The output of current from such ap-n junction element58 is correlated to the temperature. See the formula below.
• I=I0(exp(qV/kT)−1)
• where[0101]
• I is the external current flow,[0102]
• I[0103]0 is the reverse saturation current,
• q is the fundamental electronic charge of 1.602×10-19 coulombs,[0104]
• V is the applied voltage,[0105]
• k is the Boltzmann constant, and[0106]
• T is the absolute temperature.[0107]
• Under large negative applied voltage (reverse bias), the exponential term becomes negligible compared to 1.0, and I is approximately −I[0108]0. I0 is strongly dependent on the temperature of the junction and hence on the intrinsic-carrier concentration. I0 is larger for materials with smaller bandgaps than for those with larger bandgaps. The rectifier action of the diode, that is, its restriction of current flow to only one direction, is in this particular embodiment the key to the operation of thep-n junction element58.
• The alternative way to design a p-n junction element is to deposit a thin layer of semiconductor onto a supporting material which does not absorb the kind of energy utilised in the respective embodiments. For use with wirelessly transmitted energy in terms of light waves, glass could be a suitable material. Various materials may be used in the semiconductor layers such as but not limited to cadmium telluride, copper-indium-diselenide and silicon. It is also possible to use a multilayer structure with several layers of p and n-type materials to improve efficiency.[0109]
• The electric energy generated by the[0110]p-n junction element58 could be of the same type as generated by solar cells, in which the negative and positive fields create a direct current. Alternatively, the negative and positive semiconductor layers may change polarity following the transmitted waves, thereby generating the alternating current.
• The[0111]p-n junction element58 is designed to make it suited for implantation. Thus, all the external surfaces of theelement58 in contact with the human body are made of a biocompatible material. The p-n junction semiconductors are designed to operate optimally at a body temperature of 37° C. because the current output, which should be more than 1 μA, is significantly depending on temperature as shown above. Since both the skin and subcutis absorb energy, the relation between the sensitivity or working area of theelement58 and the intensity or strength of the wireless energy transmission is considered. Thep-n junction element58 preferably is designed flat and small. Alternatively, if theelement58 is made in larger sizes it should be flexible, in order to adapt to the patient's body movements. The volume of theelement58 should be kept less than 2000 cm³.
• FIG. 15 generally illustrates how any of the above-described embodiments of the impotence treatment apparatus of the invention may be implanted in a male patient. Thus, a[0112]restriction device4 implanted in a patient engages penile tissue or the prolongation thereof to form an artificial sphincter around the passageway through which the blood flow leaves the penis. An implantedoperation device68, which may also be referred to as an adjustment device, such as an electric motor or a motor/pump assembly, operates therestriction device4 through atransmission member70, such as a mechanical transmission cord or a fluid tube. The energy transforming means in the form of theelement6 having a positive region and a negative region, as described above in more detail, is placed underneath the skin of the patient. The external energy transmission means10 is adapted to transmit wireless energy to the implantedelement6. A wireless remote control includes an external control unit incorporated in the energy transmission means10, and an implanted control unit71 connected to theelement6 and theoperation device68.
• Wireless energy carried by a signal transmitted by the wireless remote control of the external energy transmission means[0113]10 at least partly penetrates the patient's skin and hits theelement6. The energy thus hitting theelement6 is transformed into energy of a different form that is suited for powering theoperation device68. For example, where theoperation device68 is an electric motor theelement6 comprises an electric p-n junction element that transforms the wireless energy into an electric current for powering the electric motor. Where theoperation device68 comprises a pump, theelement6 may transform the wireless energy into kinetic energy for powering the pump.
• The transformed energy may be utilised for directly operating the[0114]restriction device4 or, where therestriction device4 is electrically operated, for storage in a capacitor and/or an accumulator for later or parallel use. Preferably (but not necessarily) theelement6 is controlled by a microprocessor. The wireless remote control of the external energy transmission means10 is used to control the utilisation of the transmitted energy and any function or command to/from the implantedrestriction device4.
• FIG. 16 shows the basic parts of a wireless remote control of the apparatus of the invention including an[0115]electric motor128 for operating a restriction member, for example of the type illustrated in FIG. 15. In this case, the remote control is based on the transmission of electromagnetic wave signals, often of high frequencies in the order of 100 kHz-1 gHz, through theskin130 of the patient. In FIG. 15, all parts placed to the left of theskin130 are located outside the patient's body and all parts placed to the right of theskin130 are implanted. Any suitable remote control system may be used.
• An external[0116]signal transmitting antenna132 is to be positioned close to asignal receiving antenna134 implanted close to theskin130. As an alternative, the receivingantenna134 may be placed for example inside the abdomen of the patient. The receivingantenna134 comprises a coil, approximately 1-100 mm, preferably 25 mm in diameter, wound with a very thin wire and tuned with a capacitor to a specific high frequency. A small coil is chosen if it is to be implanted under the skin of the patient and a large coil is chosen if it is to be implanted in the abdomen of the patient. The transmittingantenna132 comprises a coil having about the same size as the coil of the receivingantenna134 but wound with a thick wire that can handle the larger currents that is necessary. The coil of the transmittingantenna132 is tuned to the same specific high frequency as the coil of the receivingantenna134.
• An[0117]external control unit136 comprises a microprocessor, a high frequency electromagnetic wave signal generator and a power amplifier. The microprocessor of thecontrol unit136 is adapted to switch the generator on/off and to modulate signals generated by the generator to send digital information via the power amplifier and theantennas132,134 to an implantedcontrol unit138. To avoid that accidental random high frequency fields trigger control commands, digital signal codes are used. A conventional keypad placed on theexternal control unit136 is connected to the microprocessor thereof. The keypad is used to order the microprocessor to send digital signals to either contract or enlarge the restriction device. The microprocessor starts a command by applying a high frequency signal on theantenna132. After a short time, when the signal has energised the implanted parts of the control system, commands are sent to contract or enlarge the restriction device in predefined steps. The commands are sent as digital packets in the form illustrated below.

