Devices, methods, and sytems for shrinking tissues

Abstract

Devices, systems, and method for treating urinary incontinence generally rely on energy delivered to a patient's own pelvic support tissue to selectively contract or shrink at least a portion of that pelvic support tissue so as to reposition the bladder. The energy will preferably be applied to the endopelvic fascia and/or an arcus tendineus fascia pelvis. The invention provides a variety of devices and methods for applying gentle resistive heating of these and other tissues to cause them to contract without imposing significant injury on the surrounding tissue structures. Alternatively, heat-applying probes are configured to heat tissue structures which comprise or support a patient's urethra. By applying sufficient energy over a predetermined time, the tissue can be raised to a temperature which results in contraction without significant necrosis or other tissue damage. By selectively contracting the support tissues, the bladder neck, sphincter, and other components of the urinary tract responsible for the control of urinary flow can be reconfigured or supported in a manner which reduces urinary leakage.

What is claimed is:  
     
         1 . A method for treating incontinence in a patient, said method comprising: 
 inserting a probe into the patient;    advancing a plurality of tissue-penetrating structures from the probe so that the electrodes penetrate a collagenous tissue structure; and    applying energy to the collagenous tissue structure with the tissue-penetrating structures to heat the collagenous tissue structure sufficiently to effect shrinkage of the collagenous tissue structure so that the collagenous tissue structure inhibits incontinence.    
     
     
         2 . A method as in  claim 1 , wherein the probe is inserted into a urethra of the patient.  
     
     
         3 . A method as in  claim 2 , wherein the energy is applied as a bipolar RF energy transmitted between the tissue-penetrating structures.  
     
     
         4 . A method as in  claim 3 , wherein an axis of the probe extends from the proximal end to the distal end with electrodes extending asymmetrically relative to the axis, wherein two electrodes deploy from the probe to penetrate the collagenous tissue structure on a first lateral side of the probe, and wherein two electrodes deploy from the probe to penetrate the collagenous tissue structure on a second lateral side of the probe.  
     
     
         5 . A method as in  claim 1 , wherein the collagenous tissue structure comprises at least one member selected from the group consisting of a urethral wall, a bladder, a bladder neck, a ureter, bladder suspension ligaments, a sphincter, pelvic ligaments, pelvic floor muscles, and fascia.  
     
     
         6 . A method as in  claim 3 , wherein the collagenous tissue structure comprises the bladder neck.  
     
     
         7 . A method as in  claim 1 , further comprising adjusting a power level of the energy, wherein the adjusting step is performed in response to internal temperature in the collagenous tissue structure.  
     
     
         8 . A method for treating incontinence in a patient, said method comprising: 
 inserting a probe into the patient;    electrically coupling at least one electrode of the inserted probe to a collagenous tissue structure;    applying electrical energy to the collagenous tissue structure with the at least one electrode to heat the collagenous tissue structure; and    controlling an amount of the energy applied in response to a temperature of the collagenous tissue structure so that the collagenous tissue structure inhibits incontinence.    
     
     
         9 . A method as in  claim 8 , wherein the shrinkage includes apposition of circumferentially separated regions of a urethral wall.  
     
     
         10 . A method as in  claim 8 , wherein the shrinkage provides a kink or closure point along the urethra to inhibit leakage.  
     
     
         11 . A method as in  claim 11 , wherein the energy is applied so as to cause bulking and buttressing of the collagenous tissue structure during healing.  
     
     
         12 . A method as in  claim 9 , wherein the energy is applied so as to effect shrinkage of the collagenous tissue structure, the shrinkage and tissue bulking/buttressing acting to enhance patient continence.  
     
     
         13 . A system for treatment of incontinence, the system comprising: 
 a probe body having a proximal end and a distal end, the distal end suitable for insertion into a urethra of a patient body for positioning in alignment with to a collagenous tissue structure;    a plurality of electrodes near the distal end of the probe body, the electrodes reciprocatably mounted on the probe body so that said electrodes are extendable from the probe body to penetrate into the collagenous tissues;    a connector disposed near the proximal end of the probe body, the connector coupleable to a power supply for transmission of electrical energy to the electrodes; and    a controller coupled to the power supply, the controller controlling an amount of the energy of the collagenous tissue structure so as to heat the collagenous tissue structure to a target temperature range such that the collagenous tissue structure will inhibit incontinence.    
     
     
         14 . A system as in  claim 13 , wherein the probe body has an axis extending between the proximal end and the distal end, wherein the electrodes are asymmetrically disposed about the axis, and wherein the electrodes are oriented to reciprocatably deploy into the collagenous tissue on generally opposed lateral sides of the probe body.  
     
     
         15 . A system as in  claim 13 , further comprising a sensor disposed near the electrode, the sensor measuring internal temperature in the collagenous tissue.  
     
     
         16 . A system for treatment of incontinence, the system comprising: 
 a urethral probe body having a proximal end and a distal end, the distal end suitable for insertion into a urethra adjacent to a collagenous tissue structure;    at least one electrode reciprocatably mounted near the distal end of the probe body, the at least one electrode adapted to penetrate into the collagenous tissue structure;    a power supply coupled to said at least one electrode for transmission of electrical energy therethrough; and    a feedback controller coupled to the power supply, the controller limiting an amount of the energy in response to a temperature of the collagenous tissue structure so as to heat the collagenous tissue structure so that, when healed, the collagenous tissue structure inhibits incontinence.    
     
     
         17 . A system as in  claim 16 , further comprising indicia of rotational alignment disposed adjacent the proximal end of the probe for rotationally aligning the electrodes with the collagenous tissue structure.  
     
     
         18 . A system as in  claim 17 , wherein an axis of the probe extends between the proximal and distal ends, and wherein the electrodes are asymmetrically disposed about the axis.