Methods and systems for ablation of the renal pelvis

Abstract

Apparatus, systems, and methods provide access to the renal pelvis of a kidney to treat renal nerves embedded in tissue surrounding the renal pelvis. Access to the renal pelvis may be via the urinary tract or via minimally invasive incisions through the abdomen and kidney tissue. Treatment is effected by exchanging energy, typically delivering heat or extracting heat through a wall of the renal pelvis, or by delivering active substances to ablate a thin layer of tissue lining at least a portion of the renal pelvis to disrupt renal nerves within the tissue lining of the renal pelvis.

What is claimed is: 
     
         1 . A method for inhibiting or modulating the function of renal nerves in a patient's kidney, said method comprising:
 introducing an effector into an interior of the kidney or an upper region of an adjacent ureter; and   exchanging energy or delivering active substances from the interior of the kidney to ablate a layer of tissue lining at least a portion of the renal pelvis to disrupt renal nerves within tissue and muscle layers lining of the renal pelvis.   
     
     
         2 . A method as in  claim 1 , wherein the tissue lining comprises a urothelium and a lamina propria and the ablation occurs primarily within the urothelium and the lamina propria. 
     
     
         3 . A method as in  claim 2 , wherein the ablation extends into a connective tissue and vascular layer that surrounds the lamina propria. 
     
     
         4 . A method as in  claim 1 , wherein the ablation extends to a depth in the range from 0.1 mm to 2 mm, 
     
     
         5 . A method as in  claim 1 , wherein the ablation extends to a depth in the range from preferably from 0.2 mm to 1.5 mm. 
     
     
         6 . A method as in  claim 1 , wherein the ablation extends to a depth in the range from and more preferably from 0.5 mm to 1.2 mm. 
     
     
         7 . A method as in  claim 4 , wherein electrical energy is delivered uniformly over a continuous region of the renal pelvis at a power in the range from 1 W to 200 W. 
     
     
         8 . A method as in  claim 1 , wherein introducing comprises advancing the effector through the urinary tract to the renal pelvis. 
     
     
         9 . A method as in  claim 8 , wherein the effector is disposed on a urinary catheter and the urinary catheter is advanced through the urethra, bladder, and ureter to reach the renal pelvis. 
     
     
         10 . A method as in  claim 1 , wherein introducing comprises advancing the effector percutaneously to the renal pelvis. 
     
     
         11 . A method as in  claim 1 , wherein the effector comprises electrodes and the energy comprises radiofrequency energy which is delivered to heat the wall of the renal pelvis and renal nerves embedded in the tissue bed surrounding the renal blood vessels. 
     
     
         12 . A method as in  claim 1 , wherein the effector comprises an antenna and the energy comprises microwave energy which is delivered to heat the wall of the renal pelvis and renal nerves embedded in the tissue bed surrounding the renal blood vessels. 
     
     
         13 . A method as in  claim 1 , wherein the effector comprises an ultrasound transducer and the energy comprises ultrasound energy which is delivered to heat the wall of the renal pelvis and renal nerves embedded in the tissue bed surrounding the renal blood vessels. 
     
     
         14 . A method as in  claim 11 , wherein the ultrasound transducer comprises a high intensity focused ultrasound transducer array. 
     
     
         15 . A method as in  claim 1 , wherein the effector comprises a convective heat source and the energy comprises heat which is delivered through the renal pelvis to heat the wall of the renal pelvis and renal nerves embedded in the tissue bed surrounding the renal blood vessels. 
     
     
         16 . A method as in  claim 15 , wherein the convective heat source comprises a heated fluid deployed within an inflated chamber within the renal pelvis. 
     
     
         17 . A method as in  claim 1 , wherein the effector comprises a convective cooling source and the energy comprises heat which is extracted through the renal pelvis to cool the wall of the renal pelvis and renal nerves embedded in the tissue bed surrounding the renal blood vessels. 
     
     
         18 . A method as in  claim 17 , wherein the convective cooling source comprises a cooled fluid deployed within an inflated chamber within the renal pelvis. 
     
     
         19 . A method as in  claim 1 , wherein the effector comprises a radiation-emitting source. 
     
     
         20 . A method as in  claim 19 , wherein the radiation-emitting source comprises a radioisotope or an electronic source. 
     