  	Start pattern,	Command,	Count,	Checksum,
  	8 bits	8 bits	8 bits	8 bits

• The commands are sent continuously during a rather long time period (e.g. about 30 seconds or more). When a new contract or enlarge step is desired the Count byte is increased by one to allow the implanted[0118]control unit138 to decode and understand that another step is demanded by theexternal control unit136. If any part of the digital packet is erroneous, its content is simply ignored.
• Through a line[0119]140, an implantedenergiser unit126 draws energy from the high frequency electromagnetic wave signals received by the receivingantenna134. Theenergiser unit126 stores the energy in an energy storage device, such as a large capacitor, powers thecontrol unit138 and powers theelectric motor128 via aline142.
• The[0120]control unit138 comprises a demodulator and a microprocessor. The demodulator demodulates digital signals sent from theexternal control unit136. The microprocessor of thecontrol unit138 receives the digital packet, decodes it and, provided that the power supply of theenergiser unit126 has sufficient energy stored, sends a signal via asignal line144 to themotor128 to either contract or enlarge the restriction device depending on the received command code.
• Alternatively, the energy stored in the energy storage device of the energiser unit may only be used for powering a switch, and the energy for powering the[0121]motor128 may be obtained from another implanted energy source of relatively high capacity, for example a battery. In this case the switch is adapted to connect said battery to thecontrol unit138 in an on mode when said switch is powered by the energy storage device and to keep the battery disconnected from the control unit in a standby mode when the switch is not powered.
• With reference to FIG. 17, the remote control schematically described above will now be described in accordance with a more detailed embodiment. The[0122]external control unit136 comprises amicroprocessor146, asignal generator148 and apower amplifier150 connected thereto. Themicroprocessor146 is adapted to switch thesignal generator148 on/off and to modulate signals generated by thesignal generator148 with digital commands that are sent to implanted components of the apparatus. Thepower amplifier150 amplifies the signals and sends them to the externalsignal transmitting antenna132. Theantenna132 is connected in parallel with acapacitor152 to form a resonant circuit tuned to the frequency generated by thesignal generator148.
• The implanted signal receiving[0123]antenna coil134 forms together with a capacitor154 a resonant circuit that is tuned to the same frequency as the transmittingantenna132. The signal receivingantenna coil134 induces a current from the received high frequency electromagnetic waves and a rectifyingdiode160 rectifies the induced current, which charges astorage capacitor158. Acoil156 connected between theantenna coil134 and thediode160 prevents thecapacitor158 and thediode160 from loading the circuit of thesignal receiving antenna134 at higher frequencies. Thus, thecoil156 makes it possible to charge thecapacitor158 and to transmit digital information using amplitude modulation.
• A[0124]capacitor162 and aresistor164 connected in parallel and adiode166 forms a detector used to detect amplitude modulated digital information. A filter circuit is formed by aresistor168 connected in series with aresistor170 connected in series with acapacitor172 connected in series with theresistor168 via ground, and a capacitor174, one terminal of which is connected between theresistors168,170 and the other terminal of which is connected between thediode166 and the circuit formed by thecapacitor162 andresistor164. The filter circuit is used to filter out undesired low and high frequencies. The detected and filtered signals are fed to an implantedmicroprocessor176 that decodes the digital information and controls themotor128 via an H-bridge178 comprisingtransistors180,182,184 and186. Themotor128 can be driven in two opposite directions by the H-bridge178.
• The[0125]microprocessor176 also monitors the amount of stored energy in thestorage capacitor158. Before sending signals to activate themotor128, themicroprocessor176 checks whether the energy stored in thestorage capacitor158 is enough. If the stored energy is not enough to perform the requested operation, themicroprocessor176 waits for the received signals to charge thestorage capacitor158 before activating themotor128.

