US20090060977A1 - Devices, systems and methods for treating benign prostatic hyperplasia and other conditions - Google Patents

Abstract

Devices, systems and methods for compressing, cutting, incising, reconfiguring, remodeling, attaching, repositioning, supporting, dislocating or altering the composition of tissues or anatomical structures to alter their positional or force relationship to other tissues or anatomical structures. In some applications, the invention may be used to used to improve patency or fluid flow through a body lumen or cavity (e.g., to limit constriction of the urethra by an enlarged prostate gland).

Description

FIELD OF THE INVENTION
• The present invention relates generally to medical devices and methods and more particularly to devices, systems and methods for treating conditions wherein a tissue (e.g., the prostate gland) has a) become enlarged and/or b) undergone a change in form, position, structure, rigidity or force exertion with respect to another anatomical structure and/or c) has begun to impinge upon or compress an adjacent anatomical structure (e.g., the urethra).
BACKGROUND OF THE INVENTION
• There are numerous pathological and nonpathological conditions in which a tissue (e.g., a gland, tumor, cyst, muscle, fascia, skin, adipose, mucous membrane, etc.) becomes enlarged, changed form or position and/or causes unwanted impingement, obstruction, occlusion, stretching, sagging, caving, expulsion and/or collapse of an adjacent body lumen or anatomical structure (e.g., the urethra). Examples of specific conditions which illustrate these medical problems include tissue relaxation or collapse (loose skin, fat or muscle folds, vaginal, rectal, or bladder prolapse, incontinence, etc.), tissue remodeling (scar formation, bladder stiffness secondary to chronic overexertion, infiltrative lung disease), traumatic injury, surgical manipulation (i.e. removal of supportive tissues, removal of tumors, reattachment of ligaments, etc.), tissue growth or enlargement (i.e. benign growths, cancers, angiomas, bone spurs, etc.), luminal obstruction or occlusion (coronary artery disease, peripheral vascular disease, stroke, non-communicating hydrocephalus, infertility secondary to non-patent fallopian tubes, urinary tract obstruction, etc.), tissue impingement (slipped spinal disks, degenerative joint disease, etc.), and ptosis.
• In particular, Benign Prostatic Hyperplasia (BPH) is one of the most common medical conditions that affect men, especially elderly men. It has been reported that, in the United Sates, more than half of all men have histopathologic evidence of BPH by age 60 and, by age 85, approximately 9 out of 10 men suffer from the condition. Moreover, the incidence and prevalence of BPH are expected to increase as the average age of the population in developed countries increases.
• The prostate gland enlarges throughout a man's life. In some men, the prostatic capsule around the prostate gland may prevent the prostate gland from enlarging further. This causes the inner region of the prostate gland to squeeze the urethra. This compression of the urethra increases resistance to urine flow through the region of the urethra enclosed by the prostate. Thus the urinary bladder has to exert more pressure to force urine through the increased resistance of the urethra. Chronic over-exertion causes the muscular walls of the urinary bladder to remodel and become stiffer. This combination of increased urethral resistance to urine flow and stiffness and hypertrophy of urinary bladder walls leads to a variety of lower urinary tract symptoms (LUTS) that may severely reduce the patient's quality of life. These symptoms include weak or intermittent urine flow while urinating, straining when urinating, hesitation before urine flow starts, feeling that the bladder has not emptied completely even after urination, dribbling at the end of urination or leakage afterward, increased frequency of urination particularly at night, urgent need to urinate etc.
• In addition to patients with BPH, LUTS may also be present in patients with prostate cancer, prostate infections, and chronic use of certain medications (e.g. ephedrine, pseudoephedrine, phenylpropanolamine, antihistamines such as diphenhydramine, chlorpheniramine etc.) that cause urinary retention especially in men with prostate enlargement.
• Although BPH is rarely life threatening, it can lead to numerous clinical conditions including urinary retention, renal insufficiency, recurrent urinary tract infection, incontinence, hematuria, and bladder stones.
• In developed countries, a large percentage of the patient population undergoes treatment for BPH symptoms. It has been estimated that by the age of 80 years, approximately 25% of the male population of the United States will have undergone some form of BPH treatment. At present, the available treatment options for BPH include watchful waiting, medications (phytotherapy and prescription medications), surgery and minimally invasive procedures.
• For patients who choose the watchful waiting option, no immediate treatment is provided to the patient, but the patient undergoes regular exams to monitor progression of the disease. This is usually done on patients that have minimal symptoms that are not especially bothersome.
• Medications for treating BPH symptoms include phytotherapy and prescription medications. In phytotherapy, plant products such as Saw Palmetto, African Pygeum, Serenoa repens (sago palm) and South African star grass are administered to the patient. Prescription medications are prescribed as first line therapy in patients with symptoms that are interfering with their daily activities. Two main classes of prescription medications are alpha-1a-adrenergic receptors blockers and 5-alpha-reductase inhibitors. Alpha-1a-adrenergic receptors blockers block that activity of alpha-1a-adrenergic receptors that are responsible for causing constriction of smooth muscle cells in the prostate. Thus, blocking the activity of alpha-1a-adrenergic receptors causes prostatic smooth muscle relaxation. This in turn reduces urethral resistance thereby reducing the severity of the symptoms. 5-alpha-reductase inhibitors block the conversion of testosterone to dihydrotestosterone. Dihydrotestosterone causes growth of epithelial cells in the prostate gland. Thus 5-alpha-reductase inhibitors cause regression of epithelial cells in the prostate gland and hence reduce the volume of the prostate gland which in turn reduces the severity of the symptoms.
• Surgical procedures for treating BPH symptoms include Transurethal Resection of Prostate (TURP), Transurethral Electrovaporization of Prostate (TVP), Transurethral Incision of the Prostate (TUIP), Laser Prostatectomy and Open Prostatectomy.
• Transurethal Resection of Prostate (TURP) is the most commonly practiced surgical procedure implemented for the treatment of BPH. In this procedure, prostatic urethral obstruction is reduced by removing most of the prostatic urethra and a sizeable volume of the surrounding prostate gland. This is carried out under general or spinal anesthesia. In this procedure, a urologist visualizes the urethra by inserting a resectoscope, that houses an optical lens in communication with a video camera, into the urethra such that the distal region of the resectoscope is in the region of the urethra surrounded by the prostate gland. The distal region of the resectoscope consists of an electric cutting loop that can cut prostatic tissue when an electric current is applied to the device. An electric return pad is placed on the patient to close the cutting circuit. The electric cutting loop is used to scrape away tissue from the inside of the prostate gland. The tissue that is scraped away is flushed out of the urinary system using an irrigation fluid. Using a coagulation energy setting, the loop is also used to cauterize transected vessels during the operation.
• Another example of a surgical procedure for treating BPH symptoms is Transurethral Electrovaporization of the Prostate (TVP). In this procedure, a part of prostatic tissue squeezing the urethra is desiccated or vaporized. This is carried out under general or spinal anesthesia. In this procedure, a resectoscope is inserted transurethrally such that the distal region of the resectoscope is in the region of the urethra surrounded by the prostate gland. The distal region of the resectoscope consists of a rollerball or a grooved roller electrode. A controlled amount of electric current is passed through the electrode. The surrounding tissue is rapidly heated up and vaporized to create a vaporized space. Thus the region of urethra that is blocked by the surrounding prostate gland is opened up.
• Another example of a surgical procedure for treating BPH symptoms is Transurethral Incision of the Prostate (TUIP). In this procedure, the resistance to urine flow is reduced by making one or more incisions in the prostrate gland in the region where the urethra meets the urinary bladder. This procedure is performed under general or spinal anesthesia. In this procedure, one or more incisions are made in the muscle of the bladder neck, which is the region where the urethra meets the urinary bladder. The incisions are in most cases are deep enough to cut the surrounding prostate gland tissue including the prostatic capsule. This releases any compression on the bladder neck and causes the bladder neck to spring apart. The incisions can be made using a resectoscope, laser beam etc.
• Another example of a surgical procedure for treating BPH symptoms is Laser Prostatectomy. Two common techniques used for Laser Prostatectomy are Visual Laser Ablation of the Prostate (VLAP) and the Holmium Laser Resection/Enucleation of the Prostate (HoLEP). In VLAP, a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser is used to ablate tissue by causing coagulation necrosis. The procedure is performed under visual guidance. In HoLEP, a holmium: Yttrium-aluminum-garnet laser is used for direct contact ablation of tissue. Both these techniques are used to remove tissue obstructing the urethral passage to reduce the severity of BPH symptoms.
• Another example of a surgical procedure for treating BPH symptoms is Photoselective Vaporization of the Prostate (PVP). In this procedure, laser energy is used to vaporize prostatic tissue to relieve obstruction to urine flow in the urethra. The type of laser used is the Potassium-Titanyl-Phosphate (KTP) laser. The wavelength of this laser is highly absorbed by oxyhemoglobin. This laser vaporizes cellular water and hence is used to remove tissue that is obstructing the urethra.
• Another example of a surgical procedure for treating BPH symptoms is Open Prostatectomy. In this procedure, the prostate gland is surgically removed by an open surgery. This is done under general anesthesia. The prostate gland is removed through an incision in the lower abdomen or the perineum. The procedure is used mostly in patients that have a large (greater than approximately 100 grams) prostate gland.
• Minimally invasive procedures for treating BPH symptoms include Transurethral Microwave Thermotherapy (TUMT), Transurethral Needle Ablation (TUNA), Interstitial Laser Coagulation (ILC), and Prostatic Stents.
• In Transurethral Microwave Thermotherapy (TUMT), microwave energy is used to generate heat that destroys hyperplastic prostate tissue. This procedure is performed under local anesthesia. In this procedure, a microwave antenna is inserted in the urethra. A rectal thermosensing unit is inserted into the rectum to measure rectal temperature. Rectal temperature measurements are used to prevent overheating of the anatomical region. The microwave antenna is then used to deliver microwaves to lateral lobes of the prostate gland. The microwaves are absorbed as they pass through prostate tissue. This generates heat which in turn destroys the prostate tissue. The destruction of prostate tissue reduces the degree of squeezing of the urethra by the prostate gland thus reducing the severity of BPH symptoms.
• Another example of a minimally invasive procedure for treating BPH symptoms is Transurethral Needle Ablation (TUNA). In this procedure, heat induced coagulation necrosis of prostate tissue regions causes the prostate gland to shrink. It is performed using local anesthetic and intravenous or oral sedation. In this procedure, a delivery catheter is inserted into the urethra. The delivery catheter comprises two radiofrequency needles that emerge at an angle of 90 degrees from the delivery catheter. The two radiofrequency needles are aligned are at an angle of 40 degrees to each other so that they penetrate the lateral lobes of the prostate. A radiofrequency current is delivered through the radiofrequency needles to heat the tissue of the lateral lobes to 70-100 degree Celsius at a radiofrequency power of approximately 456 KHz for approximately 4 minutes per lesion. This creates coagulation defects in the lateral lobes. The coagulation defects cause shrinkage of prostatic tissue which in turn reduces the degree of squeezing of the urethra by the prostate gland thus reducing the severity of BPH symptoms.
• Another example of a minimally invasive procedure for treating BPH symptoms is Interstitial Laser Coagulation (ILC). In this procedure, laser induced necrosis of prostate tissue regions causes the prostate gland to shrink. It is performed using regional anesthesia, spinal or epidural anesthesia or local anesthesia (periprostatic block). In this procedure, a cystoscope sheath is inserted into the urethra and the region of the urethra surrounded by the prostate gland is inspected. A laser fiber is inserted into the urethra. The laser fiber has a sharp distal tip to facilitate the penetration of the laser scope into prostatic tissue. The distal tip of the laser fiber has a distal-diffusing region that distributeslaser energy 360° along the terminal 3 mm of the laser fiber. The distal tip is inserted into the middle lobe of the prostate gland and laser energy is delivered through the distal tip for a desired time. This heats the middle lobe and causes laser induced necrosis of the tissue around the distal tip. Thereafter, the distal tip is withdrawn from the middle lobe. The same procedure of inserting the distal tip into a lobe and delivering laser energy is repeated with the lateral lobes. This causes tissue necrosis in several regions of the prostate gland which in turn causes the prostate gland to shrink. Shrinkage of the prostate gland reduces the degree of squeezing of the urethra by the prostate thus reducing the severity of BPH symptoms.
• Another example of a minimally invasive procedure for treating BPH symptoms is implanting Prostatic Stents. In this procedure, the region of urethra surrounded by the prostate is mechanically supported to reduce the constriction caused by an enlarged prostate. Prostatic stents are flexible devices that are expanded after their insertion in the urethra. They mechanically support the urethra by pushing the obstructing prostatic tissue away from the urethra. This reduces the constriction of the urethra and improves urine flow past the prostate gland thereby reducing the severity of BPH symptoms.
• Although existing treatments provide some relief to the patient from symptoms of BPH, they have significant disadvantages. Alpha-1a-adrenergic receptors blockers have side effects such as dizziness, postural hypotension, lightheadedness, asthenia and nasal stuffiness. Retrograde ejaculation can also occur. 5-alpha-reductase inhibitors have minimal side effects, but only a modest effect on BPH symptoms and the flow rate of urine. In addition, anti-androgens, such as 5-alpha-reductase, require months of therapy before LUTS improvements are observed. Surgical treatments of BPH carry a risk of complications including erectile dysfunction; retrograde ejaculation; urinary incontinence; complications related to anesthesia; damage to the penis or urethra, need for a repeat surgery etc. Even TURP, which is the gold standard in treatment of BPH, carries a high risk of complications. Adverse events associated with this procedure are reported to include retrograde ejaculation (65% of patients), post-operative irritation (15%), erectile dysfunction (10%), need for transfusion (8%), bladder neck constriction (7%), infection (6%), significant hematuria (6%), acute urinary retention (5%), need for secondary procedure (5%), and incontinence (3%) Typical recovery from TURP involves several days of inpatient hospital treatment with an indwelling urethral catheter, followed by several weeks in which obstructive symptoms are relieved but there is pain or discomfort during micturition.
• The reduction in the symptom score after minimally invasive procedures is not as large as the reduction in symptom score after TURP. Up to 25% of patients who receive these minimally invasive procedures ultimately undergo a TURP within 2 years. The improvement in the symptom score generally does not occur immediately after the procedure. For example, it takes an average of one month for a patient to notice improvement in symptoms after TUMT and 1.5 months to notice improvement after ILC. In fact, symptoms are typically worse for these therapies that heat or cook tissue, because of the swelling and necrosis that occurs in the initial weeks following the procedures. Prostatic stents often offer more immediate relief from obstruction but are now rarely used because of high adverse effect rates. Stents have the risk of migration from the original implant site (up to 12.5% of patients), encrustation (up to 27.5%), incontinence (up to 3%), and recurrent pain and discomfort. In published studies, these adverse effects necessitated 8% to 47% of stents to be explanted. Overgrowth of tissue through the stent and complex stent geometries have made their removal quite difficult and invasive.
• Thus the most effective current methods of treating BPH carry a high risk of adverse effects. These methods and devices either require general or spinal anesthesia or have potential adverse effects that dictate that the procedures be performed in a surgical operating room, followed by a hospital stay for the patient. The methods of treating BPH that carry a lower risk of adverse effects are also associated with a lower reduction in the symptom score. While several of these procedures can be conducted with local analgesia in an office setting, the patient does not experience immediate relief and in fact often experiences worse symptoms for weeks after the procedure until the body begins to heal. Additionally all device approaches require a urethral catheter placed in the bladder, in some cases for weeks. In some cases catheterization is indicated because the therapy actually causes obstruction during a period of time post operatively, and in other cases it is indicated because of post-operative bleeding and potentially occlusive clot formation. While drug therapies are easy to administer, the results are suboptimal, take significant time to take effect, and often entail undesired side effects.
• Thus there remains a need for the development of new devices, systems and methods for treating BPH as well as other conditions in which one tissue or anatomical structure impinges upon or compresses another tissue or anatomical structure.
SUMMARY OF THE INVENTION
• The present invention provides devices, systems and methods for compressing, cutting, incising, reconfiguring, remodeling, attaching, repositioning, supporting, dislocating or altering the composition of tissues or anatomical structures to alter their positional or force relationship to other tissues or anatomical structures. In some applications, the invention may be used to improve patency or fluid flow through a body lumen or cavity. Examples of body lumens through which flow may be facilitated using the present invention include the urethra, ureter, trachea, bronchus, bronchiole, other respiratory passageway, stomach, duodenum, small intestine, jejunum, illium, colon, cystic duct, hepatic duct, common bile duct, pancreatic duct, the alimentary canal, an endocrine passageway, a lymphatic, etc. Examples of tissues and anatomical structures that may be compressed, cut, incised, reconfigured, remodeled, attached, repositioned, supported, dislocated or compositionally altered by the present invention include the prostate gland, other glands and organs, neoplasms, benign growths, cancerous growths, tumors, cysts, other masses, congenital deformities, structures that have become enlarged due to hypertrophy, hyperplasia, edema, fluid build up, fluid retention, excess fluid production, impeded fluid outflow, etc.
• In accordance with the invention there are provided devices, systems and methods for implanting devices within the body to compress tissue in a manner that relieves pressure exerted on or interference with an adjacent anatomical structure. The implantable devices useable for this purpose generally comprising anchoring elements and tensioning elements that extend between the anchoring elements. The anchoring elements are implanted at selected locations and the tensioning elements then draw or pull the anchoring elements toward one another, thereby compressing tissue between the anchoring elements. In applications where these devices are implanted to treat prostatic enlargement, anchoring and tensioning element(s) are implanted and tensioned to compress or reposition prostatic tissue thereby lessening prostate induced constriction of the urethra. In at least some applications, this invention may be used to treat prostatic enlargement without causing substantial damage to the urethra (e.g., forming an opening in the urethra no larger than about 2 mm in its greatest cross-dimension). As used herein, the term “compress” includes not only actual compression of the tissue but also any application of pressure or force upon the tissue that causes the intended therapeutic effect by reconfiguring, remodeling, repositioning or altering the tissue.
• Still further in accordance with the invention there are provided devices, systems and methods for cutting tissue(s) of the body in a manner that relieves pressure exerted on or interference with an adjacent anatomical structure. In some applications of the invention, one or more working devices may be inserted into the body and used to incise the capsule of an encapsulated organ, tumor, mass or other structure, thereby relieving the capsule's constraint of the encapsulated organ, tumor, mass or other structure and allowing the encapsulated organ, tumor, mass or other structure to expand, herniate, evulse, splay, spread apart, reconfigure or move in a way that results in decreased pressure on, or decreased interference with, the adjacent anatomical structure. In applications where the invention is used to treat prostatic enlargement, a cutting device may be anchoring and tensioning element(s) are implanted and tensioned to compress or reposition prostatic tissue thereby lessening prostate induced constriction of the urethra.
• Additional and more specific aspects, elements, steps, applications, embodiments and examples of the invention will be understood by those of skill in the art upon reading of the detailed description and claims set forth herebelow.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1A is a sagittal sectional view of a male human body through the lower abdomen showing the male urinary tract.
• FIG. 1B is a coronal sectional view through the lower abdomen of a human male showing a region of the male urogenital system.
• FIG. 2A is a coronal sectional view through the prostate gland and adjacent structures showing a first trans-urethral approach that may be used to implant tissue compression devices(s) (e.g., clips, compression elements, anchoring elements, etc.) to compress or modify the shape of the prostate gland.
• FIG. 2B is a coronal sectional view through the prostate gland and adjacent structures showing a second trans-urethral approach that may be used to implant tissue compression devices(s) (e.g., clips, compression elements, anchoring elements, etc.) to compress or modify the shape of the prostate gland.
• FIG. 2C is a coronal sectional view through the prostate gland and adjacent structures showing a third trans-urethral approach that may be used to implant tissue compression devices(s) (e.g., clips, compression elements, anchoring elements, etc.) to compress or modify the shape of the prostate gland.
• FIG. 2D is a coronal sectional view through the prostate gland and adjacent structures showing a transperineal approach that may be used to implant tissue compression devices(s) (e.g., clips, compression elements, anchoring elements, etc.) to compress or modify the shape of the prostate gland.
• FIG. 2E is a coronal sectional view through the prostate gland and adjacent structures showing a percutaneous approach that may be used to implant tissue compression devices(s) (e.g., clips, compression elements, anchoring elements, etc.) to compress or modify the shape of the prostate gland.
• FIG. 2F is a coronal sectional view through the prostate gland and adjacent structures showing a percutaneous trans-osseus approach that may be used to implant tissue compression devices(s) (e.g., clips, compression elements, anchoring elements, etc.) to compress or modify the shape of the prostate gland.
• FIG. 2G is a coronal sectional view through the prostate gland and adjacent structures showing a percutaneous suprapubic approach that may be used to implant tissue compression devices(s) (e.g., clips, compression elements, anchoring elements, etc.) to compress or modify the shape of the prostate gland.
• FIG. 2H is a sagittal sectional view through the prostate gland and adjacent structures showing a percutaneous infrapubic approach that may be used to implant tissue compression devices(s) (e.g., clips, compression elements, anchoring elements, etc.) to compress or modify the shape of the prostate gland.
• FIG. 2I is a sagittal sectional view through the prostate gland and adjacent structures showing a trans-rectal approach that may be used to implant tissue compression devices(s) (e.g., clips, compression elements, anchoring elements, etc.) to compress or modify the shape of the prostate gland.
• FIGS. 3A to 3H show various components of a system for treating prostate gland disorders by compressing a region of the prostate gland.
• FIG. 3A shows the perspective view of an introducer device.
• FIG. 3B shows a perspective view of an injecting needle that may be used for injecting one or more diagnostic or therapeutic agents in the anatomy.
• FIG. 3C shows a perspective view of an introducing sheath.
• FIG. 3D shows a perspective view of a trocar.
• FIG. 3E shows a perspective view of an anchor delivery device.
• FIG. 3F shows an enlarged view of the distal region of the device inFIG. 3E.
• FIG. 3G shows a perspective view of deployed anchors showing radially expanded splayable arms of proximal anchor and distal anchor.
• FIG. 3H shows a perspective view from the proximal direction of a particular embodiment of the attachment mechanism ofFIG. 99E.
• FIGS. 4A through 4H show a coronal section through the prostate gland showing the various steps of a method of treating prostate gland disorders by compressing a region of the prostate gland using the kit shown inFIGS. 3A through 3H.
• FIGS.4G′ through4H′ show the final steps of an embodiment of method of treating prostate gland disorders by deploying a proximal anchor in the urethra.
• FIG.4H″ shows a coronal section through the prostate gland showing a final deployed configuration of an embodiment of bone anchoring devices for treating prostate gland disorders by compressing a region of the prostate gland.
• FIGS. 4I and 4J is a crossectional view through the prostatic urethra (i.e., the portion of the urethra that passes through the prostate gland) showing the appearance of the urethral lumen before and after performing the method shown inFIGS. 4A through 4H.
• FIGS. 5A through 5I show perspective views of some designs of the tension elements that can be used in the embodiments disclosed elsewhere in this patent application.
• FIG. 5A shows a perspective view of a tension element comprising a single strand of an untwisted material.
• FIG. 5B shows a perspective view of a tension element comprising one or more serrations or notches.
• FIG. 5C shows a perspective view of a tension element comprising multiple filaments of a material twisted together.
• FIG. 5D shows a perspective view of a tension element comprising a flexible, elastic, spiral or spring element.
• FIG. 5E shows a perspective view of a tension element comprising a screw threading on the outer surface of tension element.
• FIG. 5F shows a perspective view of a tension element comprising a hollow shaft comprising one or more collapsible regions.
• FIG. 5G shows a perspective view of ananchoring device522 comprising a tension element and two anchors.
• FIG. 5H shows a perspective view of a tensioning element device comprising a detachable region.
