Bladder treatment by ablative denervation

Abstract

In one aspect, the present disclosure is directed to methods of treating various conditions including bladder conditions in a patient, comprising: positioning at least one ablative element of an ablative device on or over an adventitial surface of the bladder; and using the ablative device to denervate bladder nerve fibers. Other aspects of the present disclosure pertain, for example, to devices and kits for of treating bladder conditions.

1 . A method of treating a bladder condition in a patient, comprising: positioning at least one ablative element of an ablative device on or over an adventitial surface of the bladder; and using the ablative device to denervate bladder nerve fibers. 
     
     
         2 . The method of  claim 1 , wherein the at least one ablative element is advanced through a urethra of the patient, into the bladder of the patient, and through an opening in a wall of the bladder. 
     
     
         3 . The method of  claim 1 , wherein the bladder condition is bladder overactivity. 
     
     
         4 . The method of  claim 1 , wherein the at least one ablative element delivers an ablative chemical in an amount sufficient to denervate bladder nerve fibers or creates ablative cryogenic temperatures that are sufficiently low to denervate bladder nerve fibers. 
     
     
         5 . The method of  claim 1 , wherein the at least one ablative element delivers ablative energy in an amount sufficient to denervate bladder nerve fibers. 
     
     
         6 . The method of  claim 5 , wherein denervated bladder nerve fibers are within 500 microns of the adventitial surface of the bladder. 
     
     
         7 . The method of  claim 5 , wherein the energy does not impair function of a detrusor muscle of the patient. 
     
     
         8 . The method of  claim 5 , comprising delivering at least one of radio frequency (RF) energy, microwave energy, light energy, ultrasound energy, or electrocautery energy to the bladder. 
     
     
         9 . The method of  claim 8 , wherein the at least one ablative element comprises two or more electrodes in an array and wherein RF energy is delivered to bladder tissue through the electrodes. 
     
     
         10 . The method of  claim 9 , wherein the electrodes deliver RF energy in a bipolar mode of operation. 
     
     
         11 . The method of  claim 9 , wherein the ablative device comprises penetrating electrodes having tips that are positioned in the bladder adventitia during energy delivery. 
     
     
         12 . The method of  claim 9 , wherein bladder nerve fibers are denervated in an area corresponding to 0.2 cm 2  to 5 cm 2  of the adventitial surface of the bladder. 
     
     
         13 . An ablative device for treating a bladder condition, comprising: an elongate shaft and a deployable electrode array disposed proximate an end of the elongate shaft, wherein the elongate shaft and deployable electrode array are configured such that the deployable electrode array can be (i) advanced in a laterally contracted state through a human urethra, into a human bladder and through an opening in a wall of the bladder, (ii) deployed to a laterally expanded state after being advanced through the bladder wall, (iii) brought into contact with an adventitial surface of the bladder for treatment, (iv) returned to a laterally contracted state after treatment, and (v) withdrawn through the bladder wall, bladder and urethra. 
     
     
         14 . The ablative device of  claim 13 , wherein each electrode is deployed on a physically collapsible element. 
     
     
         15 . The ablative device of  claim 13 , wherein each electrode is deployed on a shape memory element. 
     
     
         16 . The ablative device of  claim 13 , wherein each electrode is deployed on an inflatable element. 
     
     
         17 . The ablative device of  claim 13 , wherein electrodes in the array are deployed on one or more linear or curvilinear elements. 
     
     
         18 . The ablative device of  claim 13 , wherein the array ranges from 0.5 cm to 2.5 cm across. 
     
     
         19 . The ablative device of  claim 13 , further comprising an RF generator. 
     
     
         20 . A kit comprising two or more of the following components:
 (a) ablative device for treating a bladder condition, comprising: an elongate shaft and a deployable electrode array disposed proximate an end of the elongate shaft, wherein the elongate shaft and deployable electrode array are configured such that the deployable electrode array can be (i) advanced in a laterally contracted state through a human urethra, into a human bladder and through an opening in a wall of the bladder, (ii) deployed to a laterally expanded state after being advanced through the bladder wall, (iii) brought into contact with an adventitial surface of the bladder for treatment, (iv) returned to a laterally contracted state after treatment, and (v) withdrawn through the bladder wall, bladder and urethra; and   (b) a tubular device that is configured for advancement through a subject's urethra, into a subject's bladder and optionally through an opening in a wall of the bladder, wherein an ablative device is configured to be advanced through the tubular device;   (c) a dissecting element;   (d) a fluorescent dye that has selectivity for myelin;   (e) a lubricant; and   (f) an anesthetic.