Claims (148)

1. A male sexual impotence treatment apparatus, comprising an operable restriction device implantable in an impotent patient for engaging a tissue portion of the normal penile tissue or the prolongation thereof to form a restrictable penile exit blood flow passageway, characterised by an energy transmission device for wireless transmission of energy from outside the patient's body to inside the patient's body for use in connection with the operation of the restriction device, including temporarily contracting said tissue portion to restrict the penile exit blood flow in the blood flow passageway to achieve erection.

2. An apparatus according toclaim 1, wherein the energy transmission device transmits energy of a first form and the restriction device is operable in response to energy of a second form, and further comprising an energy transforming device implantable in the patient for transforming the energy of the first form wirelessly transmitted by the energy transmission device into the energy of the second form.

3. An apparatus according toclaim 2, wherein the energy of the second form is different than the energy of the first form.

4. An apparatus according toclaim 2 or3, wherein the energy transforming device comprises at least one element having a positive region and a negative region, the element is capable of creating an energy field between the positive and negative regions when exposed to the energy of the first form transmitted by the energy transmission device, and the energy field produces the energy of the second form.

5. An apparatus according toclaim 4, wherein the element comprises an electrical junction element, and the electrical junction element is capable of inducing an electric field between the positive and negative regions when exposed to the energy of the first form transmitted by the energy transmission device, whereby the energy of the second form comprises electric energy.

6. An apparatus according toclaim 5, wherein the restriction device is electrically operated, and the positive and negative regions of the electrical junction element supply electric energy for the operation of the restriction device.

7. An apparatus according toclaim 6, further comprising electric conductors connected to the positive and negative regions of the electrical junction element, whereby the electrical junction element is capable of supplying an electric current via the conductors.

8. An apparatus according toclaim 7, wherein the electrical junction element is capable of supplying a direct current or pulsating direct current via the conductors.

9. An apparatus according toclaim 7, wherein the electrical junction element is capable of supplying an alternating current or a combination of a direct and alternating current via the conductors.

10. An apparatus according toclaim 6, wherein the electrical junction element is capable of supplying a frequency or amplitude modulated signal.

11. An apparatus according toclaim 6, wherein the electrical junction element is capable of supplying an analog or digital signal.

12. An apparatus according to any of claims2-11, wherein the energy transforming device forms a flat and thin sheet, and has a volume of less than 2000 cm³.

13. An apparatus according toclaim 2 or3, wherein the energy transforming device is adapted to transform the energy of the first form directly or indirectly into the energy of the second form.

14. An apparatus according toclaim 13, further comprising an implantable motor or pump for operating the restriction device, wherein the motor or pump is powered by the energy of the second form.