• FIG. 5I shows a perspective view of a tensioning element comprising telescoping tubes.
• FIGS. 6A through 11B show various examples of anchor designs and/or anchoring device designs.
• FIGS. 6A and 6B show perspective views of two states of a crumpling anchor.
• FIGS. 7A and 7B show sectional views of an undeployed configuration and a deployed configuration respectively of a deployable anchor.
• FIGS. 8A and 8B show sectional views of an undeployed configuration and a deployed configuration respectively of a “T” shaped deployable anchor.
• FIGS. 9A through 9D show various alternate configurations of the anchoring arms inFIGS. 7A and 7B.
• FIGS.10A and10A′ show a distal view and a perspective view respectively of an anchor comprising a spiral element having a three dimensional shape.
• FIGS.10B and10B′ show a distal view and a side view respectively of an anchor comprising a spiral element having a two dimensional shape.
• FIGS.10C and10C′ show a distal view and a perspective view respectively of an anchor comprising one or more circular elements.
• FIG. 10D shows a perspective view of an embodiment of an anchoring device comprising an outer ring.
• FIG. 10E shows a partial perspective view of an anchoring device comprising a hemostatic element.
• FIG. 11A shows a perspective view of a device having a set of anchors comprising a curved sheet.
• FIG. 11B shows a perspective view of a device having a detachable region located on a tensioning element.
• FIGS. 12A through 17I show further examples of anchor designs and/or anchoring device designs.FIG. 12A shows a perspective view of an anchor comprising an arrowhead.
• FIG. 12B shows a crossectional view of an anchor comprising a cup-shaped element that encloses a cavity.
• FIG. 12C shows a perspective view of an anchor comprising a screw.
• FIGS. 13A and 13B show perspective views of an uncollapsed state and a collapsed state respectively of an anchor comprising a collapsible region.
• FIGS. 13C and 13D show perspective views of an undeployed state and a deployed state respectively of an anchor comprising radially spreading arms.
• FIG. 13E shows perspective views of an alternate embodiment of an undeployed state of an anchor comprising radially spreading arms.
• FIGS. 14A and 14B show perspective views of anchoring devices comprising an adhesive delivering element.
• FIGS. 15A and 15B show two configurations of an anchoring device comprising a ratcheted tension element.
• FIG. 16 shows a perspective view of an anchor comprising a trocar lumen.
• FIG. 17A shows a perspective view in the undeployed state of an anchor comprising a rigid or partially flexible T element and a crumpling element.
• FIGS. 17B and 17C show various steps of a method to deploy the anchoring device shown inFIG. 17A.
• FIGS. 17D and 17E show perspective views of an undeployed and deployed configuration of an anchor comprising a rigid or partially flexible T element with one or more openings or perforations.
• FIGS. 17F and 17G show perspective views of an undeployed and deployed configuration of an anchor comprising a stent.
• FIGS. 17H and 17I show perspective views of an undeployed and deployed configuration of an anchor comprising a spring.
• FIGS. 18A through 22E show various embodiments of mechanisms to deploy one or more anchors.FIGS. 18A and 18B show a crossection of an anchor deploying mechanism comprising a screw system.
• FIGS. 19A and 19B show a crossectional view of an anchor deploying system comprising an electrolytic detachment element.
• FIG. 20 shows a perspective view of an anchor deploying system comprising a looped ribbon.
• FIG. 21A shows a crossectional view of an anchor deploying system comprising a locked ball.
• FIGS. 21B and 21C show a method of deploying an anchor comprising a locked ball.
• FIGS. 22A through 22C show various views of an anchor deploying system comprising two interlocking cylinders.
• FIGS. 22D and 22E show the steps of a method of unlocking the two interlocking cylinders from the anchor deploying systems ofFIGS. 22A through 22C.
• FIG. 23A shows a perspective view of a distal end of an anchoring device that has an imaging modality.
• FIGS. 23B through 23G show various steps of a method for compressing an anatomical region using the anchoring device ofFIG. 23A.
• FIGS.24A through24C′ show the device and various steps of a method of compressing an anatomical region using a device with deploying arms deployed through a trocar.
• FIG. 24D shows a crossection through the deployed anchoring device ofFIG. 24A.
• FIG. 25A shows a perspective view of a spring clip that can be used to spread the anatomy.
• FIGS. 25B through 25F show various steps of a method of spreading an anatomical region or regions using the spring clip ofFIG. 25A.
• FIGS. 26A and 26B show a crossectional view and a perspective view respectively of a mechanism of cinching a tension element or tether to an anchor.
• FIGS. 26C and 26D show a partial section through a cinching mechanism comprising a cam element.
• FIG. 26E shows a sectional view of an embodiment of a cinching mechanism comprising a locking ball.
• FIG. 26F shows a side view of an embodiment of a cinching mechanism comprising multiple locking flanges.
• FIG. 26G shows an end view of body ofFIG. 26F.
• FIG. 26H shows a side view of an embodiment of a cinching mechanism comprising a single locking flange.
• FIG. 26I shows an end view of body ofFIG. 26H.
• FIG. 26J shows an end view of a cinching mechanism comprising a crimping lumen.
• FIGS. 26K and 26L show crossections of an embodiment of a cinching mechanism comprising a crimping anchor in the undeployed and deployed configurations respectively.
• FIG. 26M shows a perspective view of an embodiment of a cinching mechanism comprising an element providing a tortuous path to a tension element.
• FIG. 26N shows a crossectional view of an embodiment of a locking mechanism comprising a space occupying anchor securely attached to a tension element.
• FIGS. 26O and 26P shows a partial sectional view and a perspective view of an embodiment of a cinching mechanism comprising a punched disk.
• FIGS. 26Q and 26R show a perspective view of a first embodiment of a cutting device before and after cutting an elongate element.
• FIG. 26S show a crossectional view of a second embodiment of a cutting device for cutting an elongate element.
• FIGS. 27A through 27D show axial sections through the prostate gland showing various configurations of anchoring devices comprising distal anchors and a tension element.
• FIGS. 28 and 28A show perspective views of an embodiment of an anchoring device comprising an elongate element comprising multiple barbs or anchors.
• FIGS. 28B through 28E show a coronal section through the prostate gland showing various steps of a method of treating the prostate gland using the device ofFIG. 28.
• FIG. 29A shows an axial section of the prostate gland showing a pair of implanted magnetic anchors.
• FIGS. 29B through 29D show a coronal section through the prostate gland showing the steps of a method of implanting magnetic anchors ofFIG. 29A.
• FIG. 30A is a coronal sectional view of a portion of the male urogenital system showing a transurethral approach that may be used to perform a prostate cutting procedure of the present invention.
• FIG. 30B is a coronal sectional view of a portion of the male urogenital system showing another transurethral approach that may be used to perform a prostate cutting procedure of the present invention.
• FIG. 30C is a coronal sectional view of a portion of the male urogenital system showing a transurethral/transvesicular approach that may be used to perform a prostate cutting procedure of the present invention.
• FIG. 30D is a coronal sectional view of a portion of the male urogenital system showing another transurethral approach that may be used to perform a prostate cutting procedure of the present invention, wherein a device advances from the urethra, through the prostate gland, and thereafter accesses the prostate capsule from its outer surface.
• FIG. 31 is a coronal sectional view of a portion of the male urogenital system showing a percutaneous/infrapubic approach that may be used to perform a prostate cutting procedure of the present invention.
• FIG. 32 is a coronal sectional view of a portion of the male urogenital system showing a percutaneous/transvesicular approach that may be used to perform a prostate cutting procedure of the present invention.
• FIGS. 33A-33E shows perspective views of various devices that may be included in a system for performing a prostate cutting procedure in accordance with the present invention.
• FIG. 33A shows a perspective view of an introducer device comprising a first tubular element having a working device lumen.
• FIG. 33B shows a perspective view of an injecting needle that may be used for injecting one or more diagnostic or therapeutic substances.
• FIG. 33C shows a perspective view of a guiding device comprising an elongate body comprising a sharp distal tip.
• FIG. 33D shows a perspective view of a RF cutting device
• FIG. 33E shows a perspective view of an embodiment of a plugging device to plug an opening created during a procedure.
• FIGS. 33F through 33N show various alternate embodiments of the electrosurgical cutting device inFIG. 33D.
• FIGS. 33F and 33G show perspective views of the distal region of a first alternate embodiment of an electrosurgical cutting device in the undeployed and deployed states respectively.
• FIGS. 33H and 33I show perspective views of the distal region of a second alternate embodiment of an electrosurgical cutting device in the undeployed and deployed states respectively.
• FIGS. 33J through 33L show perspective views of the distal region of a second alternate embodiment of an electrosurgical cutting device showing the steps of deploying the electrosurgical cutting device.
• FIGS. 33M through 33N show perspective views of the distal region of a third alternate embodiment of an electrosurgical cutting device showing the steps of deploying the electrosurgical cutting device.
• FIG. 34 shows a perspective view of the distal region of a balloon catheter comprising a balloon with cutting blades.
• FIG. 35 shows a perspective view of the distal region of a balloon catheter comprising a balloon with cutting wires.
• FIGS. 36A and 36B series show perspective views of an undeployed state and a deployed state respectively of a tissue displacement device.
• FIGS. 36C and 36D show a coronal view and a lateral view respectively of a pair of deployed tissue displacement devices ofFIGS. 36A and 36B implanted in the prostate gland.
• FIGS. 36E through 36H show an axial section through a prostate gland showing the various steps of a method of cutting or puncturing the prostate gland and lining or plugging the cut or puncture.
• FIGS. 37A through 37K show an embodiment of a method of treating prostate gland disorders by cutting a region of the prostate gland using the devices described inFIGS. 33A through 33E.
• FIGS. 38A to 38D show various components of a kit for treating prostate gland disorders by compressing a region of the prostate gland.
• FIG. 38A shows the perspective view of an introducer device.
• FIG. 38B shows a perspective view of a bridge device
• FIG. 38C shows a perspective view of a distal anchor deployment device
• FIG. 38D shows the proximal anchor delivery tool
• FIG. 38E shows a close-up perspective view ofproximal anchor3833 mounted on proximal anchor delivery tool ofFIG. 38D.
DETAILED DESCRIPTION
• The following detailed description and the accompanying drawings are intended to describe some, but not necessarily all, examples or embodiments of the invention only and does not limit the scope of the invention in any way.
• The following detailed description and the accompanying drawings are intended to describe some, but not necessarily all, examples or embodiments of the invention only and does not limit the scope of the invention in any way.
• A number of the drawings in this patent application show anatomical structures of the male reproductive and/or urinary system. In general, these anatomical structures are labeled with the following reference letters:
• • Urethra UT
  • Urethral Lumen UL
  • Urethral Opening UO
  • Urinary Bladder UB
  • Ureters UR
  • Prostate Gland PG
  • Capsule of Prostate Gland CP
  • Testis TS
  • Vas Deferens VD
• FIG. 1A shows a sagittal section of a male human body through the lower abdomen showing the male urinary tract. The male urinary tract comprises a pair of tubular organs called ureters (UR) that conduct urine produced by the kidneys. The ureters empty into the urinary bladder. The urinary bladder is a hollow muscular organ that temporarily stores urine. It is situated posterior to the pubic bone. The inferior region of the urinary bladder has a narrow muscular opening called the bladder neck which opens into a soft, flexible, tubular organ called the urethra. The muscles around the bladder neck are called the internal urethral sphincter. The internal urethral sphincter is normally contracted to prevent urine leakage. The urinary bladder gradually fills with urine until full capacity is reached, at which point the sphincter relaxes. This causes the bladder neck to open, thereby releasing the urine stored in the urinary bladder into the urethra. The urethra begins at the bladder neck, terminates at the end of the penis, and allows for urine to exit the body.
• The region of the urethra just inferior to the urinary bladder is completely surrounded by the prostate gland. The prostate gland is part of the male reproductive system and is usually walnut shaped. Clinically, the prostate is divided into lobes. The lateral lobes are located lateral to the urethra; the middle lobe is located on the dorsal aspect of the urethra, near the bladder neck. Most commonly in BPH, the lateral lobes become enlarged and act like curtains to close the urethral conduit. Less commonly, the middle lobe grows in size and becomes problematic. Because of its superior location near the bladder neck with respect to the urethra, an enlarged middle lobe acts like a ball valve and occludes fluid passage.
• FIG. 1B shows a coronal section through the lower abdomen of a human male showing a region of the male urinary system. The prostate gland (PG) is located around the urethra at the union of the urethra and the urinary bladder.
• FIGS. 2A through 2H show various alternate approaches to deploy implantable tissue compression device(s) (e.g., one or more clips, anchoring elements, tensioning members, etc.) to compress the prostate gland PG, thereby relieving constriction of the urethra. Specific examples of implantable tissue compression device(s) (e.g., one or more clips, anchoring elements, tensioning members, etc.) useable in this invention are shown in other figures of this patent application and are described more fully herebelow.
• FIG. 2A shows a first trans-urethral approach that may be used to implant tissue compression devices(s) to compress the prostate gland PG. InFIG. 2A, an introducingdevice200 is introduced in the urethra through the urethral opening of the penis. Introducingdevice200 comprises anelongate body202 comprising a lumen that terminates distally in adistal opening204. One or more working device(s)206 is/are then introduced throughdistal opening204 into the urethra. The working device(s)206 penetrate the urethral wall and thereafter one or more lobes of the prostate gland. In some applications of the method, working device(s)206 may further penetrate the prostate capsule and enters the pelvic cavity. Working device(s)206 are also used to deploy and implant implantable tissue compression device(s) (e.g., one or more clips, anchoring elements, tensioning members, etc.) to compress the prostate gland PG, thereby relieving constriction of the urethra.
• FIG. 2B shows a second trans-urethral approach that may be used to implant tissue compression devices(s) to compress the prostate gland PG. InFIG. 2B, an introducingdevice210 is introduced in the urethra through the urethral opening UO of the penis. Introducingdevice210 comprises anelongate body212 comprising a lumen that terminates distally in adistal opening214. One or more working device(s)216 is/are insertable throughdistal opening214 into the urethra. Working device(s)216 penetrate(s) the urethral wall inferior to the prostate gland and enters the pelvic cavity. Thereafter, working device(s)216 penetrate(s) the prostate capsule CP and thereafter one or more lobes of the prostate gland. In some applications of the method the working device(s)216 may further penetrate the urethral wall enclosed by the prostate gland EG and enters the urethral lumen. Working device(s)216 may then be used to deploy and implant implantable tissue compression device(s) (e.g., one or more clips, anchoring elements, tensioning members, etc.) to compress the prostate gland PG, thereby relieving constriction of the urethra.
• FIG. 2C shows a third trans-urethral approach that may be used to implant tissue compression devices(s) to compress the prostate gland PG. InFIG. 2C, an introducingdevice220 is introduced in the urethra through the urethral opening UO of the penis. Introducingdevice220 comprises anelongate body222 comprising a lumen that terminates distally in adistal opening224. Introducingdevice220 is positioned such thatdistal opening224 is located in the urinary bladder UB. Thereafter, a one or more working device(s)226 is/are introduced throughdistal opening224 into the urinary bladder UB. Working device(s)226 penetrate(s) the wall of the urinary bladder UB and thereafter penetrate(s) one or more lobes of the prostate gland PG. In some applications of the method, the working device(s)226 may further penetrate the prostate capsule and enter the pelvic cavity. Working device(s)226 may then be used to deploy and implant implantable tissue compression device(s) (e.g., one or more clips, anchoring elements, tensioning members, etc.) to compress the prostate gland PG, thereby relieving constriction of the urethra.
• FIG. 2D shows a transperineal approach that may be used to implant tissue compression devices(s) to compress the prostate gland PG. InFIG. 2D, an introducingdevice230 is introduced in the pelvic cavity percutaneously through the perineum. Introducingdevice230 comprises anelongate body232 comprising a lumen that terminates distally in adistal opening234. Introducingdevice230 is positioned such thatdistal opening234 is located in the pelvic cavity adjacent to prostate gland. Thereafter, one or more working device(s)236 is/are introduced throughdistal opening234 into the prostate gland PG. Working device(s)236 penetrate(s) the prostate capsule CP and thereafter penetrate(s) one or more lobes of the prostate gland PG. In some applications of the method, the working device(s)236 may further penetrate the urethral wall surrounded by the prostate gland PG and enter the urethral lumen. Workingdevice236 may then be used to deploy and implant implantable tissue compression device(s) (e.g., one or more clips, anchoring elements, tensioning members, etc.) to compress the prostate gland PG, thereby relieving constriction of the urethra.
• FIG. 2E shows a percutaneous/transvesicular approach that may be used to implant tissue compression devices(s) to compress the prostate gland PG. InFIG. 2E, an introducingdevice240 is introduced percutaneously through the abdominal wall. Introducingdevice240 comprises anelongate body242 comprising a lumen that terminates distally in adistal opening244. After passing through the abdominal wall, introducingdevice240 is advanced through the wall of the urinary bladder UB such thatdistal opening244 is located in the urinary bladder UB. Thereafter, one or more working device(s)246 is/are introduced throughdistal opening244 into the urinary bladder UB. One or more working device(s)246 are advanced through the wall of the urinary bladder UB and into the prostate gland PG. In some applications of the method, working device(s)246 may further penetrate through the prostate gland capsule and enter the pelvic cavity. Working device(s)246 is/are then used to deploy and implant implantable tissue compression device(s) (e.g., one or more clips, anchoring elements, tensioning members, etc.) to compress the prostate gland PG, thereby relieving constriction of the urethra.
• FIG. 2F shows a percutaneous trans-osseus approach that may be used to implant tissue compression devices(s) to compress the prostate gland PG. InFIG. 2F, an introducingdevice250 is introduced percutaneously through the abdominal wall. Introducingdevice250 comprises anelongate body252 comprising a lumen that terminates distally in adistal opening254. Introducingdevice250 is used to penetrate a pelvic bone (e.g. the pubic bone PB). Thereafter, introducingdevice250 is positioned such thatdistal opening254 is located adjacent to the prostate gland PG. Thereafter, one or more working device(s)256 is/are introduced throughdistal opening254 into the prostate gland PG. Working device(s)256 penetrate the prostate capsule and thereafter penetrate one or more lobes of the prostate gland PG. In some applications of the method, working device(s)256 may further penetrate the urethral wall surrounded by the prostate gland and enter the urethral lumen. Working device(s)256 is/are then used to deploy and implant implantable tissue compression device(s) (e.g., one or more clips, anchoring elements, tensioning members, etc.) to compress the prostate gland PG, thereby relieving constriction of the urethra.
• FIG. 2G shows a percutaneous suprapubic approach that may be used to implant tissue compression devices(s) to compress the prostate gland PG. InFIG. 2G, an introducingdevice260 is introduced in the pelvic cavity percutaneously in a trajectory that passes superior to the pubis bone. Introducingdevice260 comprises anelongate body262 comprising a lumen that terminates distally in adistal opening264. Introducingdevice260 is then positioned such thatdistal opening264 is located in the pelvic cavity adjacent to prostate gland. Thereafter, one or more working device(s)266 is/are introduced throughdistal opening264 into the prostate gland PG. Working device(s)266 penetrate the prostate capsule CP and thereafter penetrate one or more lobes of the prostate gland PG. In some applications of the method, working device(s)266 may further penetrate the urethral wall surrounded by the prostate gland and enter the urethral lumen. Working device(s)266 is/are then used to deploy and implant implantable tissue compression device(s) (e.g., one or more clips, anchoring elements, tensioning members, etc.) to compress the prostate gland PG, thereby relieving constriction of the urethra.FIG. 2H shows a percutaneous infrapubic approach that may be used to implant tissue compression devices(s) to compress the prostate gland. InFIG. 2H, an introducingdevice270 is introduced in the pelvic cavity percutaneously in a trajectory that passes inferior to the pubis bone. Introducingdevice270 comprises anelongate body272 comprising a lumen that terminates distally in adistal opening274. Introducingdevice270 is introduced percutaneously in the pelvic cavity in a trajectory that passes inferior to the pubic bone. Introducingdevice270 is then positioned such thatdistal opening274 is located in the pelvic cavity adjacent to prostate gland. Thereafter, one or more working device(s)276 is/are introduced throughdistal opening274 into the prostate gland PG. Working device(s)276 penetrate the prostate capsule CP and thereafter penetrate one or more lobes of the prostate gland PG. In some applications of the method, working device(s)276 may further penetrate the urethral wall surrounded by the prostate gland PG and enter the urethral lumen. Working device(s)276 is/are then used to deploy and implant implantable tissue compression device(s) (e.g., one or more clips, anchoring elements, tensioning members, etc.) to compress the prostate gland PG, thereby relieving constriction of the urethra.
• FIG. 2I shows a trans-rectal approach that may be used to implant tissue compression devices(s) to compress the prostate gland PG. InFIG. 2I, an introducingdevice280 is introduced in the rectum. Introducingdevice280 comprises anelongate body282 comprising a lumen that terminates distally in adistal opening284. Introducing device is then advanced such that it penetrates the rectal wall and enters the pelvic cavity. Introducingdevice280 is then positioned such thatdistal opening284 is located in the pelvic cavity adjacent to prostate gland. Thereafter, one or more working device(s)286 is/are introduced throughdistal opening284 into the prostate gland PG. Working device(s)286 penetrate the prostate capsule CP and thereafter penetrate one or more lobes of the prostate gland. In some applications of the method, working device(s)286 may further penetrate the urethral wall surrounded by the prostate gland and enter the urethral lumen. Working device(s)286 is/are then used to deploy and implant implantable tissue compression device(s) (e.g., one or more clips, anchoring elements, tensioning members, etc.) to compress the prostate gland PG, thereby relieving constriction of the urethra.
• FIGS. 3A to 3F show various examples of devices and systems that are useable to treat conditions where the prostate gland PG is compressing a region of the urethra such that the urethra does not expand normally during micturition and urine outflow is impeded.
• FIG. 3A shows the perspective view of anintroducer device300.Introducer device300 comprises anouter body301 constructed from suitable biocompatible materials including, but not limited to Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, metals like stainless steel and fluoropolymers like PTFE, PFA, FEP, EPTFE etc.Body301 comprises a workingdevice lumen302. Distal end of workingdevice lumen302 emerges out of the distal end ofbody301. In one embodiment, distal end of workingdevice lumen302 has a bent or curved region. Proximal end of workingdevice lumen302 emerges out of a firstflexible tube304. The proximal end of firstflexible tube304 comprises astasis valve306.Body301 further comprises acystoscope lumen308. Distal end ofcystoscope lumen308 emerges out of the distal end ofbody301. Proximal end ofcystoscope lumen308 emerges out of a secondflexible tube310. The proximal end of secondflexible tube310 comprises astasis valve312.Cystoscope lumen308 may comprise one or more side ports e.g. afirst side port318 for the introduction or removal of one or more fluids. Workingdevice lumen302 may comprise one or more side ports e.g. asecond side port320 for the introduction or removal of one or more fluids.
• FIG. 3B shows a perspective view of an injecting needle. Injectingneedle330 is used for injecting one or more diagnostic or therapeutic substances. In some applications of the invention, the injectingneedle330 may be used to inject local anesthetic in the urethra, prostate gland and/or tissues near the prostate gland. Specific examples of target areas for injecting local anesthetics are the neurovascular bundles, the genitourinary diaphragm, the region between the rectal wall and prostate, etc. Examples of local anesthetics that can be injected by injectingneedle330 are anesthetic solutions e.g. 1% lidocaine solution; anesthetic gels e.g. lidocaine gels; combination of anesthetic agents e.g. combination of lidocaine and bupivacaine; etc. Injectingneedle330 comprises ahollow shaft332 made of suitable biocompatible materials including, but not limited tostainless steel 304,stainless steel 306, Nickel-Titanium alloys, titanium etc. In this example, the distal end ofhollow shaft332 comprises asharp tip334. The proximal end ofhollow shaft332 has aneedle hub336 made of suitable biocompatible materials including, but not limited to metals e.g.stainless steel 304,stainless steel 306, Nickel-Titanium alloys, titanium etc.; polymers e.g. polypropylene, Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, PTFE, PFA, FEP, EPTFE etc. In one embodiment,needle hub336 comprises a luer lock.
• FIG. 3C shows an example of an introducing device or introducingsheath340. Introducingsheath340 comprises a hollow,tubular body342 made of suitable biocompatible materials including, but not limited to metals e.g.stainless steel 304,stainless steel 306, Nickel-Titanium alloys, titanium etc. or polymers e.g. Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, PTFE, PFA, FEP, EPTFE etc.Tubular body342 further comprises two marker bands: aproximal marker band344 and adistal marker band346. The marker bands can be seen by a cystoscope. In one embodiment,proximal marker band344 anddistal marker band346 are radiopaque. The position ofproximal marker band344 anddistal marker band346 is such that after introducingsheath340 is placed in an optimum location in the anatomy,proximal marker band344 is located in the urethra where it can be seen by a cystoscope anddistal marker band346 is located in the prostrate gland or in the wall of the urethra where it cannot be seen by a cystoscope.Tubular body342 further comprises a series ofdistance markers348 on the outer surface oftubular body342. The proximal end oftubular body342 further comprises ahub350 made of suitable biocompatible materials including, but not limited to metals e.g.stainless steel 304,stainless steel 306, Nickel-Titanium alloys, titanium etc. or polymers e.g. Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, PTFE, PFA, FEP, EPTFE etc. In one embodiment,hub350 comprises a luer lock.
