Devices and methods for transurethral bladder partitioning

Abstract

Systems, devices, and methods to treat a urinary bladder are disclosed. An expandable member is introduced and expanded in the urinary bladder to appose one or more elongate conductors on the outer surface of the expandable member against the inner wall of the urinary bladder. The one or more elongate conductors are used to create a predetermined pattern of electrically isolated tissue regions having reduced electrical propagation such that electrical propagation through the urinary bladder as a whole is reduced. A mucus layer may be removed from the inner bladder wall prior to the ablation. Ablation may be regulated by impedance measurement with the one or more elongate conductors. The urinary bladder may be filled with a fluid to facilitate the impedance measurement.

What is claimed is: 
     
         1 . A system for treating a urinary bladder, the system comprising:
 a catheter shaft;   an expandable member coupled to a distal end of the catheter shaft and configured to be expanded within the urinary bladder;   at least one elongate conductor disposed on an outer surface of the expandable member and configured to ablate an inner wall of the urinary bladder when the expandable member is expanded within the urinary bladder; and   at least one shield disposed on the outer surface of the expandable member to cover at least one ureteral orifice when the expandable member is expanded within the urinary bladder.   
     
     
         2 . The system of  claim 1 , wherein the at least one shield is inserted into the urinary bladder separately from the expandable member. 
     
     
         3 . The system of  claim 1 , wherein the at least one shield has one or more of a triangular, square, oblong, heart, letter V, letter U, letter C, spiral, elliptical, oval, circular, or oblong shape. 
     
     
         4 . The system of  claim 1 , wherein the at least one shield comprises a first shield for covering a first ureteral orifice and a second shield for covering a second ureteral orifice. 
     
     
         5 . The system of  claim 1 , wherein the at least one shield is electrically or thermally insulative. 
     
     
         6 . The system of  claim 1 , wherein the at least one elongate conductor is configured to ablate the inner wall of the urinary bladder to modify one or more of sub-endothelial tissue or mucosal tissue of said wall. 
     
     
         7 . A device for treating a disorder in a urinary bladder, the device comprising:
 a shaft advanceable through a urethra of a patient to reach the urinary bladder, the shaft having a longitudinal axis;   an expandable member coupled to a distal end of the shaft, the expandable member having a collapsed configuration advanceable through the bodily passage to reach the cavity of the organ and an expanded configuration configured to contact an inner wall of the urinary bladder when the expandable member is advanced therein, wherein the expandable member in at least the expanded configuration has a central axis offset from the longitudinal axis of the shaft; and   at least one elongate conductor disposed over an outer surface of the expandable member and configured to contact the inner wall of the urinary bladder when the expandable member is advanced and expanded therein to create a predetermined pattern of one or more ablation lines therein,   wherein the central axis of the expandable member is offset from the longitudinal axis of the shaft at a tilt angle greater than 0 such that the at least one elongate conductor avoids contact with ureteral orifices of the urinary bladder when the shaft is advanced through the urethra and the expandable member is expanded within the urinary bladder.   
     
     
         8 . The device of  claim 7 , wherein the at least one elongate conductor comprises at least one longitudinal conductor and at least one latitudinal conductor. 
     
     
         9 . The device of  claim 8 , wherein at least a part of the at least one latitudinal conductor is configured to be parallel to the at least one longitudinal conductor when the expandable member is collapsed, and substantially parallel to an equator of the expandable member when the expandable member is expanded. 
     
     
         10 . The device of  claim 8 , wherein the at least one longitudinal conductor is parallel to a longitudinal axis of the shaft. 
     
     
         11 . The device of  claim 7 , wherein the predetermined pattern of the one or more ablation lines is configured to create tissue regions having reduced electrical propagation in the inner wall of the urinary bladder. 
     
     
         12 . The device of  claim 7 , wherein the expandable member is disposed over a distal end of the shaft, and the distal end of the shaft is telescopic to extend in length as the expandable member transitions from the collapsed to the expanded configuration. 
     
     
         13 . The device of  claim 12 , wherein the telescopic distal end of the shaft varies in length from 2 cm to 5 cm when collapsed to 4 cm to 15 cm when fully extended. 
     
     
         14 . The device of  claim 7 , wherein the tilt angle is between 0 and 90 degrees. 
     
     
         15 . The device of  claim 7 , further comprising a hinge coupling the shaft and the expandable member. 
     
     
         16 . The device of  claim 7 , wherein the at least one elongate conductor is configured to ablate the inner wall of the urinary bladder to modify one or more of sub-endothelial tissue or mucosal tissue of said wall. 
     
     
         17 . A device for treating a disorder in a urinary bladder, the device comprising:
 a shaft advanceable through a urethra of a patient to reach the urinary bladder, the shaft having a longitudinal axis;   an expandable member coupled to a distal end of the shaft, the expandable member having a collapsed configuration advanceable through the bodily passage to reach the cavity of the organ and an expanded configuration configured to contact an inner wall of the urinary bladder when the expandable member is advanced therein; and   at least one elongate conductor disposed over an outer surface of the expandable member and configured to contact the inner wall of the urinary bladder when the expandable member is advanced and expanded therein to create a predetermined pattern of one or more ablation lines therein,   wherein the at least one elongate conductor comprises at least one longitudinal conductor and at least one latitudinal conductor, and   wherein the at least one latitudinal conductor is configured to be inclined in relation to the at least one longitudinal conductor when the expandable member is expanded.   
     
     
         18 . The device of  claim 17 , wherein the at least one latitudinal conductor is configured to be inclined in relation to the at least one longitudinal conductor between 15 to 90 degrees when the expandable member is expanded. 
     
     
         19 . The device of  claim 17 , wherein the at least one latitudinal conductor is configured to be anteriorly inclined in relation to a long axis of a body of the patient when the expandable member is advanced into and expanded within the urinary bladder. 
     
     
         20 . The device of  claim 17 , wherein the inclination of the at least one latitudinal conductor in relation to the at least one longitudinal conductor is expanded based on a distance between a ureteral orifice and a bladder neck of the urinary bladder. 
     
     
         21 . The device of  claim 17 , wherein the at least one elongate conductor is configured to ablate the inner wall of the urinary bladder to modify one or more of sub-endothelial tissue or mucosal tissue of said wall.