15. An apparatus according toclaim 14, wherein the energy transforming device is adapted to directly power the motor or pump by the transformed energy, as the energy of the second form is being transformed from the energy of the first form.

16. An apparatus according to any of claims13-15, wherein the wireless energy of the first form comprises sound waves and the energy of the second form comprises electric energy.

17. An apparatus according to any of claims2-16, wherein the energy transforming device comprises a capacitor and the energy of the second form comprises electric energy.

18. An apparatus according toclaim 17, wherein the capacitor is adapted to produce electric pulses from the transformed electric energy.

19. An apparatus according toclaim 18, wherein the capacitor is adapted to produce the pulses of the electric energy, as the energy transforming device transforms the energy of the first form transmitted by the energy transmission device into the electric energy of the second form.

20. An apparatus according toclaim 2, further comprising an implantable stabiliser for stabilising the energy of the second form.

21. An apparatus according toclaim 20, wherein the energy of the second form comprises electric current and the stabiliser comprises at least one capacitor.

22. An apparatus according to any of the preceding claims, further comprising implantable electrical components including at least one voltage level guard.

23. An apparatus according to any of claims1-21, further comprising implantable electrical components including a single voltage level guard.

24. An apparatus according toclaim 22 or23, wherein the electrical components are devoid of any current detector and/or charge level detector.

25. An apparatus according to any of claims22-24, further comprising an implantable capacitor or accumulator, wherein the charge or discharge of the capacitor or accumulator is controlled by use of the voltage level guard.

26. An apparatus according to any of claims17-19,21 and25, wherein the capacitor has a capacity less than 0,1 μF.

27. An apparatus according toclaim 1, wherein the energy transmission device is adapted to transmit wireless energy for direct use in connection with the operation of the restriction device, as the wireless energy is being transmitted.

28. An apparatus according toclaim 27, further comprising an implantable motor or pump for operating the restriction device, wherein the energy transmission device is adapted to directly power the motor or pump with wireless energy.

29. An apparatus according toclaim 28, wherein the energy transmission device is adapted to transmit wireless energy in the form of a magnetic field or electromagnetic waves for direct power of the motor or pump

30. An apparatus according toclaim 2, wherein the energy transforming device is adapted to supply the energy of the second form for direct use in connection with the operation of the restriction device, as the energy of the first form is being transformed into the energy of the second form.

31. An apparatus according toclaim 30, further comprising an implantable motor or pump for operating the restriction device, wherein the energy transforming device is adapted to directly power the motor or pump with the energy of the second form.

32. An apparatus according toclaim 31, wherein the energy transforming device directly operates the restriction device with the energy of the second form in a non-magnetic, non-thermal or non-mechanical manner.

33. An apparatus according to any of claims2-12, further comprising an implantable motor for direct or intermittent operation of the restriction device, wherein the energy transforming device powers the motor with the energy of the second form.

34. An apparatus according toclaim 33, wherein the restriction device is operable to perform a reversible function and the motor is capable of reversing said function.

35. An apparatus according to any of claims2-27 and30, wherein the restriction device comprises a hydraulic restriction device, and further comprising an implantable pump for operating the hydraulic restriction device, the energy transforming device supplying the energy of the second form for driving the pump.

36. An apparatus according to any of claims28,29,31 and35, wherein the pump is not a plunger type of pump.

37. An apparatus according to any of the preceding claims, wherein the energy transforming device is capable of generating as the energy of the second form a current exceeding 1 μA, when transferring the energy of the first form transmitted by the energy transmission device.

38. An apparatus according to any of the preceding claims, further comprising an adjustment device for adjusting the restriction device to change the restriction of the blood flow passageway, wherein the adjustment device is adapted to mechanically adjust the restriction device, or adapted to hydraulically adjust the restriction device by using hydraulic means which is devoid of hydraulic fluid of the kind having a viscosity that substantially increases when exposed to heat or a magnetic field.

39. An apparatus according to any of claims2-12, wherein the energy transforming device comprises at least one semiconductor type of component.

40. An apparatus according toclaim 39, wherein the energy transforming device comprises a circuitry of semiconductor components.