• FIG. 3D shows a perspective view of a trocar.Trocar360 comprises atubular trocar body362. The proximal end oftrocar body362 comprises ahub364.Trocar body362 and hub can be constructed from suitable biocompatible materials including, but not limited to metals e.g.stainless steel 304,stainless steel 306, Nickel-Titanium alloys, titanium etc. or polymers e.g. Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, PTFE, PFA, FEP, EPTFE etc. Distal end oftrocar body362 ends in asharp trocar tip366.
• FIG. 3E shows a perspective view of an anchor delivery device.Anchor delivery device370 comprises abody372 having a distal opening373. A section of the distal region ofbody372 has been removed to show a view of the anchor assembly.Body372 encloses adistal anchor374 and aproximal anchor376.Proximal anchor376 anddistal anchor374 can have a variety of designs including, but not limited to the designs disclosed elsewhere in this patent application.Proximal anchor376 anddistal anchor374 can be constructed from suitable biocompatible materials including, but not limited to metals e.g.stainless steel 304,stainless steel 306, Nickel-Titanium alloys, titanium etc. or polymers e.g. Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, PTFE, PFA, FEP, EPTFE etc. In one embodiment, shown inFIGS. 3F and 3G, proximal anchor9976 and distal anchor9974 comprise splayable elements that expand in a radially outward direction when a radial compression force, as enacted by body lumen9972, on proximal anchor9976 and distal anchor9974 is removed. The splayable elements can be made of suitable super-elastic materials such as Nickel-Titanium alloys etc. Proximal anchor9976 and distal anchor9974 are connected to each other by a tension element9978. Tension element9978 can be made of suitable elastic or non-elastic materials including, but not limited to metals e.g.stainless steel 304,stainless steel 306, Nickel-Titanium alloys, suture materials, titanium etc. or polymers such as silicone, nylon, polyamide, polyglycolic acid, polypropylene, Pebax, PTFE, ePTFE, silk, gut, or any other braided or mono-filament material. Tension element9978 can have a variety of designs including the designs shown inFIGS. 5A through 5F. As shown inFIG. 3E, the proximal end of proximal anchor9976 is connected by an attachment mechanism9980 to a torquable shaft9982. The proximal end of torquable shaft9982 is attached to a control button9984. Control button9984 can be used to deploy proximal anchor9976 by sliding control button9984 along groove9985 in the distal direction. Control button9984 is then used to deploy distal anchor9974 by turning control button9984 in the circumferential direction along groove9985.
• FIG. 3H shows a perspective view from the proximal direction of a particular embodiment of the attachment mechanism ofFIG. 3E.Attachment mechanism380 comprises acircular plate386 made from suitable biocompatible materials including, but not limited to metals e.g.stainless steel 304,stainless steel 306, Nickel-Titanium alloys, titanium etc. or polymers e.g. Polycarbonate, PVC, Pebax, Polyimide, Polyurethane, Nylon, Hytrel, HDPE, PEEK, PTFE, PFA, FEP etc. The proximal face ofcircular plate386 is connected totorquable shaft382.Circular plate386 further comprises asemicircular groove388. One end ofsemicircular groove388 comprises anenlarged region390. Aknob392 located on the proximal portion ofproximal anchor376 slides onsemicircular groove388. The size of knob322 is larger than the size ofsemicircular groove388 but smaller than size ofenlarged region390. This keepsproximal anchor376 attached tocircular plate386. Whencontrol button384 is turned in the circumferential direction along groove385,torquable shaft382 is turned. This turnscircular plate386 causingknob392 to slide on thegroove388. Ultimately,knob392 reaches enlargedregion390. This releasesknob392 fromcircular plate386 thereby releasingproximal anchor376 fromanchor delivery device370.
• FIGS. 4A through 4H show a coronal section through the prostate gland showing the various steps of a method of treating prostate gland disorders by compressing a region of the prostate gland using the kit shown inFIGS. 3A through 3F. InFIG. 4A,introducer device300 is introduced in the urethra through the urethral opening at the tip if the penis. A cystoscope is inserted inintroducer device300 throughcystoscope lumen308 such that the lens of the cystoscope is located in the distal opening of cystoscope lumen. The cystoscope is used to navigateintroducer device300 through the urethra such that the distal region ofintroducer device300 is located in a target region in the prostatic urethra. Thereafter inFIG. 4B, injectingneedle330 is advanced through workingdevice lumen302 such that the distal tip of injectingneedle330 penetrates into a region of the urethral wall or the prostate gland. Injectingneedle330 is then used to inject one or more diagnostic or therapeutic agents into the urethral wall or the prostate gland. This step may be repeated one or more times to inject one or more diagnostic or therapeutic agents in one or more regions of the urethral wall and/or the prostate gland. In one method embodiment, injectingneedle330 is used to inject an anesthetic in one or more regions of the urethral wall and/or the prostate gland. In another embodiment, injectingneedle330 is used to deliver energy in the form of radiofrequency energy, resistive heating, laser energy, microwave energy etc. In another embodiment, injectingneedle330 is used to deliver alpha antagonist agents, such as phenoxybenzamine, prazosin, doxazosin, terazosin, tamsulosin, alfuzosin etc. In another embodiment, injectingneedle330 is used to deliver anti-androgen, such as flutamide or 5-alpha reductase inhibitors, such as finasteride, dutasteride, 3-oxosteroid compounds, 4-aza-3-oxosteroid derivatives of testosterone etc. In another embodiment, injectingneedle330 is used to deliver anti-inflammatory agents, such as rapamycin, paclitaxel, ABT-578, everolimus, taxol etc. In another embodiment, injectingneedle330 is used to deliver ablative agents such as methyl alcohol etc.
• In another embodiment, injectingneedle330 is used to deliver energy in the form of radiofrequency energy, resistive heating, laser energy, microwave energy etc. In another embodiment, injectingneedle330 is used to deliver alpha antagonist agents, such as phenoxybenzamine, prazosin, doxazosin, terazosin, tamsulosin, alfuzosin etc. In another embodiment, injectingneedle330 is used to deliver anti-androgen, such as flutamide or 5-alpha reductase inhibitors, such as finasteride, dutasteride, 3-oxosteroid compounds, 4-aza-3-oxosteroid derivatives of testosterone etc. In another embodiment, injectingneedle330 is used to deliver anti-inflammatory agents, such as rapamycin, paclitaxel, ABT-578, everolimus, taxol etc. In another embodiment, injectingneedle330 is used to deliver ablative agents such as methyl alcohol etc.
• In step4C, injectingneedle330 is withdrawn fromintroducer device300. Thereafter,introducer sheath340 andtrocar360 are advanced through workingdevice lumen302. In the example shown,introducer sheath340 andtrocar360 are advanced till the distal tip oftrocar360 penetrates the capsule of the prostate gland and the distal end ofintroducer sheath340 is located outside the prostate gland in the pelvic cavity. Thereafter,trocar360 is withdrawn from workingdevice lumen302 leavingintroducer sheath340 in place. InFIG. 4D,anchor delivery device370 is introduced through the lumen ofintroducer sheath340 till the distal end ofbody372 protrudes through the distal tip ofintroducer sheath340. In step4E,distal anchor374 is deployed. It should be noted that the anchor may be carried to the site and deployed from within an introducer, on the outside of an introducer, or it may be the distal tip of the introducer itself. Thereafter, anchor deliverdevice370 is pulled in the proximal direction along withintroducer sheath340 so thatdistal anchor374 is anchored on the outer surface of the prostate capsule. This step may be used to create tension in thetension element378. In one method embodiment, anchor deliverdevice370 is pulled in the proximal direction along withintroducer sheath340 such that the distal end ofanchor delivery device370 is located in the prostate gland. In another method embodiment, anchor deliverdevice370 is pulled in the proximal direction along withintroducer sheath340 till the distal end ofanchor delivery device370 is located in the urethral wall or the urethral lumen. In step4F,proximal anchor376 is deployed.Proximal anchor376 may be deployed in the prostate gland, in the urethral wall or in the urethral lumen.Proximal anchor376 is still attached byattachment mechanism380 to anchordelivery device370. The proximal anchor may be pre-loaded on the tension element, or may subsequently be loaded by the operator on the tension element.FIGS. 4G through 4H show the steps of deployingproximal anchor376 in the prostate gland. InFIG. 4G,proximal anchor376 is separated fromanchor delivery device370. This separation may be achieved via numerous means including cutting, melting, un-locking a link, or breaking the tensioning element at a desired location. Ideally this residual end of the tensioning element will not protrude substantially into the lumen of the urethra. Thusproximal anchor376 anddistal anchor374 are anchored in the anatomy. Thereafter,anchor delivery device370 andintroducer sheath340 are both pulled in the proximal direction and are withdrawn intointroducer device300. Thereafter,introducer device300 is pulled in the proximal direction to pull it out of the urethra. InFIG. 4H, the steps fromFIGS. 4A through 4G are repeated in a second region of the prostate gland if desired to implant two or more sets of anchoring devices.
• Alternatively, FIGS.4G′ through4H′ show the steps of deployingproximal anchor376 in the urethra. After the step inFIG. 4F, in FIG.4G′,proximal anchor376 is separated fromanchor delivery device370 in the urethra. Thusproximal anchor376 anddistal anchor374 are anchored in the urethra and the prostate capsule respectively. Thereafter,anchor delivery device370 andintroducer sheath340 are both pulled in the proximal direction and are withdrawn intointroducer device300. Thereafter,introducer device300 is pulled in the proximal direction to pull it out of the urethra. In FIG.4H′, the steps from FIGS.4A through4G′ are repeated optionally in a second region of the prostate gland to implant two or more sets of anchoring devices. It should be understood that this method and devices may be applied to any lobe (middle or lateral lobes) of the prostate and further more may be used multiple times in the same lobe to achieve the desired effect.
• FIG.4H″ shows a coronal section through the prostate gland showing the final deployed configuration of an embodiment of bone anchoring devices for treating prostate gland disorders by compressing a region of the prostate gland. In the method of deploying this device,introducer sheath340 andtrocar360 are advanced till the distal tip oftrocar360 penetrates a bone in the abdomen (e.g. the pelvic bone, etc.) and the distal end ofintroducer sheath340 is located outside the bone. Thereafter,trocar360 is withdrawn from workingdevice lumen302 leavingintroducer sheath340 in place. Thereafter,anchor delivery device370 is introduced through the lumen ofintroducer sheath340 until the distal end ofbody372 touches the bone through the distal tip ofintroducer sheath340. Thereafter,distal anchor374 is implanted in the bone.Distal anchor374 may comprise a variety of designs including, but not limited to designs of distal tips of Kirschner wires. Examples of such Kirschner wire distal tips are spiral drill tips, lancer tips, threaded trocar tips, lengthwise knurled tips, 3-sided trocar tips, 4-sided trocar tips, Thereafter, anchor deliverdevice370 is pulled in the proximal direction along withintroducer sheath340. This step creates tension in thetension element378. In another method embodiment, anchor deliverdevice370 is pulled in the proximal direction along withintroducer sheath340 till the distal end ofanchor delivery device370 is located in the urethral wall or the urethral lumen. The remaining method steps are similar to steps4F through4H.
• One or more anchors disclosed in this patent application may be implanted in anatomical locations that include, but are not limited to:
• • a location within prostatic lobe;
  • a location within peripheral zone of prostate;
  • a location within prostatic capsule;
  • a location between prostatic capsule and pubic fascia;
  • a location within the pubic fascia;
  • a location within the levator ani muscle
  • a location within the obturator internus muscle;
  • a location within the pelvic bone;
  • a location within the periostium of pelvic bone;
  • a location within the pubic bone;
  • a location within the periostium of pubic bone;
  • a location within the symphysis pubica;
  • a location within the urinary bladder wall;
  • a location within the ischiorectal fossa;
  • a location within the urogenital diaphragm; and
  • a location within the abdominal fascia.
• FIGS. 4I and 4J show a crossection of the urethra through the prostate gland PG showing the appearance of the urethral lumen before and after performing the method shown inFIGS. 4A through 4H.FIG. 4I shows a crossection of the urethra through the prostate gland showing the appearance of the urethral lumen in a patient with BPH.FIG. 4J shows a crossection of the urethra through the prostate gland PG showing the appearance of the urethral lumen after performing the procedure shown inFIGS. 4A through 4H. The urethral lumen shown inFIG. 4I is larger than the urethral lumen inFIG. 4J.
• FIGS. 5A through 5F show perspective views of some designs of the tension elements that can be used in the embodiments disclosed elsewhere in this patent application.FIG. 5A shows a perspective view of atension element500 comprising a single strand of an untwisted material. Examples of materials that can be used to manufacturetension element500 include but are not limited to synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc.FIG. 5B shows a perspective view of atension element502 comprising one ormore serrations504 or notches.Serrations504 may be aligned in a particular direction to allow relatively easy movement of an outer body alongtension element502 in one direction and offer significant resistance to movement of the outer body along the tension element in the other direction.FIG. 5C shows a perspective view of atension element506 comprisingmultiple filaments507 of a material twisted together. Examples of materials that can be used include to manufacturemultiple filaments507 include but are not limited to synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc.multiple filaments507 may be coated with acoating508 including, but not limited to a lubricious coating, antibiotic coating, etc. It is also possible for the tension element to comprise a composite braided structure in a plastic/metal or plastic/plastic configuration to reduce profile and increase strength. Such materials could have preset levels of elasticity and non-elasticity.FIG. 5D shows a perspective view of atension element509 comprising a flexible, elastic, spiral or spring element. Examples of materials that can be used include to manufacturetension element509 include but are not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.FIG. 5E shows a perspective view of atension element510 comprising a screw threading511 on the outer surface oftension element510. Screw threading511 enablestension element510 to be screwed through an outer element to advance or withdraw tension element through the outer element.FIG. 5F shows a perspective view of atension element512 comprising ahollow shaft514 comprising one or morecollapsible regions516. Acollapsible region516 comprises one ormore windows518.Windows518 are cut inhollow shaft514 in such a way that several thin,collapsible struts520 are created betweenadjacent windows518. Whentension element512 is compresses along its length,collapsible struts520 are deformed in the radially outward direction to create one or more anchoring regions.
• FIG. 5G shows a perspective view of ananchoring device522 comprising a tension element and two anchors. Distal end of atension element524 is attached to adistal anchor526. Proximal end oftension element524 is attached to aproximal anchor528.
• FIG. 5H shows a perspective view of a tensioning element device comprising a detachable region. Anchoringdevice530 comprises afirst anchor532 and asecond anchor534.First anchor532 andsecond anchor534 may comprise a variety of anchor designs disclosed elsewhere in this patent application. In one embodiment, one or both offirst anchor532 andsecond anchor534 comprise a substantially flat plate. The substantially flat plate may be made from various materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.; synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc.First anchor532 andsecond anchor534 are connected to a tensioning element. The tensioning element comprises two flexible members: afirst tensioning member536 and asecond tensioning member538. The distal end offirst tensioning member536 is connected tofirst anchor532 and the proximal end ofsecond tensioning member538 is connected tosecond anchor534. Proximal end offirst tensioning member536 and distal end ofsecond tensioning member538 are connected to areleasable member540.Releasable member540 can be releasably connected to a deploying device. In one embodiment of a method usinganchoring device530,first anchor532 is deployed out of an anatomical tissue (e.g. the prostate gland) into a first anatomical cavity (e.g. the pelvic cavity). Thereafter,second anchor534 is deployed into a second anatomical cavity (e.g. the urethral lumen). Thereafter,releasable member540 is released from the deploying device to deliveranchoring device530 in a target region.
• FIG. 5I shows a perspective view of a tensioning element comprising telescoping tubes. Tensioningelement544 may comprise two or more telescoping tubes. In this example, tensioningelement544 comprises three telescoping tubes: afirst telescoping tube546, asecond telescoping tube548 and athird telescoping tube550.Second telescoping tube548 slidably fits into a lumen offirst telescoping tube546. Similarlythird telescoping tube550 slidably fits into a lumen ofsecond telescoping tube548. The telescoping tubes have a locking mechanism to prevent a telescoping tube from completely disengaging from another telescoping tube. The telescoping tubes may be made from a variety of biocompatible materials including, but not limited to plastics, metals etc.
• All the components of the systems disclosed herein (including but not limited to the tensioning elements, inner and outer anchor members) may be coated or embedded with therapeutic or diagnostic substances (e.g., drugs or therapeutic agents) or such therapeutic or diagnostic substances may be introduced into or near the prostate or adjacent tissue through a catheter, cannula needles, etc. Examples of therapeutic and diagnostic substances that may be introduced or eluted include but are not limited to: hemostatic agents; antimicrobial agents (antibacterials, antibiotics, antifungals, antiprotozoals; antivirals; antimicrobial metals (e.g., silver, gold, etc.); hemostatic and/or vasoconstricting agents (e.g., pseudoephedrine, xylometazoline, oxymetazoline, phenylephrine, epinephrine, cocaine, etc.); local anesthetic agents (lidocaine, cocaine, bupivacaine,); hormones; anti-inflammatory agents (steroidal and non-steroidal); hormonally active agents; agents to enhance potency; substances to dissolve, degrade, cut, break, weaken, soften, modify or remodel connective tissue or other tissues; (e.g., enzymes or other agents such as collagenase (CGN), trypsin, trypsin/EDTA, hyaluronidase, and tosyllysylchloromethane (TLCM)); chemotherapeutic or antineoplastic agents; substances that prevent adhesion formation (e.g., hyaluronic acid gel); substances that promote desired tissue ingrowth into an anchoring device or other implanted device; substances that promote or facilitate epithelialization of the urethra or other areas; substances that create a coagulative lesion which is subsequently resorbed causing the tissue to shrink; substances that cause the prostate to decrease in size; phytochemicals that cause the prostate to decrease in size; alpha-1a-adrenergic receptor blocking agents; 5-alpha-reductase inhibitors; smooth muscle relaxants; agents that inhibit the conversion of testosterone to dihydrotestosterone, etc. Specific examples of antitumor agents (e.g., cancer chemotherapeutic agents, biological response modifiers, vascularization inhibitors, hormone receptor blockers, cryotherapeutic agents or other agents that destroy or inhibit neoplasia or tumorigenesis) that may be delivered in accordance with the present invention include but are not limited to; alkylating agents or other agents which directly kill cancer cells by attacking their DNA (e.g., cyclophosphamide, isophosphamide), nitrosoureas or other agents which kill cancer cells by inhibiting changes necessary for cellular DNA repair (e.g., carmustine (BCNU) and lomustine (CCNU)), antimetabolites and other agents that block cancer cell growth by interfering with certain cell functions, usually DNA synthesis (e.g., 6 mercaptopurine and 5-fluorouracil (5FU), antitumor antibiotics and other compounds that act by binding or intercalating DNA and preventing RNA synthesis (e.g., doxorubicin, daunorubicin, epirubicin, idarubicin, mitomycin-C and bleomycin) plant (vinca) alkaloids and other anti-tumor agents derived from plants (e.g., vincristine and vinblastine), steroid hormones, hormone inhibitors, hormone receptor antagonists and other agents which affect the growth of hormone-responsive cancers (e.g., tamoxifen, herceptin, aromatase inhibitors such as aminoglutethamide and formestane, triazole inhibitors such as letrozole and anastrazole, steroidal inhibitors such as exemestane), antiangiogenic proteins, small molecules, gene therapies and/or other agents that inhibit angiogenesis or vascularization of tumors (e.g., meth-1, meth-2, thalidomide), bevacizumab (Avastin), squalamine, endostatin, angiostatin, Angiozyme, AE-941 (Neovastat), CC-5013 (Revimid), medi-522 (Vitaxin), 2-methoxyestradiol (2ME2, Panzem), carboxyamidotriazole (CAI), combretastatin A4 prodrug (CA4P), SU6668, SU11248, BMS-275291, COL-3, EMD 121974, IMC-1C11, IM862, TNP-470, celecoxib (Celebrex), rofecoxib (Vioxx), interferon alpha, interleukin-12 (IL-12) or any of the compounds identified in Science Vol. 289, Pages 1197-1201 (Aug. 17, 2000) which is expressly incorporated herein by reference, biological response modifiers (e.g., interferon, bacillus calmette-guerin (BCG), monoclonal antibodies, interluken 2, granulocyte colony stimulating factor (GCSF), etc.), PGDF receptor antagonists, herceptin, asparaginase, busulphan, carboplatin, cisplatin, carmustine, chlorambucil, cytarabine, dacarbazine, etoposide, flucarbazine, fluorouracil, gemcitabine, hydroxyurea, ifosphamide, irinotecan, lomustine, melphalan, mercaptopurine, methotrexate, thioguanine, thiotepa, tomudex, topotecan, treosulfan, vinblastine, vincristine, mitoazitrone, oxaliplatin, procarbazine, streptocin, taxol, taxotere, analogs/congeners and derivatives of such compounds as well as other antitumor agents not listed here.
• Additionally or alternatively, in some applications such as those where it is desired to grow new cells or to modify existing cells, the substances delivered in this invention may include cells (mucosal cells, fibroblasts, stem cells or genetically engineered cells) as well as genes and gene delivery vehicles like plasmids, adenoviral vectors or naked DNA, mRNA, etc. injected with genes that code for anti-inflammatory substances, etc., and, as mentioned above, macrophages or giant cells that modify or soften tissue when so desired, cells that participate in or effect the growth of tissue.
• FIGS. 6A through 11B show various examples of anchor designs and/or anchoring device designs.FIGS. 6A and 6B show examples of acrumpling anchor600. InFIG. 6A, crumplinganchor600 comprises a substantially flattenedbody602.Body602 can be made of a variety of materials including, but not limited to synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc. Further, in any of the implantable tissue compression devices, any or all of the anchors, the tensioning element(s) and any other components may be coated, impregnated, embedded or otherwise provided with substance(s) (e.g., drugs, biologics, cells, etc.) to reduce the likelihood of infection, inflammation, treat the prostatic adenoma directly or enhance the likelihood of endothelialization, deter adhesion formation, promote healing or otherwise improve the likelihood or degree of success of the procedure. Such substance(s) may be released primarily at the time of delivery or may be released over a sustained period. Examples of such substances are listed above and include but are not limited to certain metals with bacteriostatic action (i.e. silver, gold, etc.), antibiotics, antifungals, hemostatic agents (i.e. collagen, hyaluronic acid, gelfoam, cyano-acrylate, etc.), anti-inflammatory agents (steroidal and non-steroidal), hormonally active agents, stem cells, endothelial cells, genes, vectors containing genes, etc.Body602 may be non-woven or woven.Body602 may have a variety of shapes including, but not limited to square, rectangular, triangular, other regular polygonal, irregular polygonal, circular etc.Body602 may have a substantially one dimensional, two dimensional or three dimensional shape. The material chosen for this device may have hemostatic properties to reduce bleeding from the implantation tract or site. Distal end ofbody602 is connected to the distal end oftension element604.Body602 further comprises one or more attachment means606. Attachment means are used to create a channel in thebody602 through whichtension element604 passes. Crumplinganchor600 is introduced through a region of tissue (e.g. through prostate gland tissue) into a cavity or lumen e.g. pelvic cavity, urethral lumen etc. InFIG. 6B,tension element604 is pulled in the proximal direction. The causes crumpling (e.g., collapsing) of the crumplinganchor600 between the tissue and the distal end oftension element604. This process preventstension element604 in the tissue and prevents further movement oftension element604 in the proximal direction.
• FIGS. 7A and 7B show an example of adeployable anchor700 in an undeployed configuration and a deployed configuration, respectively. Thisdeployable anchor700 comprises one or more anchoringarms702. Anchoringarms702 may be made from a variety of elastic, super-elastic or shape memory materials etc. Typical examples of such materials include but are not limited to metals e.g. stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc. Anchoringarms702 are connected to acentral hub704. Central hub in turn is connected to the distal end of atension element706. InFIG. 7A, anchoringarms702 are folded inside a hollow deployingsheath708. This reduces the undeployed diameter of anchoringarms702 and also prevents unwanted anchoring of anchoringarms702. InFIG. 7B, deployingsheath708 is pulled in the proximal direction. This releases anchoringarms702 from the distal end of deployingsheath702. This causes anchoringarms702 to open in the radially outward direction.Anchor700 can then anchor to tissue and resist movement oftension element706 in the proximal direction.
• FIGS. 8A and 8B show sectional views of an undeployed configuration and a deployed configuration respectively of a “T” shaped deployable anchor. Anchor8110 comprises anelongate region802.Elongate region802 may be made from a variety of elastic, super-elastic or shape memory materials etc. Typical examples of such materials include but are not limited to metals e.g. stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc; polymers e.g. polypropylene, Teflon etc. Middle section ofelongate region802 is connected to the distal end of atension element804 to form a “T” shaped anchor. In one embodiment, middle section ofelongate region802 is connected to the distal end of atension element804 by a hinge. InFIG. 8A,elongate region802 is folded inside a hollow deployingsheath806. This reduces the undeployed diameter of the distal region of anchor8110 and also prevents unwanted anchoring ofelongate region802 to tissue. InFIG. 8B, deployingsheath806 is pulled in the proximal direction. This releaseselongate region802 from the distal end of deployingsheath806. This in turn causeselongate region802 to twist and orient itself perpendicular to the distal end of atension element804.Anchor800 can then anchor to tissue and resist movement oftension element804 in the proximal direction.