     
         21 . A method as in  claim 1 , wherein the effector comprises tissue-penetrating electrodes which are penetrated into a wall of the renal pelvis while energy is delivered to the wall through the electrodes. 
     
     
         22 . A method as in  claim 1 , wherein the energy exchanged is mechanical energy. 
     
     
         23 . A method as in  claim 22 , wherein the mechanical energy comprises abrasion or cutting. 
     
     
         24 . An electrode structure comprising:
 a self-expanding deployment wire having a distal region configured to expand into and engage a wall of a renal pelvis; and   a plurality of rounded electrode members distributed over said distal region and having surfaces which extend radially outwardly beyond the surface of the adjacent wire.   
     
     
         25 . An electrode deployment assembly as in  claim 31 , wherein the electrode structure is free to rotate within the passage of the delivery tube. 
     
     
         26 . An electrode structure as in  claim 24 , wherein the distal region of the deployment wire has a looped distal end. 
     
     
         27 . An electrode structure as in  claim 24 , wherein at least the distal region of the deployment wire is electrically insulated over its surface between the rounded electrodes. 
     
     
         28 . An electrode structure as in  claim 24 , wherein the diameter of the rounded electrode structure is from two-fold to six fold greater than that of the deployment wire. 
     
     
         29 . An electrode structure as in  claim 28 , wherein the deployment wire has a diameter in the range from 0.1 mm to 0.7 mm and the rounded electrode members have a diameter in the range from 0.25 mm to 2.5 mm. 
     
     
         30 . An electrode structure as in  claim 24 , wherein the rounded electrodes are ball electrodes. 
     
     
         31 . An electrode deployment assembly comprising:
 an electrode structure as in  claim 24 ; and   a delivery tube having a central, passage which reciprocatably receives the electrode structure, wherein the distal region is radially constrained when present in the passage and radially expanded when advanced distally out of the passage.   
     
     
         32 . A method for delivering energy to a renal pelvis, said method comprising:
 introducing a wire into the ureter adjacent to or within the renal pelvis, wherein said wire has a pre-shaped distal region configured to conform to the renal pelvis;   advancing the distal portion of the wire into the renal pelvis, wherein the distal portion is radially constrained while being advanced;   releasing the distal region of the wire to engage tissue over a wall of the renal pelvis; and   applying energy to the wall of the renal pelvis through a plurality of electrodes on the wire, wherein the electrodes have rounded surfaces which extend beyond the surface of the adjacent wire and which embed into the wall.   
     
     
         33 . A method for delivering energy to a renal pelvis as in  claim 32 , further comprising applying a vacuum within the renal pelvis while applying energy to draw the walls of the renal pelvis against the rounded electrodes. 
     
     
         34 . A method for delivering energy to a renal pelvis as in  claim 32 , wherein the pre-shaped distal region of the wire has a helical or spiral distal geometry. 
     
     
         35 . A method for delivering energy to a renal pelvis as in  claim 32 , wherein the pre-shaped distal region of the wire has a looped distal end. 
     
     
         36 . A method for delivering energy to a renal pelvis as in  claim 32 , wherein at least the pre-shaped distal region of the wire is electrically insulated over its surface between the electrodes. 
     
     
         37 . A method for delivering energy to a renal pelvis as in  claim 32 , wherein the diameter of the electrodes is from two-fold to six fold greater than that of the wire. 
     
     
         38 . A method for delivering energy to a renal pelvis as in  claim 32 , wherein the wire has a diameter in the range from 0.1 mm to 0.7 mm and the electrodes have a diameter in the range from 0.25 mm to 2.5 mm. 
     
     
         39 . A method for delivering energy to a renal pelvis as in  claim 32 , wherein the electrodes are ball electrodes. 
     
     
         40 . A method for delivering energy to a renal pelvis as in  claim 32 , wherein the distal portion of the wire is advanced into the renal pelvis from a central passage of a delivery tube which had been positioned in the renal pelvis, wherein the distal region is radially constrained when present in the passage and radially expanded when advanced distally out of the passage. 
     
     
         41 . An electrode deployment assembly as in  claim 31 , wherein the electrode structure is free to rotate in the passage of the delivery tube.