41. An apparatus according toclaim 39, wherein the semiconductor component comprises a transistor or microchip or similar electronic components excluding rectifying diodes.

42. An apparatus according toclaim 40 or41, wherein the semiconductor component comprises at least one element having a positive region and a negative region, the element is capable of creating an energy field between the positive and negative regions when exposed to the energy of the first form transmitted by the energy transmission device, and the energy field produces the energy of the second form.

43. An apparatus according to any of the preceding claims, further comprising an implantable operation device for operating the restriction device, wherein the energy transforming device powers the operation device with the energy of the second form.

44. An apparatus according toclaim 43, further comprising a control device for controlling the operation device.

45. An apparatus according toclaim 43 or44, wherein the operation device comprises a motor.

46. An apparatus according toclaim 33 or45, further comprising an implantable gearing connected to the motor.

47. An apparatus according to claims44 and45, wherein the motor comprises a rotary motor and the control device controls the rotary motor to rotate a desired number of revolutions.

48. An apparatus according toclaim 45, wherein the motor comprises a linear motor.

49. An apparatus according toclaim 44 and45, wherein the motor comprises a hydraulic or pneumatic fluid motor, and the control device controls the fluid motor.

50. An apparatus according toclaim 45, wherein the motor comprises an electric motor having electrically conductive parts made of plastics.

51. An apparatus according toclaim 43, wherein the restriction device comprises hydraulic means and the operation device is adapted to conduct a hydraulic fluid in the hydraulic means.

52. An apparatus according toclaim 51, wherein the operation device comprises a fluid conduit connected to the hydraulic means of the restriction device, and a reservoir for fluid, the reservoir forming part of the conduit.

53. An apparatus according toclaim 52, wherein the hydraulic means and conduit are devoid of any non-return valve.

54. An apparatus according toclaim 53, wherein the reservoir forms a fluid chamber with a variable volume, and the operation device is adapted to distribute fluid from the chamber to the hydraulic means of the restriction device by reduction of the volume of the chamber and to withdraw fluid from the hydraulic means to the chamber by expansion of the volume of the chamber.

55. An apparatus according toclaim 54, wherein the operation device comprises an implantable motor used for reducing and expanding the volume of the chamber.

56. An apparatus according to any of claims51-53, wherein the operation device comprises an implantable pump for pumping the hydraulic fluid in the hydraulic means of the restriction device.

57. An apparatus according toclaim 44, wherein the control device shifts polarity of the energy of the second form to reverse the operation device.

58. An apparatus according toclaim 45 or57, wherein the operation device comprises an electric motor and the energy of the second form comprises electric energy.

59. An apparatus according to any of claims1,43 and44, wherein the restriction device is operable to perform a reversible function.

60. An apparatus according toclaim 59, further comprising a reversing device implantable in the patient for reversing the function performed by the restriction device.

61. An apparatus according to claims44 and60, wherein the control device controls the reversing device to reverse the function performed by the restriction device.

62. An apparatus according toclaim 60 or61, wherein the reversing device comprises hydraulic means including a valve for shifting the flow direction of a fluid flow in the hydraulic means.

63. An apparatus according toclaim 60 or61, wherein the reversing device comprises a mechanical reversing device.

64. An apparatus according toclaim 63, wherein the reversing device comprises a gearbox.

65. An apparatus according toclaim 60 or61, wherein the reversing device comprises a switch.

66. An apparatus according toclaim 65, wherein the switch is operable by the energy of the second form.

67. An apparatus according toclaim 66, wherein the control device controls the operation of the switch by shifting polarity of the energy of the second form.

68. An apparatus according toclaim 66 or67, wherein the switch comprises an electric switch and the energy of the second form comprises electric energy.

69. An apparatus according toclaim 43, wherein the operation device comprises hydraulic means and at least one valve for controlling a fluid flow in the hydraulic means.

70. An apparatus according toclaim 69, further comprising a wireless remote control for controlling the valve.

71. An apparatus according to any one of claims18,19 and44, wherein the control device is adapted to control the energy transforming device to produce the energy of the second form in a train of energy pulses for direct use in connection with the operation of the restriction device.