• Anchoringarms702 inFIGS. 7A and 7B can have a variety of configurations including, but not limited to configurations shown inFIGS. 9A through 9D.FIG. 9A shows a distal end view of an embodiment of an anchor comprising two triangular arms.Anchor900 comprises twoanchor arms902.Anchor arms902 can be made of a variety of materials including, but not limited to metals e.g. stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc; polymers e.g. polypropylene, Teflon etc.Anchor arms902 are connected to atension element904. In one embodiment, anchorarms902 are connected to a central hub, which in turn is connected totension element904. The arms in each of these devices may be folded or contained prior to deployment through the use of a sheath or grasping or mounting device.FIG. 9B shows a distal end view of an embodiment of an anchor comprising four rectangular arms.Anchor906 comprises fouranchor arms908.Anchor arms908 can be made of a variety of materials including, but not limited to metals e.g. stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc; polymers e.g. polypropylene, Teflon etc.Anchor arms908 are connected to atension element910. In one embodiment, anchorarms908 are connected to a central hub, which in turn is connected totension element910.FIG. 9C shows a distal end view of an embodiment of an anchor comprising a mesh or a woven material.Anchor912 comprises fouranchor arms914.Anchor arms914 can be made of a variety of materials including, but not limited to metals e.g. stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc; polymers e.g. polypropylene, Teflon etc.Anchor arms914 are connected to atension element916. In one embodiment, anchorarms914 are connected to a central hub, which in turn is connected totension element916. A layer ofporous material918 is located betweenanchor arms914.Porous material918 comprises a plurality of pores that allow for tissue ingrowth.Porous material918 may also help to distribute the pressure onanchor arms914 over a wider area.Porous material918 can be made of variety of materials including, but not limited to synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc.Porous material918 may be non-woven or woven. Any of the arms or struts in one or more anchoring devices may comprise bent or curved regions. For example,FIG. 9D shows a distal end view of an embodiment of an anchor comprising four curved arms.Anchor920 comprises fourcurved anchor arms922.Curved anchor arms922 can be made of a variety of materials including, but not limited to metals e.g. stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc; polymers e.g. polypropylene, Teflon etc.Curved anchor arms922 are connected to atension element924. In one embodiment,curved anchor arms922 are connected to a central hub which in turn is connected totension element924.
• FIG. 10A shows a distal end view of an anchor comprising a spiral element having a three dimensional shape.Anchor1000 comprises a threedimensional spiral element1002. Diameter ofspiral element1002 may be substantially constant or may substantially vary along the length ofspiral element1002.Spiral element1002 may be made of an elastic, super-elastic or shape memory materials.Spiral element1002 may be made of a variety of materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.; synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc.Spiral element1002 is connected to acentral hub1004, which in turn is connected to a tension element. In one embodiment,spiral element1002 is directly connected to a tension element without usingcentral hub1004. FIG.10A′ shows a side view of the anchor inFIG. 10A. FIG.10A′ showsanchor1000 comprisingspiral element1002 connected tocentral hub1004 which in turn is connected to atension element1006.FIG. 10B shows a distal end view of an anchor comprising a spiral element having a two dimensional shape.Anchor1000 comprises a twodimensional spiral element1010.Spiral element1010 may be made of an elastic, super-elastic or shape memory materials.Spiral element1010 may be made of a variety of materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.; synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc.Spiral element1010 is connected to acentral hub1012 which in turn is connected to a tension element. In one embodiment,spiral element1010 is directly connected to a tension element without usingcentral hub1012. FIG.10B′ shows a side view of the anchor inFIG. 10B. FIG.10B′ shows anchor1008 comprisingspiral element1010 connected tocentral hub1012 which in turn is connected to atension element1014.FIG. 10C shows a distal end view of an anchor comprising one or more circular elements. InFIG. 10C,anchor1016 comprises an innercircular element1018 and an outercircular element1020. A series of radial arms or struts1022 connect innercircular element1018 to outercircular element1020 and to acentral hub1024.Central hub1024 may have alumen1026.Anchor1016 may be substantially two dimensional or three dimensional. FIG.10C′ shows a perspective view of the anchor inFIG. 10C. FIG.10C′ shows ananchor1016 comprising an innercircular element1018, an outercircular element1020 and series of radial arms or struts1022 connecting innercircular element1018 to outercircular element1020 and to acentral hub1024.Central hub1024 is connected to a tension element.
• FIG. 10D shows a perspective view of an embodiment of an anchoring device comprising an outer ring.Anchor1040 comprises acentral hub1042 and anouter ring1044. In one embodiment,central hub1042 acts as a plug to plug an opening in the anatomy to reduce or prevent bleeding or leakage of fluids.Central hub1042 is connected toouter ring1044 by one or more bars or struts1046. In one embodiment,central hub1042 is connected to aninner ring1048 which in turn is connected toouter ring1044 by one or more bars or struts1046.Central hub1042 further comprises alocking element1050. Lockingelement1050 comprises alumen1052 through which a tension element can slide. After positioninganchor1040 in a desired position with respect to the tension element, lockingelement1050 is used to securely attachanchor1040 on the tension element. Lockingelement1050 may comprise a design disclosed including various locking designs disclosed elsewhere in this patent application.Anchor1040 may be made from a variety of materials including, but not limited to synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc.
• FIG. 10E shows a partial perspective view of an anchoring device comprising a hemostatic element.Anchor1060 comprises acentral hub1062. In one embodiment,central hub1062 acts as a plug to plug an opening in the anatomy to reduce or prevent bleeding or leakage of fluids.Central hub1062 comprises a cinching mechanism to allowcentral hub1062 to cinch on to atension element1064 passing throughcentral hub1062. Thefree end1066 oftension element1064 is severed to minimize the presence oftension element1064 in the anatomy.Anchor1060 further comprises anouter ring1068.Central hub1062 is connected toouter ring1068 by one ormore struts1070.Anchor1060 further comprises a mesh orporous element1072 betweenouter ring1068 and struts1070. The mesh orporous element1072 may be concave shaped as shown inFIG. 10E. Mesh orporous element1072 allows for tissue ingrowth over a period of time thus providing additional securing ofanchor1060 to tissue.
• FIG. 11A shows a perspective view of a device having a set of anchors comprising a curved sheet.Anchoring device1100 may comprise one or more anchors comprising a curved sheet. In this example,anchoring device1100 comprises afirst anchor1102 and asecond anchor1104.First anchor1102 andsecond anchor1104 may comprise elastic, super elastic or shape memory materials.First anchor1102 andsecond anchor1104 may be made from various materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.; synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc. The concave surface offirst anchor1102 is connected to a first end of atension element1106. Second end oftension element1106 is connected to the convex surface ofsecond anchor1104. In one embodiment of a method to deployanchoring device1106,first anchor1102 is deployed out of an anatomical tissue (e.g. the prostate gland) into a first anatomical cavity (e.g. the pelvic cavity). Thereafter,second anchor1104 is deployed into a second anatomical cavity (e.g. the urethral lumen). This method embodiment has the advantage of using the natural curvature offirst anchor1102 andsecond anchor1104 to distribute pressure onfirst anchor1102 andsecond anchor1104 over a large area.
• FIGS. 12A through 17I show further examples of anchor designs and/or anchoring device designs.FIG. 12A shows a perspective view of an anchor comprising an arrowhead.Anchor1200 comprises anarrowhead1202.Arrowhead1202 may be made from various materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.; rubber materials e.g. various grades of silicone rubber etc.Arrowhead1202 may comprise a sharp distal tip.Arrowhead1202 may have a three dimensional or a substantially two dimensional design. Proximal region ofarrowhead1202 is wider that the distal region ofarrowhead1202 to resist motion ofarrowhead1202 along the proximal direction after it is deployed in a tissue. Proximal region ofarrowhead1202 is connected to atension element1204.FIG. 12B shows a crossectional view of an anchor comprising a cup-shaped element that encloses a cavity.Anchor1208 comprises a cup-shapedelement1210. Proximal, concave surface of cup-shapedelement1210 encloses a cavity. Cup-shapedelement1210 may be made from various materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.; rubber materials e.g. various grades of silicone rubber etc. Proximal region of cup-shapedelement1210 is connected to atension element1212.FIG. 12C shows a perspective view of an anchor comprising a screw.Anchor1216 comprises ascrew1218.Screw1218 may be made from various materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.Screw1218 may comprise a sharp distal tip. Proximal region ofscrew1218 may be wider that the distal region ofscrew1218 to resist motion ofscrew1218 along the proximal direction after it is deployed in a tissue.Screw1218 comprises a thread rolled thread including, but not limited to wood screw style thread, double lead thread, tapping style thread, tapered wood thread etc. Proximal region ofarrowhead1202 is connected to atension element1204.
• FIGS. 13A and 13B show perspective views of an uncollapsed state and a collapsed state respectively of an anchor comprising a collapsible region. InFIG. 13A,anchor element1300 is in an uncollapsed state.Anchor element1300 comprises ahollow shaft1302 comprising one or more collapsible regions. A collapsible region comprises one ormore windows1304.Windows1304 are cut inhollow shaft1302 in such a way that several thin,collapsible struts1306 are created betweenadjacent windows1304. InFIG. 13B,anchor element1300 is in a collapsed state. Whenanchor element1300 is compresses along its length,collapsible struts1306 are deformed in the radially outward direction to create one or more anchoring regions.
• FIGS. 13C and 13D show perspective views of an undeployed state and a deployed state respectively of an anchor comprising radially spreading arms. InFIG. 13C,anchor1312 comprises ahollow tube1314.Hollow tube1314 is made from suitable elastic, super-elastic or shape memory materials such as metals including, but not limited to titanium, stainless steel, Nitinol etc.; suitable elastic polymers etc.U-shaped slots1316 are cut inhollow tube1314 in such a way thatarms1318 are created withinU-shaped slots1316. In this embodiment, U-shaped slots are substantially parallel to the axis ofhollow tube1314. In absence of an external force,arms1318 tend to spread in a radially outward direction.Anchor1312 is kept in an undeployed state by enclosinganchor1312 in a sheath.Anchor1312 is deployed by removing the sheath to allowarms1318 to spread in a radially outward direction as shown inFIG. 13D.
• Hollow tube1314 may comprise one or more cinching elements. Cinching elements may be located on the proximal region, distal region or a middle region ofhollow tube1314. The cinching element or elements may comprise cinching mechanisms including, but not limited to cinching mechanisms disclosed inFIGS. 26A through 29P.
• FIG. 13E shows perspective views of an alternate embodiment of an undeployed state of an anchor comprising radially spreading arms. InFIG. 13C,anchor1320 comprises ahollow tube1322.Hollow tube1322 is made from suitable elastic, super-elastic or shape memory materials such as metals including, but not limited to titanium, stainless steel, Nitinol etc.; suitable elastic polymers etc.U-shaped slots1324 are cut inhollow tube1322 in such a way thatarms1326 are created withinU-shaped slots1324. In this embodiment, U-shaped slots are at an angle to the axis ofhollow tube1322 as shown inFIG. 13E.
• FIGS. 14A and 14B show perspective views of anchoring devices comprising an adhesive delivering element.FIG. 14A shows a perspective view of ananchoring device1400 comprising ahollow shaft1402 with a shaft lumen.Hollow shaft1402 can be made of suitable biocompatible materials including, but not limited to Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, metals like stainless steel and fluoropolymers like PTFE, PFA, FEP and EPTFE etc. Distal end of shaft lumen ends in adelivery opening1404. When an adhesive is injected through the shaft lumen, it emerges out ofanchoring device1400 throughdelivery opening1404.Hollow shaft1402 may also comprise an attachment element1406 such as a porous woven or non-woven circular sleeve securely attached tohollow shaft1402. The circular sleeve may be made of a variety of materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.; synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc. The adhesive flowing out through delivery opening comes into contact with attachment element1406 and securely attaches attachment element1406 to surrounding tissue.FIG. 14B shows a perspective view of ananchoring device1408 comprising ahollow shaft1410 with a shaft lumen.Hollow shaft1410 can be made of suitable biocompatible materials including, but not limited to Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, metals like stainless steel and fluoropolymers like PTFE, PFA, FEP and EPTFE etc. Distal end of shaft lumen ends in adelivery opening1412. When an adhesive is injected through the shaft lumen, it emerges out ofanchoring device1408 throughdelivery opening1412.Hollow shaft1410 may also comprise anattachment element1414 such as porous foam securely attached tohollow shaft1410. The porous foam may be made of a variety of materials including, but not limited to polymers e.g. polypropylene, Teflon etc.; synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; rubber materials e.g. various grades of silicone rubber etc. The adhesive flowing out through delivery opening comes into contact withattachment element1414 and securely attachesattachment element1414 to surrounding tissue. Typical examples of adhesives that can be used withanchoring device1400 andanchoring device1408 include but are not limited to cyanoacrylates, marine adhesive proteins, fibrin-based sealants etc.
• FIGS. 15A and 15B show two configurations of an anchoring device comprising a ratcheted tension element.Anchoring device1500 comprises a distal anchor. Distal anchor may comprise a design selected from the variety of designs disclosed elsewhere in this document. In this particular example, distal anchor comprises a series ofradial arms1502 connected to acentral hub1504. The proximal end of central hub is attached to a ratchetedtension element1506. A proximal anchor is located on ratchetedtension element1506 proximal to the distal anchor. Proximal anchor may comprise a design selected from the variety designs disclosed elsewhere in this document. In this particular example, distal anchor comprises a series ofradial arms1508 connected to acentral hub1510. Central hub8368 has a central lumen through which ratchetedtension element1506 can slide. Ratchetedtension element1506 has ratchets arranged such that proximal anchor can slide easily over ratchetedtension element1506 in the distal direction but cannot slide easily in the proximal direction. InFIG. 15B, proximal anchor slides over ratchetedtension element1506 in the distal direction. This causes a compression of tissue between distal anchor and proximal anchor. The compression of tissue can be maintained since proximal anchor cannot slide easily in the proximal direction. In one embodiment of a method usinganchoring device1500, distal anchor is introduced via an anatomical lumen (e.g. the urethral lumen) and through a tissue (e.g. the prostate gland) into an anatomical cavity (e.g. the pelvic cavity). Thereafter, proximal anchor is advanced along ratchetedtension element1506 till it encounters a wall (e.g. the urethral wall) of the anatomical lumen.Anchoring device1500 may be made from various materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.
• FIG. 16 shows a perspective view of an anchor comprising a trocar lumen.Anchor1600 comprises ahollow shaft1602 comprising a lumen. Atrocar1604 or a penetrating device can pass throughhollow shaft1602 such that the distal tip oftrocar1604 emerges out through the distal end ofhollow shaft1602. Distal end ofhollow shaft1602 comprises atapering region1606 with a smaller distal diameter and a larger proximal diameter.Tapering region1606 further comprises a series ofsharp projections1608 located on the proximal end of taperingregion1606.Projections1608 may be projecting in the proximal direction, radially outward direction etc.Projections1608 prevent the movement ofanchor1600 in the proximal direction after it has penetrated through a tissue.Anchor1600 may also comprise a sleeve1610 located proximal to taperingregion1606. Sleeve1610 is made of a porous material that has a plurality of pores that allow for tissue ingrowth thus anchoring sleeve1610 firmly in tissue. Sleeve1610 may also help to distribute the pressure on taperingregion1606 over a wider area. Sleeve1610 may be non-woven or woven. Sleeve1610 can be made of variety of materials including, but not limited to synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc.
• FIG. 17A shows a perspective view in the undeployed state of an anchor comprising a rigid or partially flexible T element and a crumpling element. InFIG. 17A,anchoring device1700 comprises a distal,T element1702. TheT element1702 may be made of a variety of materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.; rubber materials e.g. various grades of silicone rubber etc. Further it may be a composite material or have cut out sections to allow it to be flexible in certain dimensions but rigid in other dimensions. In this example,T element1702 is in the form of a hollow cylinder. The proximal end ofT element1702 is in contact with the distal end of adelivery rod1704.Delivery rod1704 is hollow and is used to deliver T element8266 in a target anatomical region. Atrocar1705 can pass throughdelivery rod1704 and throughT element1702 such that the distal tip of trocar emerges through the distal end ofrigid element1702. The T-element could also be contained within a lumen of the trocar or may be the trocar itself. of theT element1702 is connected to the distal end of aflexible tension element1706. Various connection means are possible such as the tension element being tied or crimped to the T element, or passing through a loop in the T element, or being adhered by adhesive or weld, or by being made of a continuous material which becomes the T element. Although the T element is shown as a T, any shape which is larger in at least one dimension compared to its other dimensions could appropriately be released and cause to change it's orientation to produce an anchoring effect. Examples of materials that can be used to manufacturetension element1706 include but are not limited to synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc. A substantially flattenedbody1708 is located on the distal region oftension element1706.Tension element1706 is threaded throughbody1708 in such a way thattension element1706 can slide throughbody1708.Body1708 may be non-woven or woven.Body1708 can be made of a variety of materials including, but not limited to synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc.Body1708 may have a variety of shapes including, but not limited to square, rectangular, triangular, other regular polygonal, irregular polygonal, circular etc.Body1708 may have a substantially one dimensional, two dimensional or three dimensional shape.FIGS. 17B and 17C show various steps of a method to deploy the anchoring device shown inFIG. 17A. InFIG. 17B,anchoring device1700 is introduced in an anatomical cavity (e.g. the pelvic cavity) through a tissue (e.g. the prostate gland). Thereafter,trocar1705 is withdrawn by pullingtrocar1705 in the proximal direction. Thereafter,delivery rod1704 is withdrawn by pullingdelivery rod1704 in the proximal direction. Thereafter,tension element1706 is pulled in the proximal direction.Tension element1706 in turn pullsT element1702 in the proximal direction. InFIG. 17C,rigid element1702 is pulled against a wall of the tissue (e.g. the prostate gland) but is unable to penetrate the tissue because of its size. This causesbody1708 to crumple because of compression ofbody1708 between the wall of the tissue andrigid element1702.Crumpled body1708 may be designed to cause tissue ingrowth or epithelialization inbody1708 as well as healing, hemostasis or a more even force distribution.
• FIGS. 17D and 17E show perspective views of an undeployed and deployed configuration of an anchor comprising a rigid or partially flexible T element with one or more openings or perforations.FIG. 17D shows a perspective view of ananchoring device1720 comprising ananchor1722.Anchor1722 comprises a tubular body. The tubular body may comprise one or more openings orperforations1724 in the tubular body. Openings orperforations1724 increase the flexibility ofanchor1722. This makes it easier to navigateanchoring device1720 through the anatomy before reaching its target location. Further it enables anchoringdevice1720 to be passed through a tight bend in the anatomy or through a delivery device. Within tubular body ofanchor1722 is trocar tip1727 that is fixedly attached totensioning element1728. In the embodiment shown inFIG. 17D,anchor1722 comprises a lumen. A length of the distal end of deployment element1726 passes through the proximal end of the lumen and abuts trocar tip1727 that enablesanchor1722 to puncture tissue. In an alternate embodiment trocar tip is fixedly attached to elongate deployment element1726 and is retracted fully into element1729 upon anchor deployment. In an alternate embodiment, distal tip of deployment device1726 is not exposed through the distal end ofanchor1722. Distal end ofanchor1722 comprises a sharp tip to enableanchor1722 to puncture tissue. Anchoringelement1720 further comprises atension element1728 attached totubular body1722. In this embodiment, distal end oftension element1728 attached to the inner surface of the trocar tip1727. Proximal region oftension element1728 passes through deployment element1726.Anchor1722 is deployed by pushing in a distal direction one elongate deployment element1726, that runs within lumen ofanchor1722 abutting trocar tip1727 distally, in tandem with another elongate deployment element1729 that abuts the proximal end ofanchor1722.Anchoring device1720 punctures tissue to transportanchor1722 through a first anatomical location (e.g. a prostate gland) to a second anatomical location (e.g. the pelvic cavity, urethra etc.). Thereafter, deployment element1726 is withdrawn by pulling deployment element1726 in the proximal direction. Thereafter,tension element1728 is pulled in the proximal direction. This causesanchor1722 to anchor in tissue as shown inFIG. 17E. Proximal portion oftension element1728 emerges out ofanchor1722 through a lengthwise groove inanchor1722 to create a T shaped anchor as shown inFIG. 17E. Tension ontensioning element1728 causes trocar tip1727 to retract intolumen1722. In the example shown, the first anatomical location is the prostate gland PG and the second anatomical location is the pelvic cavity.Anchoring device1720 can be made from a variety of materials including, but not limited to metals such as synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc.Tension element1728 may then be connected to any one of the other anchoring elements such as anchor10D.
• FIGS. 17F and 17G show perspective views of an undeployed and deployed configuration of an anchor comprising a stent.Anchor1730 comprises a self-expandingstent1732 and atension element1734. Distal end oftension element1734 is attached tostent1732. In one embodiment, distal end oftension element1734 is attached on the mid section ofstent1732.Stent1732 may comprise various designs including, but not limited to metallic tube designs, polymeric tube designs, spiral designs, chain-linked designs, rolled sheet designs, single wire designs etc.Stent1732 may have an open celled or closed celled structure. A variety of fabrication methods can be used for fabricatingstent1732 including but not limited to laser cutting a metal or polymer element, welding metal elements etc. A variety of materials can be used for fabricatingstent1732 including but not limited to metals, polymers, foam type materials, super elastic materials etc. A variety of features can be added tostent1732 including but not limited to radiopaque coatings, drug elution mechanisms etc.Anchor1730 is introduced through asheath1736 into a target anatomy. Thereafter,sheath1736 is withdrawn. This causesstent1732 to revert to its natural shape as shown inFIG. 17G and act as an anchor.
• FIGS. 17H and 17I show perspective views of an undeployed and deployed configuration of an anchor comprising a spring.Anchor1740 comprises anelastic spring1742 and atension element1744. Distal end oftension element1744 is attached tospring1742. In one embodiment, distal end oftension element1744 is attached on the mid section ofspring1742. A variety of materials can be used for fabricatingspring1742 including but not limited to metals, polymers, foam type materials, super elastic materials etc. A variety of features can be added tospring1742 including but not limited to radiopaque coatings, drug elution mechanisms etc.Anchor1740 is introduced through asheath1746 into a target anatomy to reduce the profile ofspring1742. Thereafter,sheath1746 is withdrawn. This causesspring1742 to revert to its natural shape as shown inFIG. 171 and act as an anchor.
• FIGS. 18A through 22E show various embodiments of mechanisms to deploy one or more anchors.FIG. 18A shows a crossection of an anchor deploying mechanism comprising a screw system.FIG. 18A shows an anchor deploying mechanism comprising ananchor1800 comprising ananchor body1802 and anchoringelements1804 attached to anchorbody1802.Anchor body1802 comprises an inner lumen. Inner lumen ofanchor body1802 comprises screw threading. Anchoringelements1804 may have various designs including, but not limited to anchor designs disclosed elsewhere in this document.Anchor body1802 and anchoringelements1804 may be made of a variety of materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.; rubber materials e.g. various grades of silicone rubber etc. The anchor deploying mechanism further comprises a deployingshaft1806. Distal region of deployingshaft1806 comprises a screw threading such that deployingshaft1806 can be screwed intoanchor body1802.FIG. 18B shows the method of deploying an anchor comprising a screw mechanism. Deployingshaft1806 is rotated to release the distal region of deployingshaft1806 fromanchor body1802 after positioninganchor1800 in a desired location. Such a mechanism can be used to deploy one or more anchors. In one embodiment, more than one anchors are located on deployingshaft1806. The anchors can be sequentially deployed by rotating deployingshaft1806. Deployingshaft1806 may be made of a variety of materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc. In one embodiment, the anchor deploying mechanism is located inside an outer sheath.
• FIGS. 19A and 19B show a crossectional view of an anchor deploying system comprising an electrolytic detachment element.FIG. 19A shows a crossection of an anchor deploying mechanism comprising adeployable anchor1900.Deployable anchor1900 comprises ananchor body1902 and anchoringelements1904 attached to anchorbody1902. Anchoringelements1904 may have various designs including, but not limited to anchor designs disclosed elsewhere in this document. Anchor body8402 and anchoring elements8404 may be made of a variety of materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.; rubber materials e.g. various grades of silicone rubber etc. Proximal region ofdeployable anchor1900 further comprises anelectrolyzable element1906.Electrolyzable element1906 is made of a length of metallic wire e.g. steel wire. Proximal region ofelectrolyzable element1906 is electrically connected to a deployingshaft1908. Proximal region of deployingshaft1908 is further connected to a first electrode. The anchor deploying system further comprises asecond electrode1910 connected to a bodily region of the patient to be treated. InFIG. 19B, the first electrode is connected to a positive terminal of a power supply and the second electrode is connected to the negative terminal of the power supply to form an electrical circuit. Electrical current flowing betweenelectrolyzable element1906 andsecond electrode1910 causes metallic ions fromelectrolyzable element1906 to dissolve into surrounding anatomy. This causeselectrolyzable element1906 to detach from deployingshaft1908.
• FIG. 20 shows a perspective view of an anchor deploying system comprising a looped ribbon. The anchor deploying system comprises adeployable anchor2000.Deployable anchor2000 comprises ananchor body2002 and anchoringelements2004 attached to anchorbody2002. Anchoringelements2004 may have various designs including, but not limited to anchor designs disclosed elsewhere in this document.Anchor body2002 and anchoringelements2004 may be made of a variety of materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.; rubber materials e.g. various grades of silicone rubber etc. Proximal region ofdeployable anchor2000 further comprises alooping lumen2006. A loopedribbon2008 is looped throughlooping lumen2006. Loopedribbon2008 may be made of a variety of materials including, but not limited to synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc. loopedribbon2008 extends to a proximal region where it can be cut by a user. In a method of deployingdeployable anchor2000, a single cut is made in loopedribbon2008 at a proximal region. This turns loopedribbon2008 into a straight ribbon. The straight ribbon can then be pulled in the proximal direction to remove it fromdeployable anchor2000. Loopedribbon2008 may also be in the form of a looped monofilament or multifilament wire or suture.
• FIG. 21A shows a crossectional view of an anchor deploying system comprising a locked ball. The anchor deploying system comprises adeployable anchor2100.Deployable anchor2100 comprises ananchor body2102.Deployable anchor2100 may have various designs including, but not limited to anchor designs disclosed elsewhere in this document. Proximal end ofanchor body2102 is connected to athin shaft2104. Proximal end ofthin shaft2104 comprises alocking ball2106. Anchor body8428,thin shaft2104 and lockingball2106 may be made of a variety of materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.; rubber materials e.g. various grades of silicone rubber etc. The anchor deploying system further comprises anouter locking sheath2108. Distal end of lockingsheath2108 comprises anopening2110. Diameter ofopening2110 is greater than the diameter ofthin shaft2104 but greater than diameter of lockingball2106. Thus, lockingball2106 is locked in lockingsheath2108. The anchor deploying system further comprises a deployingshaft2112 located within lockingsheath2108. Deployingshaft2112 can be pushed in the distal direction within lockingsheath2108 by a user. Lockingsheath2108 and deployingshaft2112 may be made of a variety of materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc. In one embodiment, distal region of lockingsheath2108 comprises one or more longitudinal grooves or windows to allow distal region of lockingsheath2108 to expand easily in the radial direction.FIGS. 21B and 21C show a method of deploying an anchor comprising a locked ball. InFIG. 21B, deployingshaft2112 is pushed in the distal direction by a user. This causes distal end of deployingshaft2112 to pushlocking ball2106 in the distal direction. This in turn causes lockingball2106 to exert a force on the distal end of lockingsheath2108. This force causes opening2110 to enlarge and release lockingball2106. InFIG. 21C, lockingball2106 is released by lockingsheath2108 thus releasingdeployable anchor2100.
• FIGS. 22A through 22C show various views of an anchor deploying system comprising two interlocking cylinders. The anchor deploying system comprises a proximal interlocking cylinder and a distal interlocking cylinder. The distal interlocking cylinder is located on an anchor to be deployed.FIG. 22A shows a perspective view of aproximal interlocking cylinder2200 comprising alocking element2202 located on the distal end ofproximal interlocking cylinder2200. In this example, lockingelement2202 comprises a solid cylinder with a ninety degree bend.Proximal interlocking cylinder2200 and lockingelement2202 may be made of a variety of materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.FIG. 22B shows a crossectional view of the anchor deploying system comprisingproximal interlocking cylinder2200 interlocked with adistal interlocking cylinder2204.Distal interlocking cylinder2204 comprises agroove2206 which locks lockingelement2202. Lockingelement2202 can be unlocked fromdistal interlocking cylinder2204 by turningproximal interlocking cylinder2200.distal interlocking cylinder2204 may be made of a variety of materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; polymers e.g. polypropylene, Teflon etc.; rubber materials e.g. various grades of silicone rubber etc.FIG. 22C shows a crossectional view through plane A-A inFIG. 22B.FIG. 22C shows distal interlockingcylinder comprising groove2206. Also shown is lockingelement2202 located ingroove2206. Turningproximal interlocking cylinder2200 turns lockingelement2202. At a particular orientation, distal region of lockingelement2202 can pass easily throughgroove2206 unlockingproximal interlocking cylinder2200 fromdistal interlocking cylinder2204.
• FIGS. 22D and 22E show the steps of a method of unlocking the two interlocking cylinders from the anchor deploying systems ofFIGS. 22A through 22C. InFIG. 22D, lockingelement2202 ofproximal interlocking cylinder2200 is locked ingroove2206 ofdistal interlocking cylinder2204. InFIG. 22E,proximal interlocking cylinder2200 is turned in a clockwise or counterclockwise direction to unlock lockingelement2202 fromgroove2206. Thereafter,proximal interlocking cylinder2200 is pulled in the proximal direction to separateproximal interlocking cylinder2200 fromdistal interlocking cylinder2204.
• FIG. 23A shows a perspective view of a distal end of an anchoring device that has an imaging modality.Anchoring device2300 comprises anelongate shaft2302 comprising a lumen.Elongate shaft2302 can be made of suitable biocompatible materials such as metals, polymers etc. The lumen ofshaft2302 terminates in awindow2304 located on the distal region ofshaft2302. Anchoring device further comprises an imaging modality such as a cystoscope, an ultrasound imaging system etc. In this example, the imaging modality is acystoscope2306. Distal end ofcystoscope2306 is located inwindow2304 to allow visualization of the anatomy adjacent towindow2304. In one embodiment,cystoscope2306 is permanently fixed to anchoringdevice2300. In another embodiment,cystoscope2306 can be introduced through the proximal region of anchoringdevice2300.Anchoring device2300 further comprises apuncturing device2308.Puncturing device2308 comprises a sharp distal tip and a lumen that holds an anchor.Anchoring device2300 further comprises ananchor deployment device2310. Distal end ofanchor deployment device2310 is detachably attached to the anchor.
• FIGS. 23B through 23G show various steps of a method for compressing an anatomical region using the anchoring device ofFIG. 23A. InFIG. 23B,Anchoring device2300 is introduced in an anatomical region such that distal end of anchoringdevice2300 is located adjacent to a target anatomical region to be treated. In one method embodiment,anchoring device2300 is introduced transurethrally into the prostatic urethra. Thereafter,puncturing device2308 is advanced to puncture the anatomical region. In this example,puncturing device2308 punctures the prostate gland PG such that distal end of puncturingdevice2308 is located in the pelvic cavity. Puncturing device comprises an anchor located in the lumen ofpuncturing device2308. The anchor comprises adistal anchor2312, atension element2314 connected at one end todistal anchor2312 and aproximal anchor2316 that can slide overtension element2314.Puncturing device2308 comprises a groove at the distal end such that tension element exitspuncturing device2308 through the groove.Puncturing device2308 further comprises apusher2318 that can pushdistal anchor2312 out ofpuncturing device2308.Proximal anchor2316 is detachably attached to the distal region ofanchor deployment device2310.Proximal anchor2312,distal anchor2316 andtension element2314 may comprise designs including, but not limited to the designs disclosed elsewhere in this patent application. The imaging modality may be used to verify the accurate placement and working of anchoringdevice2300. InFIG. 23C,pusher2318 is pushed in the distal direction to pushdistal anchor2312 out ofpuncturing device2308.Distal anchor2312 is thus deployed in the anatomy e.g. in the pelvic cavity surrounding the prostate gland PG. Thereafter, in step23D,Puncturing device2308 is withdrawn by pulling it in the proximal direction. In step23E,tension element2314 is pulled in the proximal direction throughanchor deployment device2310. Thereafter, in step23F,tension element2314 is pulled further in the proximal direction such that the anatomical region betweenproximal anchor2316 anddistal anchor2312 is compressed. Thereafter, in step23G,proximal anchor2316 is securely locked on totension element2314. Further in step23G,proximal anchor2316 is detached fromanchor deployment device2310. The detachment can be performed by a variety of mechanisms including, but not limited to the anchor detachment mechanisms disclosed elsewhere in this patent application. Further in step23G, excess length oftension element2314 is removed. This removal can be done using a variety of methods including, but not limited to the methods disclosed elsewhere in this patent application such as cutting, delinking, melting, and breaking. Thereafter,anchoring device2300 is withdrawn from the anatomy. It should be understood that these deployment steps may be repeated in the same, opposing or neighboring tissues to essentially tack up the encroaching tissue (i.e. prostatic tissue, tumor, relaxed tissue, expanded tissue or growth). It may be desired that over time both anchors become completely embedded within the tissue and covered to prevent encrustation, clotting or other tissue or body-fluid interaction—this may be facilitated by the processes, therapeutic agents and coatings described elsewhere in the application. Although these anchors are shown on either side of the tissue, it may be possible to deploy either or both of them within the body of the tissue itself to help bury them and eliminate the possibility that they may interact with other parts of the body. It should further be noted that in the case of application to the prostate, that this technique may be used on any of the lateral or middle lobes to compress or hold the prostate gland PG away from the lumen of the urethra.
• If removal of the intra or para luminal anchor is required, it may be possible to resect that region completely, capturing the anchor embedded within the tissue and removing it en-bloc, severing the tether in the process. In the case of prostate applications, such removal may be accomplished with a standard resectoscope system. In other regions, and energized RF or sharp curette or blade may be used to resect the anchor minimally invasively. Alternatively if engagement with the locking mechanism is still achievable, it may be possible to simply unlock the tether, releasing the anchor. Lastly, if applying additional tension at some point after the procedure is required, it may be possible to engage and grasp the tether as it exits the locking device in the anchor and apply additional tension.
• FIGS.24A through24C′ show various steps of a method of compressing an anatomical region using a device with deploying arms deployed through a trocar. InFIG. 24A, ananchoring device2400 is introduced in an anatomical region.Anchoring device2400 comprising adistal anchor2402 is introduced in the anatomy.Distal anchor2402 comprises a hollow shaft. Distal end ofdistal anchor2402 comprises one or more outwardly curling or spreadingarms2404. Curling or spreadingarms2404 are made of an elastic, springy, super-elastic or shape memory material such that they tend to curl or spread in a radially outward direction in absence of an external force.Anchoring device2400 further comprises a proximal anchor comprising a variety of designs including, but not limited to the designs disclosed elsewhere in this patent application. In this example, proximal anchor is designed similar toanchor1040 inFIG. 10D.Anchor1040 can slide along proximal region ofdistal anchor2402.Anchor1040 can also be attached todistal anchor2402 after a desired positioning betweenanchor1040 anddistal anchor2402 is achieved.Anchoring device2400 is delivered through atrocar2406.Trocar2406 comprises a sharpdistal tip2408 that can penetrate through tissue. The proximal region ofdistal tip2408 comprises one or more grooves or notches such that distal ends of curling or spreadingarms2404 can be temporarily held together bydistal tip2408 to allow for easy introduction into a target anatomy.Anchoring device2400 is introduced into a target tissue to be compressed such that curling or spreadingarms2404 are distal to the target tissue andanchor1040 is proximal to the target tissue. FIG.24A′ shows the distal end view of theanchoring device2400. InFIG. 24B,trocar2406 is pushed in the distal direction relative toproximal anchor2402. This releases the distal ends of curling or spreadingarms2404 causing them to curl or spread outwards. FIG.24A′ shows the distal end view of theanchoring device2400 with released curling or spreadingarms2404. InFIG. 24C,anchor1040 is pushed in the distal direction overdistal anchor2402 to compress tissue betweenanchor1040 anddistal anchor2402. Thereafter,anchor1040 is attached to the hollow shaft ofdistal anchor2402. Thereafter trocar2406 is withdrawn from the anatomy. In the above embodiment, the tethering function is performed by the shaft of the distal anchor, and the force is created by the curling arms. This tension may be pre-set into the arms through heat forming. It should be noted that any mechanism capable of expanding from within a tubular shape and capable of applying retrograde forces on the tissue are within the scope of this invention such as expandable flanges, balloons, cages, molly-bolt-like structures, stent-like structures and springs.
• FIG. 24D shows a crossection through the deployedanchoring device2400 ofFIG. 24A.
• In one anchoring device embodiment,anchoring device2400 comprises a distal anchor such as the distal anchor described inFIG. 17A instead of distal anchor2412.
• FIG. 25A shows a perspective view of a spring clip that can be used to spread the anatomy.Clip2500 comprises two or more spreadingarms2502. Spreadingarms2502 may be curved or straight. Distal ends of spreadingarms2502 may comprise a flattened region. The proximal ends orcurved arms2502 are connected to each other by aheel region2504.Heel region2504 may be made from the same material ascurved arms2502. In an undeployed configuration, spreadingarms2502 are held close to each other. Whenclip2500 is deployed, spreadingarms2502 tend to expand away from each other thus spreading the anatomical region or regions between spreadingarms2502.Clip2500 can be made of suitable elastic, super-elastic or shape memory biocompatible materials including, but not limited to synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, etc.
• FIGS. 25B through 25F show various steps of a method of spreading an anatomical region or regions using the spring clip ofFIG. 25A. InFIG. 25B, adelivery tool2506 comprising aclip2500 is introduced in the anatomy and positioned near the target anatomy to be spread.Delivery tool2506 comprises an elongatehollow body2508 comprising a lumen. Distal end ofbody2508 may comprise a blunt, atraumatic end. Distal region ofbody2508 comprises aslot2510 that is in fluid communication with the lumen ofbody2508. Delivery tool may further comprise anouter sheath2512 and animaging modality2514.Imaging modality2514 may be permanently attached todelivery tool2506 or may be introduced intodelivery tool2506 by a user. In this example,imaging modality2514 is a cystoscope. InFIG. 25C,clip2500 is introduced into the anatomy by pushingclip2500 out ofslot2510 such that the distal ends of spreadingarms2502 emerge first.Slot2510 is designed such that spreadingarms2504 are biased towards each other as they emerge out ofslot2510. InFIG. 25D,clip2500 is further advanced such that distal tips of spreadingarms2502 penetrate into the tissue to be spread. InFIG. 25E,clip2500 is advanced further such that the biasing forces on spreadingarms2502 are removed. Spreadingarms2502 tend to spread away from each other thus spreading the tissue between them.Clip2500 is detachably attached todelivery tool2506 by adetaching mechanism2516 including, but not limited to the several detaching mechanisms disclosed elsewhere in this patent application. InFIG. 25F,detaching mechanism2516 is used to detachclip2500 fromdelivery tool2506 or deployclip2500 in the target anatomy. In this example, distal region ofdelivery tool2506 is inserted transurethrally into the prostatic urethra.Clip2500 is then delivered into the anterior commissure to spread the two lateral lobes of the prostate gland PG apart. In one method embodiment, an opening in the commissure is made prior to the method ofFIGS. 25B through 25G. In another embodiment, the spreading force exerted by spreadingarms2502 cause cutting of the anterior commissure.Clip2500 may be placed completely sub-urethrally or a small amount ofheel region2504 remains in the urethra.
• The embodiments of anchoring devices wherein a sliding anchor is slid over a tension element may comprise one or more cinching elements. These cinching elements may be present on the sliding anchors, on the tension elements etc. A cinching element may be a separate device that cinches to a tension element. In doing so, it increases the effective diameter of that region of the tension element and prevents the tension element from sliding through a sliding anchor. Cinching elements may allow only unidirectional motion of the sliding anchor over the tension element or may prevent any substantial motion of the sliding anchor over the tension element. Typical examples of such cinching mechanisms include, but are not limited to mechanisms described in theFIG. 26 series. For example,FIGS. 26A and 26B show a crossectional view and a perspective view respectively of a mechanism of cinching a tension element or tether to an anchor. InFIG. 26A,cinching mechanism2600 comprises anouter base2602.Outer base2602 comprises one or more grooves created by the presence of two ormore leaflets2604.Leaflets2604 are biased along a first axial direction as shown inFIG. 26A. When atension element2606 is located in the one or more grooves,cinching mechanism2600 allows motion oftension element2606 only along the first axial direction and prevents substantial movement oftension element2606 in the opposite direction.
• FIGS. 26C and 26D show a partial section through a cinching mechanism comprising a cam element. InFIG. 26C,cinching mechanism2610 comprises anouter body2612 made of suitable biocompatible metals, polymers etc. Body2162 comprises acam2614 located on apivot2616.Cam2614 may comprise a series of teeth to grip atension element2618 passing throughbody2612. In one embodiment, body2162 comprises anopening2620 located proximal tocam2614. Proximal region oftension element2618 passes out ofbody2612 throughopening2620.Cinching mechanism2610 allows movement of body2162 overtension element2618 in the proximal direction. InFIG. 26D, body2162 is moved overtension element2618 in the distal direction. Motion oftension element2618 overcam2614 causescam2614 to turn in the anti-clockwise direction. This causestension element2618 to be pinched betweencam2614 andbody2612. This in turn prevents further motion of body2162 overtension element2618.
• FIG. 26E shows a sectional view of an embodiment of a cinching mechanism comprising a locking ball.Cinching mechanism2630 comprises anouter body2632 comprising a lumen. Atension element2634 passes through the lumen ofouter body2632. The lumen of outer body gradually reduces in the proximal direction as shown inFIG. 26E. Alocking ball2636 is present in the lumen. Motion ofouter body2632 overtension element2634 in the distal direction pushes lockingball2636 in the proximal region ofouter body2632. Aproximal end region2638 of a small diameter prevents lockingball2636 from falling out ofouter body2632. The large lumen diameter in the proximal region ofouter body2632 allows free motion of lockingball2636. Thus, presence of lockingball2636 does not hinder the motion ofouter body2632 overtension element2634 in the proximal direction. Whenouter body2632 is moved overtension element2634 in the proximal direction, lockingball2636 is pushed in the distal region ofouter body2632. The small lumen diameter in the proximal region ofouter body2632 constricts motion of lockingball2636. This causes a region oftension element2634 to be pinched betweenanchoring ball2636 andouter body2632. This in turn prevents further motion ofouter body2632 overtension element2634 in the proximal direction. This mechanism thus allows unidirectional motion ofouter body2632 is over tension element.
• FIG. 26F shows a side view of an embodiment of a cinching mechanism comprising multiple locking flanges. In this embodiment,cinching mechanism2644 comprises abody2646 comprising a lumen lined by afirst locking flange2648 and asecond locking flange2650. First lockingflange2648 andsecond locking flange2650 are biased in the proximal direction as shown. Atension element2652 passes through the lumen ofbody2646. First lockingflange2648 andsecond locking flange2650 together allow the movement ofbody2646 overtension element2652 in the distal direction, but prevent movement ofbody2646 overtension element2652 in the proximal direction. Similar cinching mechanisms may be designed comprising more than two locking flanges.FIG. 26G shows an end view ofbody2646 comprising a lumen lined byfirst locking flange2648 andsecond locking flange2650.Body2646 may be made of suitable biocompatible metals, polymers etc.
• FIG. 26H shows a side view of an embodiment of a cinching mechanism comprising a single locking flange. In this embodiment,cinching mechanism2656 comprises abody2658 comprising a lumen lined by alocking flange2660. Lockingflange2660 is biased in the proximal direction as shown. Atension element2662 passes through the lumen ofbody2658. Lockingflange2660 allows the movement ofbody2658 overtension element2662 in the distal direction, but prevents movement ofbody2658 overtension element2662 in the proximal direction.FIG. 26I shows an end view ofbody2658 comprising alumen2662 lined by lockingflange2660.Body2658 may be made of suitable biocompatible metals, polymers etc.
• FIG. 26J shows an end view of a cinching mechanism comprising a crimping lumen.Cinching mechanism2670 comprises abody2672 comprising a crimpinglumen2674. Crimpinglumen2674 is in the form of an arc with a gradually reducing size as shown inFIG. 26J. Atension element2676 passes through crimpinglumen2674. InFIG. 26J,tension element2676 is locked in a region of crimpinglumen2674 of a diameter smaller than the diameter oftension element2676.Tension element2676 can be unlocked from crimpinglumen2674 by rotatingbody2672 in the anti-clockwise direction. Similarly, rotatingbody2672 in the clockwise direction causes anunlocked tension element2676 to be locked into crimpinglumen2674.
• In an alternate embodiment, cinching mechanism comprises a disk shaped body comprising a central lumen. Central lumen is large enough to allow a tension element to slide easily through the central lumen. One or more radially oriented slits emerge from the central lumen. The radially oriented slits have a diameter that is of the same size or is slightly smaller than the diameter of the tension element. To lock cinching mechanism to the tension element, the tension element is forced through one of the radially oriented slits. The friction between the disk shaped body and the tension element prevents or resists sliding of tension element through the disk shaped body. To unlock cinching mechanism from the tension element, the tension element is moved back to the central lumen.
• In another alternate embodiment, cinching mechanism comprises a disk shaped body comprising a small central lumen. The central region of the body comprises three or more triangular flaps biased together out of the plane of the body. The ends of the triangular flaps together form the central lumen that is of the same size or is slightly smaller than the diameter of the tension element. Tension element can pass easily through the central lumen in the direction of the bias of the triangular flaps. But, tension element cannot pass or encounters substantial resistance when the tension element is pulled through the central lumen in the opposite direction.
• FIGS. 26K and 26L show crossections of an embodiment of a cinching mechanism comprising a crimping anchor in the undeployed and deployed configurations respectively.Cinching mechanism2680 comprises a crimpinganchor2680 comprising a lumen. Crimpinganchor2680 can be made of a variety of biocompatible materials including, but not limited to metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc., polymers, etc. Atension element2684 passes through the lumen of crimpinganchor2680. The lumen of an undeployed crimpinganchor2680 is larger than the diameter oftension element2684. InFIG. 26L, crimpinganchor2680 is deployed by compressing the middle section of crimpinganchor2680 such that crimpinganchor2680 compressestension element2684. Friction between crimpinganchor2680 andtension element2684 prevents relative motion between crimpinganchor2680 andtension element2684. Crimpinganchor2680 may be a component of a sliding anchor or may be a stand-alone device used to prevent or restrict motion of a sliding anchor over a tension element.
• FIG. 26M shows a perspective view of an embodiment of a cinching mechanism comprising an element providing a tortuous path to a tension element. In this example,cinching mechanism2686 comprises aspring2688. Atension element2690 is passed throughspring2688 such that the path oftension element2690 throughspring2688 is tortuous. Whenspring2688 is moved over tension element, motion oftension element2690 through the tortuous path generates high frictional forces that prevent or reduce motion ofspring2688 overtension element2690. The frictional forces are strong enough to resist motion ofspring2688 overtension element2690 after deployingcinching mechanism2686 in the anatomy. A user can movespring2688 overtension element2690 by applying a force that overcomes the resistive frictional forces that prevent movement ofspring2688 overtension element2690. Similarly, other cinching mechanisms comprising a tortuous path can be used instead ofspring2688. Examples of such mechanisms are solid elements comprising tortuous lumens, elements comprising multiple struts or bars that provide a tortuous path etc. In another embodiment the cinching mechanism comprises a knot on one or more tensioning element. Said knot can be advanced fully tightened or can be loose when advanced and tightened in situ.
• FIG. 26N shows a crossectional view of an embodiment of a locking mechanism comprising a space occupying anchor securely attached to a tension element.Locking mechanism2692 comprises ahollow element2694 comprising a lumen.Hollow element2694 is a component of a sliding anchor that slides overtension element2696.Tension element2696 comprises aspace occupying anchor2698 comprising a taperingdistal end2699.Anchor2698 is securely attached totension element2696. Diameter ofanchor2698 is larger than the diameter of the lumen of hollow element. Due to this,anchor2698 cannot pass throughhollow element2694 effectively locking the position oftension element2696 with respect to the position ofhollow element2694.