72. An apparatus according toclaim 2, further comprising an energy storage device implantable in the patient for storing the energy of the second form and for supplying energy in connection with the operation of the restriction device.

73. An apparatus according toclaim 72, wherein the energy storage device comprises an accumulator.

74. An apparatus according toclaim 73, wherein the energy of the second form comprises electric energy and the energy storage device comprises an electric accumulator.

75. An apparatus according toclaim 74, wherein the electric accumulator comprises at least one capacitor or at least one rechargeable battery, or a combination of at least one capacitor and at least one rechargeable battery.

76. An apparatus according to any of claims2,65,71-75, further comprising a switch implantable in the patient for directly or indirectly switching the operation of the restriction device.

77. An apparatus according toclaim 76, further comprising a source of energy implantable in the patient, wherein the switch is operated by the energy of the second form supplied by the energy storage device to switch from an off mode, in which the source of energy is not in use, to an on mode, in which the source of energy supplies energy for the operation of the restriction device.

78. An apparatus according toclaim 76, further comprising a source of energy implantable in the patient, and a remote control for controlling the supply of energy of the source of energy, wherein the switch is operated by the energy of the second form supplied by the energy storage device to switch from an off mode, in which the remote control is prevented from controlling the source of energy and the source of energy is not in use, to a standby mode, in which the remote control is permitted to control the source of energy to supply energy for the operation of the restriction device.

79. An apparatus according toclaim 76, further comprising a source of energy implantable in the patient for supplying energy for the operation of the restriction device, wherein the switch is operated by the energy of the second form supplied by the energy transforming device to switch from an off mode, in which the source of energy is not in use, to an on mode, in which the source of energy supplies energy for the operation of the restriction device.

80. An apparatus according toclaim 76, further comprising a source of energy implantable in the patient for supplying energy for the operation of the restriction device, and a remote control for controlling the supply of energy of the implantable source of energy, wherein the switch is operated by the energy of the second form supplied by the energy transforming device to switch from an off mode, in which the remote control is prevented from controlling the source of energy and the source of energy is not in use, to a standby mode, in which the remote control is permitted to control the source of energy to supply energy for the operation of the restriction device.

81. An apparatus according toclaim 76, further comprising a source of energy implantable in the patient for supplying energy for the operation of the restriction device, wherein the switch is operated by the energy of the first form supplied by the energy transmission device to switch from an off mode, in which the source of energy is not in use, to an on mode, in which the source of energy supplies energy for the operation of the restriction device.

82. An apparatus according toclaim 76, further comprising a source of energy implantable in the patient for supplying energy for the operation of the restriction device, and a remote control for controlling the supply of energy of the implantable source of energy, wherein the switch is operated by the energy of the first form supplied by the energy transmission device to switch from an off mode, in which the remote control is prevented from controlling the source of energy and the source of energy is not in use, to a standby mode, in which the remote control is permitted to control the source of energy to supply energy for the operation of the restriction device.

83. An apparatus according toclaim 2, wherein the restriction device is electrically operated, and the energy of the second form comprises electric energy.

84. An apparatus according toclaim 83, further comprising electric conductors connected to the energy transforming device, whereby the energy transforming device is capable of supplying an electric current via the conductors.

85. An apparatus according toclaim 2, wherein the energy transforming device is capable of supplying a frequency, amplitude or frequency and amplitude modulated signal.

86. An apparatus according toclaim 2, wherein the energy transforming device is capable of supplying an analog, digital or a combination of an analog and digital signal.

87. An apparatus according toclaim 1, further comprising an activatable source of energy implantable in the patient, wherein the source of energy is activated by wireless energy transmitted by the energy transmission device, to supply energy which is used in connection with the operation of the restriction device.

88. An apparatus according toclaim 1, wherein the energy transmission device transmits energy by at least one wireless signal.

89. An apparatus according toclaim 88, wherein the signal contains radiant energy.

90. An apparatus according toclaim 88, wherein the signal comprises a wave signal.

91. An apparatus according toclaim 90, wherein the wave signal comprises an electromagnetic wave signal including one of an infrared light signal, a visible light signal, an ultra violet light signal, a laser signal, a micro wave signal, a radio wave signal, an x-ray radiation signal, and a gamma radiation signal.