• FIGS. 26O and 26P shows a partial sectional view and a perspective view of an embodiment of a cinching mechanism comprising a punched disk.Cinching mechanism2602′ comprises adisk2604′ comprising a punchedhole2606′. Punchedhole2606′ is made by punchingdisk2604′ along the proximal direction such that the punching action leaves an edge that is biased along the proximal direction as shown inFIG. 26O.Disk2604′ can slide over atension element2608′ along the distal direction. However, motion ofdisk2604′ overtension element2608′ along the proximal direction is substantially resisted by the proximally biased edges of punchedhole2606′.
• Excess lengths of tension elements or other severable regions of one or more devices disclosed in this patent application may be cut, severed or trimmed using one or more cutting devices. For example,FIGS. 26Q and 26R show a perspective view of a first embodiment of a cutting device before and after cutting an elongate element. InFIG. 26Q,cutting device2610′ comprises anouter sheath2612′ comprising a sharpdistal edge2614′.Outer sheath2612′ encloses aninner sheath2616′. Inner diameter ofouter sheath2612′ is slightly larger than outer diameter ofinner sheath2616′ such thatinner sheath2616′ can slide easily throughouter sheath2612′.Inner sheath2616′ comprises a lumen that terminates distally in anopening2618′. An elongate severable device passes through the lumen and emerges out of opening2618′. An example of an elongate severable device is atension element2620′. In the method of cutting or trimmingtension element2620′ the desired area oftension element2620′ to be cut or severed is positioned near opening2618′ by advancing or withdrawingcutting device2610′ overtension element2620′. Thereafter,outer sheath2612′ is advanced overinner sheath2616′ to cuttension element2620′ between sharpdistal edge2614′ and an edge of opening2618′.Inner sheath2616′ andouter sheath2612′ may be substantially rigid or flexible. They may be made of suitable materials including, but not limited to Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, metals like stainless steel and fluoropolymers like PTFE, PFA, FEP and EPTFE etc.
• FIG. 26S show a crossectional view of a second embodiment of a cutting device for cutting an elongate element.Cutting device2622′ comprises anouter sheath2624′ comprising a lumen that opens in anopening2626′ inouter sheath2624′.Outer sheath2624′ encloses aninner sheath2628′ that comprises a lumen and a sharpdistal edge2630′. Inner diameter ofouter sheath2624′ is slightly larger than outer diameter ofinner sheath2628′ such thatinner sheath2628′ can slide easily throughouter sheath2624′. An elongate severable device passes through the lumen ofinner sheath2628′ and emerges out of distal end ofinner sheath2628′ and out ofouter sheath2624′ throughopening2626′. An example of an elongate severable device is atension element2632′. In the method of cutting or trimmingtension element2632′ the desired area oftension element2632′ to be cut or severed is positioned near opening2626′ by advancing or withdrawingcutting device2622′ overtension element2632′. Thereafter,inner sheath2628′ is advanced throughouter sheath2624′ to cuttension element2632′ between sharpdistal edge2630′ and an edge of opening2626′.Inner sheath2628′ andouter sheath2624 may be substantially rigid or flexible. They may be made of suitable materials including, but not limited to Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, metals like stainless steel and fluoropolymers like PTFE, PFA, FEP and EPTFE etc.
• In a third embodiment of a cutting device for cutting an elongate element, the cutting device comprises an outer hollow sheath. Outer hollow sheath has a distal end plate comprising a window. An elongate severable device passes through the window. An example of an elongate severable device is a tension element. An inner shaft can slide and rotate within outer hollow sheath. Distal end of inner shaft comprises a blade that is usually located away from the window and adjacent to the distal end plate of the outer hollow sheath. In the method of cutting or trimming tension element the elongate severable device, the desired area of the elongate severable device to be cut or severed is positioned near the window. This is done by advancing or withdrawing the cutting device over the elongate severable device. Thereafter, the inner shaft is rotated within outer hollow sheath such that the blade cuts the elongate severable device between a sharp edge of the blade and an edge of the window. Inner shaft and outer hollow sheath may be substantially rigid or flexible. They may be made of suitable materials including, but not limited to Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, metals like stainless steel and fluoropolymers like PTFE, PFA, FEP and EPTFE etc. The end plate and the blade are preferentially rigid. They may be made of suitable materials including, but not limited to metals like stainless steel, polymers like Polycarbonate, Polyimide, PVC, Hytrel, HDPE, PEEK and fluoropolymers like PTFE, PFA, FEP etc.
• The anchoring devices disclosed herein may be used in a variety of configurations depending on the location of the disease process, ease of procedure etc.FIGS. 27A through 27D show axial sections through the prostate gland PG showing various configurations of anchoring devices comprisingdistal anchors2700 and atension element2702 that is anchored at a suitable location such that a sufficient tension exists intension element2702.
• FIGS. 28 and 28A show perspective views of an embodiment of an anchoring device comprising an elongate element comprising multiple barbs or anchors.FIG. 28 shows a perspective view ofanchoring device2800 comprising anelongate element2802.Elongate element2802 can be made of several biocompatible materials including, but not limited to synthetic fibers e.g. various grades of Nylon, polyethylene, polypropylene, polyester, Aramid etc.; metals e.g. various grades of stainless steel, titanium, nickel-titanium alloys, cobalt-chromium alloys, tantalum etc.; natural fibers e.g. cotton, silk etc.; rubber materials e.g. various grades of silicone rubber etc.Elongate element2802 may comprise natural or artificial suture materials. Examples of such materials include but are not limited to Polyamide (Nylon), Polypropylene, Polyglycolic Acid (PGA), polylactic acid (PLA) and copolymers of polylactic acid, polyglycolic acid and copolymers of polyglycolic acid, copolymers of PLA and PGA, Silk, Polyester, silicone, collagen, Polymers of Glycolide and Lactide. A particular example of a suture is the Nordstrom suture which is a highly elastic silicone suture. In one embodiment, the suture material is bioabsorbable.Elongate element2802 comprises two sets of projections such as barbs, anchors or hooks. In the example shown,elongate element2802 comprises a set ofdistal barbs2804 and a set ofproximal barbs2806.Distal barbs2804 are oriented in the proximal direction andproximal barbs2806 are oriented in the distal direction as shown inFIG. 25.FIG. 28A shows a magnified view of the region28A ofanchoring device2800 showingproximal barbs2806.
• FIGS. 28B through 28E show a coronal section through the prostate gland PG showing various steps of a method of treating the prostate gland PG using the device ofFIG. 28. InFIG. 28B,introducer device300 ofFIG. 3A comprising a working device lumen and acystoscope lumen308 is introduced into the urethra such that the distal end ofintroducer device300 is located in the prostatic urethra. Thereafter, ahollow puncturing device2808 is inserted in the working device lumen of introducer device.Puncturing device2808 is advanced such that distal end of puncturingdevice2808 penetrates the prostate gland PG. InFIG. 28C,anchoring device2800 is introduced throughpuncturing device2808 into the prostate gland PG. Thereafter,puncturing device2808 is pulled in the proximal direction. Simultaneously,anchoring device2800 is pulled in the proximal direction to anchordistal barbs2804 in the anatomy. InFIG. 28D, puncturingdevice2808 is pulled further in the proximal direction to expose theentire anchoring device2800. Thereafter, in step28E, the proximal end of anchoringdevice2800 is detached to deployanchoring device2800 in the anatomy. Thus, tissue betweendistal barbs2804 andproximal barbs2806 is anchored to anchoringdevice2800.
• FIG. 29A shows an axial section of the prostate gland PG showing a pair of implanted magnetic anchors. InFIG. 29A, a firstmagnetic anchor2900 and a secondmagnetic anchor2902 are implanted in the prostate gland PG on either side of the urethra. Like poles of firstmagnetic anchor2900 and secondmagnetic anchor2902 face each other such that there is magnetic repulsion between firstmagnetic anchor2900 and secondmagnetic anchor2902. This causes the urethral lumen to widen potentially reducing the severity of BPH symptoms.
• FIGS. 29B through 29D show a coronal section through the prostate gland PG showing the steps of a method of implanting magnetic anchors ofFIG. 29A. InFIG. 29B, adeployment device2904 is advanced trans-urethrally.Deployment device2904 comprises a sharpdistal tip2906 and firstmagnetic anchor2900.Distal tip2906 ofdeployment device2904 penetrates prostatic tissue and implants firstmagnetic anchor2900 in the prostate gland PG. Similarly, anotherdeployment device2908 comprising a sharp distal tip2920 is used to implant secondmagnetic anchor2902 in the prostate gland PG. Firstmagnetic anchor2900 and secondmagnetic anchor2902 are implanted on opposite sides of the urethra such that like poles of firstmagnetic anchor2900 and secondmagnetic anchor2902 face each other. This causes magnetic repulsion between firstmagnetic anchor2900 and secondmagnetic anchor2902. This causes the urethral lumen to widen potentially reducing the severity of BPH symptoms. In one embodiment,deployment device2904 can be used to deploy multiple magnetic anchors.
• FIG. 30A shows a coronal section of a region of the male urinary system showing the general working environment of a method of treating prostate disorders by cutting prostrate tissue using a device inserted into the prostate gland PG from the urethra.Cutting device3000 comprises anouter body3002 comprising aside port3004.Outer body3002 can be made of suitable biocompatible materials including, but not limited to metals e.g. stainless steel, Nickel-Titanium alloys, titanium etc.; polymers e.g. etc.Cutting device3000 further comprises anaccess device3006 that can be deployed out ofside port3004.Access device3006 can be retracted back intoside port3004. Typical examples of elements that can be used asaccess device3006 are needles, trocars etc.Access device3006 may be made from suitable biocompatible materials including, but not limited to metals e.g. stainless steel, Nickel-Titanium alloys, titanium etc.; polymers e.g. etc.Access device3006 penetrates the walls of the urethra and enters the prostate gland PG by creating an access channel in the prostate gland PG.Cutting device3000 further comprises acutting element3008 that is introduced into the prostate gland PG through the access channel in the prostate gland PG. In one embodiment, cuttingelement3008 enters the prostate gland PG throughaccess device3006. Cuttingelement3008 comprises one or more cutting modalities such as electrosurgical cutter, Laser cutter, mechanical cutter e.g. a knife edge etc. Cuttingelement3008 may be moved through prostate tissue by several mechanisms including one or more deflecting or bending elements located on cuttingelement3008; one or more articulating elements located on cuttingelement3008; motion of cuttingdevice3000 along the urethra etc. Cuttingelement3008 is used to cut one or more regions of the prostate gland PG including peripheral zone, transition zone, central zone or prostatic capsule. After the desired region or regions of the prostate gland PG are cut, cuttingelement3008 andaccess device3006 are withdrawn intocutting device3000. Thereafter,cutting device3000 is withdrawn from the urethra. In one device embodiment,cutting device3000 comprises an endoscope or means for inserting an endoscope.
• FIG. 30B shows a coronal section of a region of the male urinary system showing the general working environment of a method of treating prostate disorders by cutting prostrate tissue using a device that accesses outer surface of the prostate gland PG by passing through the walls of the urethra distal to the prostate gland PG.Cutting device3020 comprises anouter body3022 comprising aside port3024.Outer body3022 can be made of suitable biocompatible materials including, but not limited to metals e.g. stainless steel, Nickel-Titanium alloys, titanium etc.; polymers e.g. etc.Cutting device3020 is advanced into the urethra such thatside port3024 is located distal to the prostate gland PG.Cutting device3020 further comprises anaccess device3026 that can be deployed out ofside port3024.Access device3026 can be retracted back intoside port3024. Typical examples of elements that can be used asaccess device3026 are needles, trocars etc.Access device3026 may be made from suitable biocompatible materials including, but not limited to metals e.g. stainless steel, Nickel-Titanium alloys, titanium etc.; polymers e.g. etc.Access device3026 is deployed fromside port3024 in a desired orientation such thataccess device3026 penetrates the wall of the urethra.Access device3026 is advanced further such that distal end ofaccess device3026 is located near the prostate gland PG. Thereafter, acutting element3028 is introduced throughaccess device3026 to the outer surface of the prostate gland PG. Cuttingelement3028 comprises one or more cutting modalities such as electrosurgical cutter, Laser cutter, mechanical cutter e.g. a knife edge etc. Cuttingelement3028 is used to cut one or more regions of the prostate gland PG including prostatic capsule, peripheral zone, transition zone or central zone. Cuttingelement3028 may be moved relative to prostate tissue by several mechanisms including one or more deflecting or bending elements located on cuttingelement3028; motion of cuttingelement3028 alongaccess device3026 etc. In one method embodiment, cuttingelement3028 cuts prostatic capsule while being withdrawn intoaccess device3026. After the desired region or regions of the prostate gland PG are cut, cuttingelement3028 andaccess device3026 are withdrawn intocutting device3020. Thereafter,cutting device3020 is withdrawn from the urethra. In one device embodiment,cutting device3020 further comprises an endoscope or means for inserting an endoscope.
• FIG. 30C shows a coronal section of a region of the male urinary system showing the general working environment of a method of treating prostate disorders by cutting prostrate tissue using a device that accesses outer surface of the prostate gland PG by passing through the wall of the urinary bladder.Cutting device3040 comprises anouter body3042 comprising aside port3044.Outer body3042 can be made of suitable biocompatible materials including, but not limited to metals e.g. stainless steel, Nickel-Titanium alloys, titanium etc.; polymers e.g. etc.Cutting device3040 is advanced into the urethra such thatside port3044 is located inside the urinary bladder.Cutting device3040 further comprises anaccess device3046 that can be deployed out ofside port3044.Access device3046 can be retracted back intoside port3044. Typical examples of elements that can be used asaccess device3046 are needles, trocars etc.Access device3046 may be made from suitable biocompatible materials including, but not limited to metals e.g. stainless steel, Nickel-Titanium alloys, titanium etc.; polymers e.g. etc.Access device3046 is deployed fromside port3044 in a desired orientation such thataccess device3046 penetrates the wall of the urinary bladder.Access device3046 is advanced further such that distal end ofaccess device3046 is located near the prostate gland PG. Thereafter, acutting element3048 is introduced throughaccess device3046 to the outer surface of the prostate gland PG. Cuttingelement3048 comprises one or more cutting modalities such as electrosurgical cutter, Laser cutter, mechanical cutter e.g. a knife edge etc. Cuttingelement3048 is used to cut one or more regions of the prostate gland PG including prostatic capsule, peripheral zone, transition zone or central zone. Cuttingelement3048 may be moved relative to prostate tissue by several mechanisms including one or more deflecting or bending elements located on cuttingelement3048; motion of cuttingelement3048 alongaccess device3046 etc. In one method embodiment, cuttingelement3048 cuts prostatic capsule while being withdrawn intoaccess device3046. After the desired region or regions of the prostate gland PG are cut, cuttingelement3048 andaccess device3046 are withdrawn intocutting device3040. Thereafter,cutting device3040 is withdrawn from the urethra. In one device embodiment,cutting device3040 further comprises an endoscope or means for inserting an endoscope.
• FIG. 30D shows a coronal section of a region of the male urinary system showing the general working environment of a method of treating prostate disorders by cutting prostrate tissue using a device that accesses outer surface of the prostate gland PG by passing through the walls of the urethra enclosed to the prostate gland PG.Cutting device3060 comprises anouter body3062 comprising a side port3064.Outer body3062 can be made of suitable biocompatible materials including, but not limited to metals e.g. stainless steel, Nickel-Titanium alloys, titanium etc.; polymers e.g. etc.Cutting device3060 is advanced into the urethra such that side port3064 is located in the region of the urethra enclosed by the prostate gland PG.Cutting device3060 further comprises anaccess device3066 that can be deployed out of side port3064.Access device3066 can be retracted back into side port3064. Typical examples of elements that can be used asaccess device3066 are needles, trocars etc.Access device3066 may be made from suitable biocompatible materials including, but not limited to metals e.g. stainless steel, Nickel-Titanium alloys, titanium etc.; polymers e.g. etc.Access device3066 is deployed from side port3064 in a desired orientation such thataccess device3066 penetrates the prostate. Thereafter, acutting element3068 is introduced throughaccess device3066 such that the distal region of cutting element can access the outer surface of the prostate gland PG. Cuttingelement3068 comprises one or more cutting modalities such as electrosurgical cutter, Laser cutter, mechanical cutter e.g. a knife edge etc. Cuttingelement3068 is used to cut one or more regions of the prostate gland PG including prostatic capsule, peripheral zone, transition zone or central zone. Cuttingelement3068 may be moved relative to prostate tissue by several mechanisms including one or more deflecting or bending elements located on cuttingelement3068; motion of cuttingelement3068 alongaccess device3066 etc. In one method embodiment, cuttingelement3068 cuts prostatic capsule while being withdrawn intoaccess device3066. After the desired region or regions of the prostate gland PG are cut, cuttingelement3068 andaccess device3066 are withdrawn intocutting device3060. Thereafter,cutting device3060 is withdrawn from the urethra. In one device embodiment,cutting device3060 further comprises an endoscope or means for inserting an endoscope.
• FIG. 31 shows a coronal section of a region of the male urinary system showing the general working environment of a method of treating prostate disorders by cutting prostrate tissue by a percutaneous device that accesses the prostate gland PG through an incision in the abdomen. In this method, acannula3100 is introduced percutaneously into the lower abdomen.Cannula3100 can be made of suitable biocompatible materials including, but not limited to metals e.g. stainless steel, Nickel-Titanium alloys, titanium etc.; polymers etc.Cannula3100 is advanced into the abdomen such that it passes below the pubic bone. The distal end ofcannula3100 is positioned near the prostate gland PG. Thereafter, acutting device3102 is advanced through distal end ofcannula3100 to the outer surface of the prostate gland PG.Cutting device3102 can be retracted back intocannula3100.Cutting device3102 comprises one or more cutting modalities such as electrosurgical cutter, Laser cutter, mechanical cutter e.g. a knife edge etc.Cutting device3102 is used to cut one or more regions of the prostate gland PG including prostatic capsule, peripheral zone, transition zone or central zone.Cutting device3102 may be moved relative to prostate tissue by several mechanisms including one or more deflecting or bending elements located on cuttingdevice3102; motion of cuttingdevice3102 alongcannula3100 etc. In one method embodiment,cutting device3102 cuts prostatic capsule while being withdrawn intocannula3100. After the desired region or regions of the prostate gland PG are cut,cutting device3102 is withdrawn intocannula3100. Thereafter,cannula3100 is withdrawn from the urethra. In one device embodiment,cannula3100 further comprises an endoscope or means for inserting an endoscope.
• FIG. 32 shows a coronal section of a region of the male urinary system showing the general working environment of a method of treating prostate disorders by cutting prostrate tissue by a percutaneous device that penetrates the urinary bladder and accesses the outer surface of the prostate gland PG through an incision in the urinary bladder. In this method, acannula3200 is introduced percutaneously into the lower abdomen.Cannula3200 can be made of suitable biocompatible materials including, but not limited to metals e.g. stainless steel, Nickel-Titanium alloys, titanium etc.; polymers etc.Cannula3200 is advanced into the abdomen such that it passes above the pubic bone. The distal end ofcannula3200 enters the urinary bladder. Thereafter, anaccess device3202 is advanced throughcannula3200 such thataccess device3202 penetrates the urinary bladder wall as shown inFIG. 4. Thereafter, acutting device3204 is advanced through distal end ofaccess device3202 to the outer surface of the prostate gland PG.Cutting device3202 can be retracted back intoaccess device3202.Cutting device3202 comprises one or more cutting modalities such as electrosurgical cutter, Laser cutter, mechanical cutter e.g. a knife edge etc.Cutting device3202 is used to cut one or more regions of the prostate gland PG including prostatic capsule, peripheral zone, transition zone or central zone.Cutting device3202 may be moved relative to prostate tissue by several mechanisms including one or more deflecting or bending elements located on cuttingdevice3202 oraccess device3202; motion of cuttingdevice3202 alongaccess device3202 etc. In one method embodiment,cutting device3202 cuts prostatic capsule while being withdrawn intoaccess device3202. After the desired region or regions of the prostate gland PG are cut,cutting device3202 is withdrawn intoaccess device3202.Access device3202 is then withdrawn intocannula3200. Thereafter,cannula3200 is withdrawn from the urinary bladder. In one device embodiment,cannula3200 further comprises an endoscope or means for inserting an endoscope.
• FIG. 33 series shows a perspective view of a prostate treatment kit to cut prostate tissue.FIG. 33A shows a perspective view of an introducer device.Introducer device3300 comprises a firsttubular element3302 enclosing a workingdevice lumen3304. Firsttubular element3302 can be made of suitable biocompatible materials such as Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, metals like stainless steel and fluoropolymers like PTFE, PFA, FEP and EPTFE etc. The proximal end of workingdevice lumen3304 comprises afirst stasis valve3306. The distal end of workingdevice lumen3304 comprises a deflection mechanism. The deflection mechanism is used to bend the distal region of workingdevice lumen3304. One example of deflection mechanism is a pull wire and adeflection dial3310 to adjust the magnitude and/or the direction of deflection caused by the pull wire. Similarly, other deflection mechanisms can be used in the introducer device instead of a pull wire.Introducer device3300 further comprises a secondtubular element3312 which encloses acystoscope lumen3314. A cystoscope can be introduced throughcystoscope lumen3314 into the urethra. Typical examples of cystoscopes that can be used with introducer device are those manufactured by Olympus, Pentax, Storz, Wolf, Circon-ACMI, etc. These may have pre-set angles (i.e. 0, 30, 70, 120 degrees) or may be flexible scopes where in the tip may be deflectable. The proximal end ofcystoscope lumen3314 comprises asecond stasis valve3316. The cystoscope is inserted through the proximal end ofcystoscope lumen3314 and emerges out into the urethra from the distal end ofcystoscope lumen3314. The cystoscope can then be used to visualize the anatomy and various instruments during a procedure. Workingdevice lumen3314 may comprise one or more side ports e.g. afirst side port3318 for the introduction or removal of one or more fluids.Cystoscope lumen3314 may comprise one or more side ports e.g. asecond side port3320 for the introduction or removal of one or more fluids.
• FIG. 33B shows a perspective view of an injecting needle. Injectingneedle3330 is used for injecting one or more diagnostic or therapeutic agents in the anatomy. In one method embodiment, injectingneedle3330 is used to inject local anesthetic in the urethra and/or prostate gland PG. Specific examples of target areas for injecting local anesthetics are the neurovascular bundles, the genitourinary diaphragm, the region between the rectal wall and prostate, etc. Examples of local anesthetics that can be injected by injectingneedle3330 are anesthetic solutions e.g. 1% lidocaine solution; anesthetic gels e.g. lidocaine gels; combination of anesthetic agents e.g. combination of lidocaine and bupivacaine; etc. Injectingneedle3330 comprises ahollow shaft3332 made of suitable biocompatible materials including, but not limited tostainless steel 304,stainless steel 306, Nickel-Titanium alloys, titanium etc. The length ofhollow shaft3332 can range from to centimeters. The distal end ofhollow shaft3332 comprises asharp tip3334. The proximal end ofhollow shaft3332 has aneedle hub3336 made of suitable biocompatible materials including, but not limited to metals e.g. likestainless steel 304,stainless steel 306, Nickel-Titanium alloys, titanium etc.; polymers e.g. polypropylene etc. In one embodiment,needle hub3336 comprises a luer lock.
• FIG. 33C shows a perspective view of a guiding device.Guiding device3338 comprises anelongate body3340 comprising a sharpdistal tip3342. In one embodiment, guidingdevice3338 is a guidewire. Distal end ofelongate body3340 may comprise an anchoring element to reversibly anchor guidingdevice3338 into tissue. Examples of suitable anchoring elements are barbs, multipronged arrowheads, balloons, other mechanically actuable members (e.g. bendable struts), screw tips, shape memory elements, or other suitable anchor designs disclosed elsewhere in this patent application.
• FIG. 33D shows a perspective view of a RF cutting device.Cutting device3343 comprises aninner sheath3344 and anouter sheath3346.Inner sheath3344 comprises a lumen of a suitable dimension such thatcutting device3343 can be advanced over guidingdevice538.Outer sheath3346 can slide oninner sheath3344.Outer sheath3346 also comprises two marker bands: aproximal marker band3348 and adistal marker band3350. The marker bands can be seen by a cystoscope. In one embodiment,proximal marker band3348 anddistal marker band3350 are radiopaque. The position ofproximal marker band3348 anddistal marker band3350 is such that after cuttingdevice3343 is placed in an optimum location in the anatomy,proximal marker band3348 is located in the urethra where it can be seen by a cystoscope anddistal marker band3350 is located in the prostrate gland PG or in the wall of the urethra where it cannot be seen by the cystoscope.Cutting device3343 further comprises acutting wire3352 that is capable of delivering electrical energy to the surrounding tissue. The distal end ofcutting wire3352 is fixed to the distal region ofouter sheath3344. The proximal end ofcutting wire3352 is connected to a distal region ofouter sheath3346 and is further connected to a source of electrical energy. InFIG. 33D, cuttingwire3352 is in an undeployed configuration. FIG.33D′ shows the distal region of cuttingdevice3343 when cuttingwire3352 is in a deployed configuration. To deploycutting wire3352,inner sheath3344 is moved in the proximal direction with respect toouter sheath546. This causes cuttingwire3352 to bend axially outward thus deployingcutting wire3352 in the surrounding anatomy.
• FIG. 33E shows a perspective view of an embodiment of a plugging device to plug an opening created during a procedure. Pluggingdevice3354 comprises atubular shaft3356 comprising adistal opening3358.Distal opening3358 is used to deliver one or more pluggingmaterials3360 in the adjacent anatomy. Pluggingmaterial3360 may comprise a porous or non-porous matrix formed of a biodegradable or non-biodegradable material such as a flexible or rigid polymer foam, cotton wadding, gauze, hydrogels, etc. Examples of biodegradable polymers that may be foamed or otherwise rendered porous include but are not restricted to polyglycolide, poly-L-lactide, poly-D-lactide, poly(amino acids), polydioxanone, polycaprolactone, polygluconate, polylactic acid-polyethylene oxide copolymers, modified cellulose, collagen, polyorthoesters, polyhydroxybutyrate, polyanhydride, polyphosphoester, poly(alpha-hydroxy acid) and combinations thereof. In one embodiment, pluggingmaterial3360 comprises biocompatible sealants including but not limited to fibrin sealants, combination of natural proteins (e.g. collagen, albumin etc.) with aldehyde cross-linking agents (e.g. glutaraldehyde, formaldehyde) or other polymeric, biological or non-polymeric materials capable of being implanted with the body, etc. Pluggingdevice3354 may be introduced in the anatomy by various approaches including the approaches disclosed elsewhere in this patent application. Pluggingdevice3354 may be introduced in the anatomy through a cannula, over a guiding device such as a guidewire etc. In the embodiment shown inFIG. 33E, pluggingmaterial3360 is preloaded in pluggingdevice3354. Pluggingmaterial3360 is introduced throughdistal opening3358 by pushingplunger3362 in the distal direction. In another embodiment, pluggingdevice3354 comprises a lumen that extends from the proximal end todistal opening3358. Pluggingmaterial3360 may be injected through the proximal end of the lumen such that it emerges out throughdistal opening3358.
• FIGS. 33F through 33N show various alternate embodiments of the electrosurgical cutting device inFIG. 33D.FIGS. 33F and 33G show perspective views of the distal region of a first alternate embodiment of an electrosurgical cutting device in the undeployed and deployed states respectively.FIG. 33F show an electrosurgical cutting device570 comprising anelongate shaft3372.Shaft3372 is made of an electrically insulating material.Electrosurgical cutting device3370 further comprises anelectrosurgical cutting wire3374.Electrosurgical cutting wire3374 can be made of a variety of materials including, but not limited to tungsten, stainless steel, etc. Distal end ofcutting wire3374 is attached to distal region ofshaft3372. The proximal region ofcutting wire3374 can be pulled in the proximal direction by an operator. In one embodiment,electrosurgical cutting device3370 is introduced in the target anatomy through asheath3376. InFIG. 33F,electrosurgical cutting device3370 is deployed by pullingcutting wire3374 in the proximal direction. This causes distal region ofshaft3372 to bend. Thereafter, electrical energy is delivered throughcutting wire3374 to cut tissue. This may be accompanied by motion ofelectrosurgical cutting device3370 along the proximal or distal direction.
• FIGS. 33H and 33I show perspective views of the distal region of a second alternate embodiment of an electrosurgical cutting device in the undeployed and deployed states respectively.Electrosurgical cutting device3380 comprises anelongate sheath3382 comprising a lumen. Distal region ofsheath3382 has awindow3384.Electrosurgical cutting device3380 further comprises anelectrosurgical cutting wire3386 located in the lumen. Distal end ofcutting wire3386 is fixed to the distal end ofsheath3384. Proximal end ofcutting wire3386 can be pushed in the distal direction by a user. InFIG. 331,cutting wire3386 is deployed by pushingcutting wire3386 in the distal direction. This causes a region ofcutting wire3386 to bend in the radially outward direction and thus emerge out ofwindow3384. Thereafter, electrical energy is delivered throughcutting wire3386 to cut tissue. This may be accompanied by motion ofelectrosurgical cutting device3380 along the proximal or distal direction.
• FIGS. 33J through 33L show perspective views of the distal region of a second alternate embodiment of an electrosurgical cutting device showing the steps of deploying the electrosurgical cutting device.Electrosurgical cutting device3390 comprises anelongate sheath3391 comprising alumen3392. InFIG. 33J, anelectrosurgical cutting wire3394 is introduced throughlumen3392 such that it emerges out through the distal opening oflumen3392. InFIG. 33K,cutting wire3394 is further advanced in the distal direction. Distal end ofcutting wire3394 has a curved region so that cuttingwire3394 starts to bend as it emerges out oflumen3392. INFIG. 33L,cutting wire3394 is further advanced in the distal direction to fully deploycutting wire3394. Thereafter, electrical energy is delivered throughcutting wire3394 to cut tissue. This may be accompanied by motion ofelectrosurgical cutting device3390 along the proximal or distal direction.
• FIGS. 33M through 33N show perspective views of the distal region of a third alternate embodiment of an electrosurgical cutting device showing the steps of deploying the electrosurgical cutting device.Electrosurgical cutting device3395 comprises anelongate sheath3396 comprising a lumen.Cutting device3395 further comprises acutting wire3398 located in the lumen ofelongate sheath3396. The proximal end ofcutting wire3398 is connected to a source of electrical energy. Distal end ofcutting wire3398 is connected to the inner surface of the distal region ofelongate sheath3396.Cutting wire3398 may be made from suitable elastic, super-elastic or shape memory materials including but not limited to Nitinol, titanium, stainless steel etc. InFIG. 33N,Electrosurgical cutting device3395 is deployed by pushing the proximal region ofcutting wire3398 in the distal direction. This causes a distal region ofcutting wire3398 to emerge from the distal end ofelongate sheath3396 as a loop. Thereafter, electrical energy is delivered throughcutting wire3398 to cut tissue. This may be accompanied by motion ofelectrosurgical cutting device3395 along the proximal or distal direction.Electrosurgical cutting device3395 can be used to cut multiple planes of tissue by withdrawingcutting wire3398 inelongate sheath3396, rotatingelongate sheath3396 to a new orientation, redeployingcutting wire3398 and delivering electrical energy throughcutting wire3398. The devices33H through33N may be introduced by one or more access devices such as guidewires, sheaths etc.
• FIG. 34 shows a perspective view of the distal region of a balloon catheter comprising a balloon with cutting blades.Balloon catheter3400 can be introduced into a lumen or in the tissue of an organ to be treated using one or more of the introducing methods disclosed elsewhere in this patent application.Balloon catheter3400 comprises ashaft3402.Shaft3402 may comprise a lumen to allowballoon catheter3400 to be introduced over a guidewire. In one embodiment,shaft3402 is torquable.Shaft3402 comprises aballoon3404 located on the distal end ofshaft3402.Balloon3404 can be fabricated from materials including, but not limited to polyethylene terephthalate, Nylon, polyurethane, polyvinyl chloride, crosslinked polyethylene, polyolefins, HPTFE, HPE, HDPE, LDPE, EPTFE, block copolymers, latex and silicone.Balloon3404 further comprises one ormore cutter blades3406.Balloon catheter3400 is advanced withballoon3404 deflated, into a natural or surgically created passageway and positioned adjacent to tissue or matter that is to be cut, dilated, or expanded. Thereafter,balloon3404 is inflated to causecutter blades3406 to make one or more cuts in the adjacent tissue or matter. Thereafterballoon3404 is deflated andballoon catheter3400 is removed.Cutter blades3406 may be energized with mono or bi-polar RF energy.Balloon catheter3400 may comprise one or more navigation markers including, but not limited to radio-opaque markers, ultrasound markers, light source that can be detected visually etc.
• FIG. 35 shows a perspective view of the distal region of a balloon catheter comprising a balloon with cutting wires.Balloon catheter3500 can be introduced into a lumen or in the tissue of an organ to be treated using one or more of the introducing methods disclosed elsewhere in this patent application.Balloon catheter3500 comprises ashaft3502.Shaft3502 may comprise a lumen to allowballoon catheter3500 to be introduced over a guidewire. In one embodiment,shaft3502 is torquable.Shaft3502 comprises aballoon3504 located on the distal end ofshaft3502.Balloon3504 can be fabricated from materials including, but not limited to polyethylene terephthalate, Nylon, polyurethane, polyvinyl chloride, crosslinked polyethylene, polyolefins, HPTFE, HPE, HDPE, LDPE, EPTFE, block copolymers, latex and silicone.Balloon3504 further comprises one ormore radiofrequency wires3506.Balloon catheter3500 is advanced withballoon3504 deflated, into a natural or surgically created passageway and positioned adjacent to tissue or matter that is to be cut, dilated, or expanded. Thereafter,balloon3504 is inflated and an electrical current is delivered throughradiofrequency wires3506 to make one or more cuts in the adjacent tissue or matter. Thereafter the electrical current is stopped,balloon3504 is deflated andballoon catheter3500 is removed.Radiofrequency wires3504 may be energized with mono or bi-polar RF energy.Balloon catheter3500 may comprise one or more navigation markers including, but not limited to radio-opaque markers, ultrasound markers, light source that can be detected visually etc.
• FIGS. 36A and 36B series show perspective views of an undeployed state and a deployed state respectively of a tissue displacement device.FIG. 36A shows atissue anchoring device3600 in the undeployed state.Anchoring device3600 comprises an elongate body having aproximal end3602 and adistal end3604.Anchoring device3600 may be made of a variety of elastic or super-elastic materials including, but not limited to Nitinol, stainless steel, titanium etc.Anchoring device3600 is substantially straight in the undeployed state and has a tendency to become substantially curved in the deployed state.Anchoring device3600 is maintained in the undeployed state by a variety of means including, but not limited to enclosinganchoring device3600 in a cannula or sheath, etc.FIG. 36B showstissue anchoring device3600 in the deployed state.Anchoring device3600 comprises a curved region. When anchoringdevice3600 changes from an undeployed state to a deployed state, the anatomical tissue adjacent to the central region of anchoringdevice3600 is displaced along the direction of motion of the central region.Anchoring device3600 can be deployed by a variety of methods including, but not limited to removinganchoring device3600 from a sheath or cannula, etc. In one embodiment,anchoring device3600 is made from a shape memory material such as Nitinol. In this embodiment,anchoring device3600 is maintained in the undeployed state by maintaininganchor device3600 in a temperature lower than the transition temperature of the super-elastic material.Anchoring device3600 is converted to the deployed state by implantinganchoring device3600 in a patient such that the device is warmed to the body temperature which is above the transition temperature of the super-elastic material.
• FIGS. 36C and 36D show a coronal view and a lateral view respectively of a pair of deployed tissue displacement devices ofFIGS. 36A and 36B implanted in the prostate gland PG. InFIG. 36C, two anchoring devices are implanted in the prostate gland PG near the prostatic urethra in a patient with BPH. Afirst anchoring device3600 is introduced on a first side of the urethra and is deployed there as shown. Similarly, asecond anchoring device3606 comprising aproximal end3608 and adistal end3610 is introduced on the other side of the urethra and is deployed there as shown.First anchoring device3600 andsecond anchoring device3606 change into the deployed curved configuration. This causes prostate gland PG tissue near the central regions offirst anchoring device3600 andsecond anchoring device3606 to be displaced radially away from the urethra. This displacement of prostate gland PG tissue can be used to eliminate or reduce the compression of the urethra by an enlarged prostate gland PG.FIG. 36D shows a lateral view of the urethra enclosed by the prostate gland PG showing deployedfirst anchoring device3600 andsecond anchoring device3606.
• The various cuts or punctures made by one or more cutting devices disclosed in this patent application may be plugged or lined by a plugging or space filling substance.FIGS. 36E through 36H show an axial section through a prostate gland showing the various steps of a method of cutting or puncturing the prostate gland and lining or plugging the cut or puncture.FIG. 36E shows a section of the prostate gland showing the urethra, the lateral lobes and the middle lobe surrounded by the prostatic pseudocapsule. InFIG. 36F, one or more cuts are made in a region of the prostatic pseudocapsule. In addition, one or more cuts may be made in a region of between two lobes of the prostate gland. InFIG. 36G, a pluggingmaterial3619 is introduced in the one or more regions of the prostate gland that are cut or punctured. Pluggingmaterial3619 may be delivered through one or more delivery devices including, but not limited to the device disclosed inFIG. 33E. Pluggingmaterial3619 may comprises a material such as pluggingmaterial3360.
• The various cuts or punctures made by one or more cutting devices disclosed in this patent application may be spread open by a clipping device. For example,FIG. 36H shows an axial section through a prostate gland showing a clip for spreading open a cut or punctured region of the prostate gland. Spreadingdevice3620 comprises a body having a central region and two distal arms. Spreadingdevice3620 may be made of a variety of elastic or super-elastic materials including, but not limited to Nitinol, stainless steel, titanium etc. Spreadingdevice3620 has a reduced profile in the undeployed state by maintaining distal arms close to each other. Spreading device5000 is maintained in the undeployed state by a variety of means including, but not limited to enclosing spreadingdevice3620 in a cannula or sheath, etc. When spreadingdevice3620 changes from an undeployed state to a deployed state, the distance between the two distal arms increases. This causes any anatomical tissue between two distal arms to spread along the straight line between two distalarms Spreading device3620 can be deployed by a variety of methods including, but not limited to removing spreadingdevice3620 from a sheath or cannula, etc. In one embodiment, spreadingdevice3620 is made from a shape memory material such as Nitinol. In this embodiment, spreadingdevice3620 is maintained in the undeployed state by maintaininganchor device3620 in a temperature lower than the transition temperature of the super-elastic material. Spreadingdevice3620 is converted to the deployed state by implanting spreadingdevice3620 in a patient such that the device is warmed to the body temperature which is above the transition temperature of the super-elastic material. Stretching of prostate gland tissue can be used to eliminate or reduce the compression of the urethra by an enlarged prostate gland or to prevent cut edges of a cut from rejoining.
• More than one spreadingdevice3620 may be used to treat the effects of an enlarged prostate or to eliminate or reduce the compression of the urethra by an enlarged prostate gland or to prevent cut edges of a cut from rejoining.
• FIGS. 37A through 37K show an embodiment of a method of treating prostate gland disorders by cutting a region of the prostate gland using the devices described inFIGS. 33A through 33E. InFIG. 37A,introducer device3300 is introduced in the urethra. It is advanced through the urethra such that the distal tip ofintroducer device3300 is located in the prostatic urethra. Thereafter, injectingneedle3330 is introduced throughintroducer device3300. The distal tip of injectingneedle3330 is advanced such that injectingneedle3330 penetrates the prostate gland. Injectingneedle3330 is then used to inject a substance such as an anesthetic in the prostate gland. Thereafter, inFIG. 37B, injectingneedle3330 is withdrawn from the anatomy. The distal region ofintroducer device3300 is positioned near a region of the prostate gland to be punctured. Thereafter, inFIG. 37C, firsttubular element3302 is bent or deflected with a bending or deflecting mechanism such as the bending mechanism in FIGS.37C″ and37C″′ to align the distal region of firsttubular element3302 along a desired trajectory of puncturing the prostate gland.
• FIG.37C′ shows the proximal region ofintroducer device3300. Acystoscope3700 is introduced throughsecond stasis valve3316 such that the distal end ofcystoscope3700 emerges through the distal end ofintroducer device3300.Cystoscope3700 is then used to visualize the anatomy to facilitate the method of treating prostate gland disorders.
• FIG.37C″ shows a perspective view of the distal region of an embodiment ofintroducer device3300 comprising a bending or deflecting mechanism. In this embodiment, firsttubular element3302 comprises a spiral cut distal end and a pull wire. In FIG.37C″′, the pull wire is pulled bydeflection dial3310. This deflects the distal tip of firsttubular element3302 as shown.
• After the step inFIG. 37C, guidingdevice3338 is introduced through firsttubular element3302.Guiding device3338 is advanced through firsttubular element3302 such that the distal tip of guidingdevice3338 penetrates into the prostate gland. In one method embodiment, guidingdevice3338 is further advanced such that the distal tip of guidingdevice3338 penetrates through the prostate gland and enters the urinary bladder. In one embodiment, distal region of guidingdevice3338 comprises ananchoring element3702. Anchoringelement3702 is deployed as shown inFIG. 37E. Thereafter, guidingdevice3338 is pulled in the proximal direction till anchoringelement3702 is snug against the wall of the urinary bladder.Cystoscope3700 can be used to visualize the steps of penetrating the prostate gland by guidingdevice3338 and deployinganchoring element3702. If guidingdevice3338 is not positioned in a satisfactory position, guidingdevice3338 is pulled back inintroducer device3300. The deflection angle of distal end of firsttubular lumen3302 is changed and guidingdevice3338 is re-advanced into the urinary bladder. FIG.37E′ shows a perspective view of an embodiment of anchoringelement3702. Anchoring element comprises ahollow sheath3704. Distal region ofhollow sheath3704 is attached to distal region of guidingdevice3338. A number of windows are cut in the distal region ofhollow sheath3704 such that several thin, splayable strips are formed between adjacent windows. Pushinghollow sheath3704 in the distal direction causes splayable strips to splay in the radially outward direction to form an anchoring element. InFIG. 37F,cutting device3343 is advanced overguiding device3338 into the prostate gland. InFIG. 37G,cutting device3343 is positioned in the prostate gland such thatproximal marker band3348 can be seen bycystoscope3700 butdistal marker band3350 cannot be seen.
• Thereafter, inFIG. 37H, relative motion betweenouter sheath3343 andinner sheath3344causes cutting wire3352 to deploy outward in the axial direction. In one embodiment, this step is carried out by movingouter sheath3343 in the distal direction while theinner sheath3344 is stationary. In another embodiment, this step is carried out by movinginner sheath3344 in the proximal direction whileouter sheath3343 is kept stationary. Also during step, electrical energy is delivered throughcutting wire3352 to cut tissue. InFIG. 37I,cutting device3343 is pulled in the proximal direction such that the deployedcutting wire3352 slices through tissue. Thereafter,cutting wire3352 is withdrawn again in cuttingdevice3343.Cutting device3343 is then removed from the anatomy.
• InFIG. 37J, pluggingdevice3354 is introduced overguiding device3338 through the puncture or opening in the prostate gland. Thereafter, inFIG. 37K, anchoringelement3702 is undeployed andguiding device3343 is withdrawn from the anatomy. Thereafter, pluggingdevice3354 is used to deliver one or more plugging materials in the adjacent anatomy. The plugging materials can be used to plug or line some or all of the cuts or punctures created during the method.
• FIGS. 38A to 38D show various components of a kit for treating prostate gland disorders by compressing a region of the prostate gland.FIG. 38A shows the perspective view of anintroducer device3800.Introducer device3800 comprises anouter body3801 constructed from suitable biocompatible materials including, but not limited to metals like stainless steel, Nichol plated brass, polymers like Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK and fluoropolymers like PTFE, PFA, FEP, EPTFE etc.Body3801 comprises a workingdevice lumen3802. Distal end of workingdevice lumen3802 emerges out of the distal end ofbody3801. Proximal end of workingdevice lumen3802 incorporateslock thread3803 such that introducer device may join with other devices.Device lumen3802 may comprise one or more side ports e.g. afirst side port3804 and asecond side port3805 for the introduction or removal of one or more fluids.
• FIG. 38B shows a perspective view of abridge device3806 constructed from suitable biocompatible materials including, but not limited to metals like stainless steel, Nichol plated brass, polymers like Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK and fluoropolymers like PTFE, PFA, FEP, EPTFE etc. Bridge device may insert intointroducer lumen3802 and lock into place by threadablymating thread lock3807 withthread3803. Bridge may incorporateport3808 for cystoscope with locking means3809 that joins to cystoscope when inserted. Bridge device may incorporate one or more working lumens. Workinglumen3810 emerges out of the distal end ofbody3806. In one embodiment, distal end of workingdevice lumen3810 has a bent or curved region. Proximal end oflumen3810 emerges fromport3811 that may incorporatefluid stasis valve3812 and a luer lock. Workinglumen3813 emerges distally in straight fashion throughblunt obturator3814 at distal end ofbody3806 and emerges proximally through second port that may incorporate fluid stasis valve and luer lock.
• FIG. 38C shows a perspective view of a distalanchor deployment device3815 constructed from suitable biocompatible materials including, but not limited to polymers like Polycarbonate, PVC, Pebax, Polyimide, Braided Pebax, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, metals like stainless steel, Nichol plated brass, and fluoropolymers like PTFE, PFA, FEP, EPTFE etc.Deployment device3815 compriseshandle3816, which incorporates movablethumb ring pusher3817 andanchor deployment latch3818; anddistal shaft3819 which hastrocar point3820 at distal end. Mounted ondistal shaft3819 isdistal anchor3821 that incorporatestether3822.Tether3822 can be made of suitable elastic or non-elastic materials including, but not limited to metals e.g.stainless steel 304,stainless steel 306, Nickel-Titanium alloys, suture materials, titanium etc. or polymers such as silicone, nylon, polyamide, polyglycolic acid, polypropylene, Pebax, PTFE, ePTFE, silk, gut, or any other monofilament or any braided or mono-filament material. Proximal end oftether3822 may incorporatehypotube3823.Distal anchor3821 is constructed from suitable biocompatible materials including, but not limited to metals e.g.stainless steel 304,stainless steel 306, Nickel-Titanium alloys, titanium etc. or polymers e.g. Pebax, Braided Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, PTFE, PFA, FEP, EPTFE etc.Deployment device3815 is inserted intobridge working lumen3810. Advancement ofthumb ring3817 extendsdistal shaft3819 through distal end of workinglumen3810, preferably into tissue for deployment ofdistal anchor3821. Depth of distal shaft deployment can be monitored on cystoscope by visualizingdepth markers3824. Oncedistal shaft3819 is deployed to desired depth,anchor deployment latch3818 is rotated to releasedistal anchor3821. Retraction ofthumb ring3817 then retractsdistal shaft3819 while leavingdistal anchor3821 in tissue.Bridge3806 is then disconnected fromintroducer device3800 and removed.
• FIG. 38D shows the proximalanchor delivery tool3825 constructed from suitable biocompatible materials including, but not limited to polymers like Polycarbonate, PVC, Pebax, Polyimide, Braided Pebax, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, metals like stainless steel, Nichol plated brass, and fluoropolymers like PTFE, PFA, FEP, EPTFE etc. Proximalanchor delivery tool3825 compriseshandle3826, which incorporatesanchor deployment switch3827 inslot3828 andtether cut switch3829; anddistal shaft3830 which houses hypotube3831. Lumen ofhypotube3831 emerges proximally atport3832 which may incorporate a luer lock. Mounted on the hypotube and distal shaft is theproximal anchor3833 with cinchinghub3834.Proximal anchor3833 is constructed from suitable biocompatible materials including, but not limited to metals e.g.stainless steel 304,stainless steel 306, Nickel-Titanium alloys, titanium etc. or polymers e.g. Pebax, Braided Pebax, Polyimide, Braided Polyimide, Polyurethane, Nylon, PVC, Hytrel, HDPE, PEEK, PTFE, PFA, FEP, EPTFE or biodegradable polymers e.g. polyglycolic acid, poly(dioxanone), poly(trimethylene carbonate) copolymers, and poly (ε-caprolactone) homopolymers and copolymers etc.FIG. 38E shows a close-up perspective view ofproximal anchor3833 mounted onhypotube3831 anddistal shaft3830 of proximalanchor delivery tool3825.Hypotube3831 biases open the cinchinglock3835 of cinchinghub3834. In order to deployproximal anchor3833, hypotube3823 is loaded intohypotube3831 until it exitsproximal port3832.Hypotube3823 is then stabilized while proximalanchor delivery tool3825 is advanced intointroducer device lumen3802 and advanced to tissue target. Because hypotube3831 biases open cinchinglock3835, the proximal anchor delivery tool travels freely alongtether3822. Onceproximal anchor3833 is adequately apposed to urethral wall of prostate,anchor deployment switch3827 is retracted. During retraction ofswitch3827, hypotube3831 is retracted proximal to cinchinghub3834 andtether3822 is tightened. Whenswitch3827 is fully retracted or desired tension is accomplished,tether3822 is cut within cinchinghub3834 by advancing cuttingswitch3829.
• Any of the anchoring devices disclosed herein may comprise one or more sharp distal tips, barbs, hooks etc. to attach to tissue.
• Various types of endoscopes can be used in conjunction with the devices disclosed herein such as flexible scopes that are thin, flexible, fibre-optic endoscopes and rigid scopes that are thin, solid, straight endoscopes. The scopes may have one or more side channels for insertion of various instruments. Further they may be used with in conjunction with standard and modified sheaths intended for endoscopic and transurethral use.
• Local or general anesthesia may be used while performing the procedures disclosed herein. Examples of local anesthetics that can be used are anesthetic gels e.g. lidocaine gels in the urethra; combination of anesthetic agents e.g. combination of lidocaine and bupivacaine in the urethra; spinal anesthetics e.g. ropivacaine, fentanyl etc.; injectable anesthetics e.g. 1% lidocaine solution injected into the neurovascular bundles, the genitourinary diaphragm, and between the rectal wall and prostate; etc.
• An optional trans-rectal ultrasound exam may be performed before and/or during the procedures disclosed herein. In this exam, a device called ultrasound transducer is inserted into the rectum. The ultrasound transducer is then used to image the prostate gland PG using ultrasound waves. The devices may be modified so that they are more visible under ultrasound such as etched surfaces. Other imaging devices may also be optionally used such as MRI, RF, electromagnetic and fluoroscopic or X-ray guidance. The anchoring devices or delivery devices may contain sensors or transmitters so that certain elements may be tracked and located within the body. The tethering devices may be used as cables to temporarily transmit energy to the distal and/or proximal anchors during deployment.
• The invention has been described hereabove with reference to certain examples or embodiments of the invention but various additions, deletions, alterations and modifications may be made to those examples and embodiments without departing from the intended spirit and scope of the invention. For example, any element or attribute of one embodiment or example may be incorporated into or used with another embodiment or example, unless to do so would render the embodiment or example unsuitable for its intended use. Also, where the steps of a method or process are described, listed or claimed in a particular order, such steps may be performed in any other order unless to do so would render the embodiment or example un-novel, obvious to a person of ordinary skill in the relevant art or unsuitable for its intended use. All reasonable additions, deletions, modifications and alterations are to be considered equivalents of the described examples and embodiments and are to be included within the scope of the following claims.