92. An apparatus according toclaim 90, wherein the wave signal comprises a sound or ultrasound wave signal.

93. An apparatus according to any one of claims88-92, wherein the signal comprises a digital or analog signal, or a combination of a digital and analog signal.

94. An apparatus according toclaim 2, wherein the energy of the first form transmitted by the energy transmission device comprises an electric, an electromagnetic or a magnetic field, or a combination thereof.

95. An apparatus according toclaim 94, wherein the electric, electromagnetic or magnetic field, or the combination thereof is transmitted in pulses or digital pulses, or a combination of pulses and digital pulses by the energy transmission device.

96. An apparatus according toclaim 2, wherein the energy of a first form transmitted by the energy transmission device comprises an electric, an electromagnetic or a magnetic field, or a combination thereof.

97. An apparatus according toclaim 96, wherein the electric, electromagnetic or magnetic field, or the combination thereof is transmitted in waves or analog pulses or a combination thereof by the energy transmission device.

98. An apparatus according to any one of claims1-97, wherein the energy transmitted by the energy transmission device comprises polarised energy.

99. An apparatus according toclaim 2, wherein the energy transforming device transforms the energy of the first form into a direct current or pulsating direct current, or a combination of a direct current and pulsating direct current.

100. An apparatus according toclaim 2, wherein the energy transforming device transforms the energy of the first form into an alternating current or a combination of a direct and alternating current.

101. An apparatus according toclaim 2, further comprising an implantable pulse generator for generating electrical pulses from the energy of the second form produced by the energy field.

102. An apparatus according to any one of the preceding claims, further comprising at least one implantable sensor for sensing at least one physical parameter of the patient.

103. An apparatus according toclaim 102, wherein the sensor comprises a pressure sensor for directly or indirectly sensing as the physical parameter the pressure in the blood flow passageway.

104. An apparatus according toclaim 102, further comprising a control device for controlling the restriction device in response to signals from the sensor.

105. An apparatus according toclaim 104, wherein the control device comprises an internal control unit implantable in the patient for controlling the restriction device in response to signals from the sensor.

106. An apparatus according toclaim 105, wherein the internal control unit directly controls the restriction device in response to signals from the sensor.

107. An apparatus according toclaim 104, wherein the control device comprises an external control unit outside the patient's body for controlling the restriction device in response to signals from the sensor.

108. An apparatus according toclaim 107, wherein the external control unit stores information on the physical parameter sensed by the sensor and is manually operated to control the restriction device based on the stored information.

109. An apparatus according to any one of claims102-108, further comprising at least one implantable sender for sending information on the physical parameter sensed by the sensor.

110. An apparatus according to any one of the preceding claims, further comprising a wireless remote control for transmitting at least one wireless control signal for controlling the restriction device.

111. An apparatus according toclaim 110, wherein the control signal comprises a frequency, amplitude or frequency or amplitude modulated signal.

112. An apparatus according toclaim 110, wherein the control signal comprises an analog or a digital signal, or a combination of an analog and digital signal.

113. An apparatus according to any of claims110-112, wherein the remote control is capable of obtaining information on the condition of the implantable restriction device and to control the restriction device in response to the information.

114. An apparatus according to any of claims110-113, wherein the remote control comprises an implantable control unit for controlling the restriction device.

115. An apparatus according toclaim 114, wherein the control unit comprises a microprocessor.

116. An apparatus according to any one of claims110-115, wherein the wireless remote control comprises at least one external signal transmitter or transceiver and at least one internal signal receiver or transceiver implantable in the patient.

117. An apparatus according to any one of claims110-115, wherein the wireless remote control comprises at least one external signal receiver or transceiver and at least one internal signal transmitter or transceiver implantable in the patient.

118. An apparatus according to any one of claims110-117, wherein the remote control is capable of sending information related to the restriction device from inside the patients body to the outside thereof.

119. An apparatus according toclaim 118, wherein the remote control controls the restriction device in response to the information.

120. An apparatus according to any one of claims110-119, wherein the remote control comprises a control signal transmitter for transmitting the wireless control signal, and the energy transmission device comprises the control signal transmitter, whereby energy is transmitted by the control signal.

121. An apparatus according to any one of claims110-119, wherein the energy transmission device transmits energy by at least one signal separate from the control signal.

122. An apparatus according to any one of claims110-119, wherein the remote control transmits a carrier signal for carrying the control signal.

123. An apparatus according to any one of claims110-119, wherein the energy transmission device transmits energy by at least one signal, which is used as a carrier signal for the control signal transmitted by the remote control.

124. An apparatus according toclaim 123, wherein the carrier signal is frequency, amplitude or frequency and amplitude modulated.

125. An apparatus according toclaim 123 or124, wherein the carrier signal comprises digital, analog or a combination of digital and analog signals.

126. An apparatus according toclaim 125, wherein the signals comprise wave signals.

127. An apparatus according to any one of claims110-126, wherein the control signal comprises a wave signal comprising one of a sound wave signal, an ultrasound wave signal, an electromagnetic wave signal, an infrared light signal, a visible light signal, an ultra violet light signal, a laser light signal, a micro wave signal, a radio wave signal, an x-ray radiation signal and a gamma radiation signal.

128. An apparatus according to any one of claims110-126. wherein the control signal comprises an electric or magnetic field, or a combined electric and magnetic field.

129. An apparatus according toclaim 112, wherein the remote control transmits an electromagnetic carrier wave signal for carrying the digital or analog control signal.

130. An apparatus according toclaim 2, wherein the energy of the second form used for operating the restriction device is wirelessly transmitted by the energy transforming device.

131. An apparatus according toclaim 1, further comprising an implantable control unit for controlling the restriction device.

132. An apparatus according toclaim 131, wherein the control unit is programmable for controlling the restriction device in accordance with a program.

133. An apparatus according toclaim 131, wherein the control unit controls the restriction device over time in accordance with an activity schedule program

134. An apparatus according to any one of claims131-133, further comprising an external wireless remote control for programming the implantable control unit.

135. An apparatus according toclaim 1, further comprising an external data communicator and an implantable internal data communicator communicating with the external data communicator, wherein the internal communicator feeds data related to the restriction device back to the external data communicator or the external data communicator feeds data to the internal data communicator.

136. An apparatus according toclaim 135, wherein the internal data communicator feeds data related to at least one physical signal of the patient.

137. An apparatus according to any one of the preceding claims, wherein the restriction device is adapted to control the restriction of the blood flow passageway when implanted.

138. An apparatus according to any one of the preceding claims, wherein the restriction device is non-inflatable.

139. An apparatus according toclaim 2, wherein one of the energy of the first form and the energy of the second form comprises magnetic energy, kinetic energy, sound energy, chemical energy, radiant energy, electromagnetic energy, photo energy, nuclear energy or thermal energy.

140. An apparatus according toclaim 2, wherein one of the energy of the first form and the energy of the second form is non-magnetic, non-kinetic, non-chemical, non-sonic, non-nuclear or non-thermal.

141. An apparatus according toclaim 1, wherein the energy transmission device functions different from the energy transforming device.

142. An apparatus according toclaim 2, wherein the energy transmission device functions similar to the energy transforming device.

143. An apparatus according to any one of the preceding claims, wherein the energy transforming device is designed to be implanted subcutaneously or in the abdomen, thorax or cephalic region of the patient.

144. An apparatus according to any one of claims1-142, wherein the energy transforming device is designed to be implanted in an orifice of the patient's body and under the mucosa or intraluminar outside the mucosa of the orifice.

145. An apparatus according to any one of claims1-142, wherein the energy transforming means is designed to be implanted in the retropritoneum or in the scrotum of the patient.

146. An apparatus according to any of the preceding claims, wherein the restriction device is embedded in a soft or gel-like material.

147. An apparatus according to any of the preceding claims, wherein the restriction device is embedded in a silicone material having hardness less than 20 Shore.

148. An apparatus according toclaim 102, wherein the sensor is adapted to sense ejaculation as the physical parameter, and the restriction device is adapted to release the penile tissue or the prolongation thereof in response to the sensor sensing ejaculation.

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