Claims (69)

1-249. (canceled)

250. A method for treating a condition in a human or animal subject wherein the prostate gland is causing undesirable constriction of the urethra, said method comprising the steps of:

A) inserting an introducer device into the subject's body;

B) advancing a cutting device from the introducer device;

C) using the cutting device to cut at least a portion of the prostate without substantially damaging the urethra such that the constriction of the urethra is lessened; and

D) implanting at least one tissue compressing device to compresses the prostate in a manner that lessens constriction of the urethra.

251. A method according toclaim 250 wherein the introducer device inserted in Step A comprises a scope lumen and a working lumen and wherein a scope is inserted into the scope lumen and the cutting device is advanced through the working lumen.

252. A method according toclaim 250 further comprising the step of using the scope to view at least a portion of the performance of the method.

253. A method according toclaim 250 wherein Step A comprises inserting the introducer to a position within the urethra and wherein Steps B and C comprise forming an opening in the wall of the urethra, advancing either the introducer or the cutting apparatus though the opening formed in the wall of the urethra and thereafter causing the cutting apparatus to form a cut that extends through the capsule of the prostate gland.

254. A method according toclaim 250 wherein Step B comprises advancing the cutting device into the prostate gland.

255. A method according toclaim 250 wherein Step B comprises advancing the cutting device to a position adjacent to the outer surface of the prostate capsule.

256. A method according toclaim 250 wherein Step B comprises advancing a guide to a position within or near the prostate and advancing the cutting device over or through said guide.

257. A method according toclaim 256 wherein the guide comprises a guidewire and wherein the cutting device comprises a guidewire lumen that facilitates advancement of the cutting device over the guidewire.

258. A method according toclaim 256 further comprising the step of anchoring the guide.

259. A method according toclaim 250 wherein Step C comprises using the cutting device to form a subcapsular cut within the prostate gland.

260. A method according toclaim 250 wherein Step C comprises using the cutting device to form a cut through the capsule of the prostate gland.

261. A method according toclaim 250 wherein Step C comprises forming a cut between the lobes of the prostate gland such that the lobes separate from one another.

262. A method according toclaim 250 wherein the cutting device comprises an elongate shaft and a cutting element that is deployable from the shaft.

263. A method according toclaim 262 wherein the cutting element comprises a cutting member that is initially in a non-cutting configuration substantially parallel to a longitudinal axis of the shaft and may be caused to bow outwardly from the shaft thereby cutting tissue as it bows outwardly.

264. A method according toclaim 263 wherein the cutting device is advanced into the prostate gland with the cutting member in its non cutting configuration and, thereafter, causing the cutting member to bow outwardly thereby forming a cut in the prostate gland.

265. A method according toclaim 262 wherein Step C comprises causing the cutting member to emit energy to facilitate formation of said cut.

266. A method according toclaim 250 further comprising the step of maintaining separation of opposing surface of the cut for at least a period of time after formation of the cut.

267. A method according toclaim 250 further comprising the step of delivering a therapeutic substance to a location within or near the prostate gland wherein the therapeutic substance is selected from the group consisting of:

hemostatic agents; antimicrobial agents; antibiotics; antifungals; antiprotozoals; antivirals; antimicrobial metals; hemostatic and/or vasoconstricting agents; pseudoephedrine; xylometazoline; oxymetazoline; phenylephrine; epinephrine; cocaine; local anesthetic agents; lidocaine; cocaine; bupivacaine; hormones; anti-inflammatory agents; corticosteroids; non-steroidal anti-inflammatory agents; hormonally active agents; agents that enhance potency; substances that dissolve, degrade, cut, break, weaken, soften, modify or remodel connective tissue or other tissue; enzymes; collagenase; trypsin; EDTA; trypsin combined with EDTA; hyaluronidase; tosyllysylchloromethane (TLCM)); chemotherapeutic or antineoplastic agents; substances that prevent adhesion formation; hyaluronic acid gel; space occupying substances; substances that promote desired tissue ingrowth into an anchoring device or other implanted device; substances that promote or facilitate epithelialization; substances that create a coagulative lesion which is subsequently resorbed causing the tissue to shrink, substances that cause the prostate to decrease in size; phytochemicals that cause the prostate to decrease in size; alpha-1a-adrenergic receptor blocking agents; 5-alpha-reductase inhibitors; smooth muscle relaxants and agents that inhibit the conversion of testosterone to dihydrotestosterone.

268. A method according toclaim 267 wherein the step of delivering a therapeutic substance to a location within or near the prostate gland comprises injecting said therapeutic substance into or near the prostate gland.

269. A method according toclaim 267 wherein the step of delivering a therapeutic substance to a location within or near the prostate gland comprises placing a substance eluting implant in or near the prostate gland.

270. A method according toclaim 269 wherein the substance eluting implant is further operative to maintain separation of opposing surface of the cut for at least a period of time after formation of the cut.

271. A method according toclaim 250 further comprising the step of:

forming a lesion within the tissue which subsequently causes shrinkage of the tissue.

272. A method according toclaim 271 wherein a coagulative lesion is formed by heating the tissue.

273. A method according toclaim 272 wherein the coagulative lesion subsequently becomes resorbed thereby causing the tissue to shrink.

274. A method according toclaim 250 wherein the step of implanting at least one tissue compressing device to compresses the prostate in a manner that lessens constriction of the urethra comprises:

placing a first anchor at a first location on, in or adjacent to the prostate;

placing a second anchor at a second location on, in or adjacent to the prostate; and

placing a connecting member between the first and second anchors, said connecting member drawing at least one of said first and second anchors toward the other thereby compressing at least a portion of the prostate.

275. A transvesicular method for delivering a treatment to the prostate gland of a human or animal subject, said method comprising the steps of:

A) percutaneously inserting a device through the wall of the abdomen;

B) forming a first opening in the wall of the urinary bladder;

C) advancing the device inserted in Step A through the first opening and into the urinary bladder;

D) forming a second opening in the wall of the bladder;

E) advancing at least one treatment delivering device through the second opening in the wall of the urinary bladder to a position within or near the urinary bladder; and

F) using said at least one treatment delivering device to deliver the treatment to the prostate gland.

276. A method according toclaim 275 wherein the treatment comprises implantation of an implant device within or near the prostate gland.

277. A method according toclaim 276 wherein the prostate is causing constriction of the urethra and wherein the implant comprises a device that compresses the prostate in a manner that lessens constriction of the urethra.

278. A method according toclaim 276 wherein the implant delivers a therapeutic substance to treat a condition of the prostate.

279. A method according toclaim 278 wherein the implant delivers a therapeutic substance selected from the group consisting of:

hemostatic agents; antimicrobial agents; antibiotics; antifungals; antiprotozoals; antivirals; antimicrobial metals; hemostatic and/or vasoconstricting agents; pseudoephedrine; xylometazoline; oxymetazoline; phenylephrine; epinephrine; cocaine; local anesthetic agents; lidocaine; cocaine; bupivacaine; hormones; anti-inflammatory agents; corticosteroids; non-steroidal anti-inflammatory agents; hormonally active agents; agents that enhance potency; substances that dissolve, degrade, cut, break, weaken, soften, modify or remodel connective tissue or other tissue; enzymes; collagenase; trypsin; EDTA; trypsin combined with EDTA; hyaluronidase; tosyllysylchloromethane (TLCM)); chemotherapeutic or antineoplastic agents; substances that prevent adhesion formation; hyaluronic acid gel; space occupying substances; substances that promote desired tissue ingrowth into an anchoring device or other implanted device; substances that promote or facilitate epithelialization; substances that create a coagulative lesion which is subsequently resorbed causing the tissue to shrink, substances that cause the prostate to decrease in size; phytochemicals that cause the prostate to decrease in size; alpha-1a-adrenergic receptor blocking agents; 5-alpha-reductase inhibitors; smooth muscle relaxants and agents that inhibit the conversion of testosterone to dihydrotestosterone.

280. A method according toclaim 275 wherein the treatment comprises forming a cut in the prostate in a manner that lessens constriction of the urethra.

281. A method according toclaim 280 wherein the cut extends through the capsule of the prostate gland.

282. A method according toclaim 281 wherein the cut is formed at or near the commissure of the prostate gland.

283. A method according toclaim 275 wherein the treatment comprises forming a lesion in the prostate gland that subsequently causes shrinkage of the prostate gland.

284. A method according toclaim 283 wherein the lesion is a coagulative lesion is formed by heating the tissue.

285. A method according toclaim 284 wherein the coagulative lesion subsequently becomes resorbed thereby causing the tissue to shrink.

286. A method for compressing at least one region of the prostate in a manner that relieves constriction of the urethra, said method comprising the steps of

placing a first member in an anatomical structure outside of the urethra;

placing a second member in the lumen or wall of the urethra;

bringing the first member closer to the second member in a manner that relieves constriction of the urethra.

287. A device for compressing at least one region of the prostate comprising

a first element configured to communicate force to an anatomical structure outside of the urethra;

a second element configured to communicate force to the urethra; and

a tethering element capable of linking the first and second elements.

288. A method of relieving obstruction of the urethra by the prostate, said method comprising the steps of:

delivering at least one device through the wall of the urethra;

using said at least one device to performing at least one action on the prostate which changes the force exerted by the prostate on the urethra without removing or destroying prostatic tissue.

289. A device for relieving a urethral obstruction caused by the prostate gland, said device comprising

an implant that modifies at least one property of the tissue beyond the prostatic urethra without destroying or removing tissue.

290. A method for decompressing a compressed lumen within the body of a human or animal subject, said method comprising the steps of.

forming an opening in the wall of the lumen;

placing a first attachment element in or near the lumen,

placing a second attachment element in the subject's body at a location farther away from the lumen than the first attachment element;

placing a tensioning element between the first attachment element and the second attachment element said tensioning element being under sufficient tension to decompress the lumen;

wherein the lumen within the body comprises the lumen of the urethra and the first attachment element, second attachment element and tensioning element are placed so as to modify forces exerted on the urethra.

291. A system for treating a condition where a prostate tissue or anatomical structure causes constriction or interferes with an adjacent tissue or anatomical structure in the body of a human or animal subject, said system comprising:

a first anchor;

a second anchor; and

a tensioning member that extends between the first and second anchors.

292. A system according toclaim 291 wherein at least one of the first and second anchors comprises a crumpling anchor.

293. A system according toclaim 291 wherein at least one of the first and second anchors comprises T shaped anchor.

294. A system according toclaim 291 wherein at least one of the first and second anchors comprises a bow shaped anchor.

295. A system according toclaim 291 wherein at least one of the first and second anchors comprises a cross shaped anchor.

296. A system according toclaim 291 wherein at least one of the first and second anchors comprises a woven fabric, screen, textile, paper or other porous material.

297. A system according toclaim 291 wherein at least one of the first and second anchors comprises an adhesive.

298. A system according toclaim 291 wherein at least one of the first and second anchors comprises a plurality of arms extending outwardly from a central hub.

299. A system according toclaim 291 wherein at least one of the first and second anchors comprises a spiral anchor.

300. A system according toclaim 291 wherein at least one of the first and second anchors is configured to generally conform to the shape of an anatomical structure against which it is intended to rest.

301. A system according toclaim 291 wherein at least one of the first and second anchors comprises a screw.

302. A system according toclaim 291 wherein at least one of the first and second anchors comprises a plurality of splayable members.

303. A system according toclaim 291 wherein at least one of the first and second anchors comprises a molly bolt anchor.

304. A system according toclaim 291 wherein at least one of the first and second anchors is constructed to receive a trocar during insertion of the anchor.

305. A system according to claim191 wherein at least one of the first and second anchors comprises a device that is a) implantable in tissue before it is connected to the tensioning member and b) is configured to facilitate connection of the tensioning member thereto after it has been implanted in tissue.

306. A system according to claim191 wherein at least one of the first and second anchors comprises a spring.

307. A system according to claim191 wherein at least one of the first and second anchors comprises a screw.

308. A system according to claim191 wherein the tensioning member comprises an elongate member having at least one toothed surface.

309. A system according to claim191 wherein the tensioning member comprises a helical member.

310. A system according to claim191 wherein the tensioning member comprises a telescoping member.

311. A system according to claim191 wherein the tensioning member comprises a first elongate portion, a second elongate portion and a connecting body, the first elongate portion being connected to and extending from the connecting body in a first direction and the second elongate portion being connected to and extending from the connecting body in a second direction.

312. A system according to claim191 wherein the tensioning member is capable of being shortened after at least one of the anchors has been implanted.

313. A system according to claim191 further comprising apparatus for placing the tensioning member under a desired amount of tension.

314. A system according to claim191 further comprising a delivery device for delivering the system into the subject's body wherein the delivery device comprises an elongate member having a lumen and wherein the system is initially disposed within the lumen of the elongate member and wherein the system is expellable out of the lumen of the elongate member.

315. A system according toclaim 314 wherein the delivery device is attached to at least one of said first anchor, second anchor and tensioning member and wherein the system further comprises apparatus for severing that attachment.

316. A method for treating a prostate, comprising:

passing an anchor through a prostate in a first orientation; and

releasing the anchor to a second orientation for retention in anatomy adjacent the prostate.

317. A method for treating a prostate involving an anchor delivery device including a needle assembly and at least one anchor assembly including a connector attached to an anchor, comprising:

placing the needle assembly at an interventional site;

advancing the anchor assembly through the needle assembly by applying a force on the connector; and

deploying the anchor assembly at the interventional site.

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