US20130074847A1 - Systems and Methods for Male Sterilization - Google Patents

Abstract

An energy delivery probe is provided that may include any of a number of features. One feature of the energy delivery probe is that it can apply energy to tissue, such as a duct, to shrink, damage, or occlude the duct. In some embodiments, the energy can be applied with a vapor media. In some embodiments, the duct can be a ductus deferens or an ejaculatory duct of the male reproductive system. Another feature of the energy delivery probe is that it can utilize an inflatable member to form a seal to contain the vapor media. Methods associated with use of the energy delivery probe are also covered.

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• This application is a continuation of U.S. patent application Ser. No. 12/436,703, filed May 6, 2009, now U.S. Pat. No. 8,272,383, which application claims the benefit under 35 U.S.C. 119 of U.S. Provisional Patent Application No. 61/126,620, filed May 6, 2008, titled “MEDICAL SYSTEM AND METHOD OF USE.” These applications are incorporated by reference in their entirety.
INCORPORATION BY REFERENCE
• All publications and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference.
FIELD OF THE INVENTION
• This invention relates to methods for male contraception and devices used for the delivery of ablative energy to occlude a patient's ejaculatory ducts or vas differentia.
BACKGROUND OF THE INVENTION
• Several methods are known in the field of male contraception, with surgical vasectomies and occlusion of the vas deferens with implants being the most common approaches.
• A surgical vasectomy can be an effective method for causing male sterility, however, the procedure itself can be painful as it requires incisions to access the vas deferens, and in many cases pain can linger over the long term.
• Another method of male contraception utilizes plugs that are surgically implanted in the vas deferens. The plugs block the path of sperm from the testicles to the ejaculatory ducts and urethra. Such surgical methods of implanting plugs can be expensive and time-consuming.
• Accordingly, the present invention is directed to provide safe, efficient, and timely methods for male sterilization procedures. Additionally, the present invention is directed to providing apparatus that can be easily positioned within the prostate during male sterilization procedures.
SUMMARY OF THE INVENTION
• Generally, the present invention contemplates the use of a vapor delivery probe to occlude a duct in the male reproductive system.
• One aspect of the invention includes a method of male sterilization, comprising introducing a vapor delivery tool into or proximate to a duct of a male reproductive system, and delivering vapor media through the vapor delivery tool into the duct to occlude the duct.
• In some embodiments of the method, the introducing step comprises introducing the vapor delivery tool transurethrally. In other embodiments, the introducing step comprises introducing the vapor delivery tool through a skin incision.
• In further embodiments, the method further comprises forming a seal in a urethra to contain the vapor media. Forming the seal can further direct the vapor media into the duct. In some embodiments, the step of forming the seal includes expanding an expandable member. In other embodiments, forming the seal includes expanding an expandable portion of the vapor delivery tool.
• In some embodiments, the vapor media damages a wall of the duct. In other embodiments, the vapor media denatures collagen in the wall of the duct.
• In some embodiments, the vapor media has a temperature of at least 60° C. In other embodiments, the vapor media has a temperature between approximately 60° C. and 100° C.
• In some embodiments, the vapor media is delivered for an interval ranging from approximately 0.1 second to 30 seconds.
• In additional embodiments, the vapor media carries a second composition. The second composition can comprise a pharmacologic agent or a sealant, for example.
• In some embodiments of the invention, the duct is an ejaculatory duct. In other embodiments, the duct is a ductus deferens.
• In some embodiments, male sterilization method is provided that comprises introducing an energy delivery tool into or proximate to a duct of a male reproductive system, and applying energy by a fluid from the delivery tool to occlude the duct.
• In some embodiments, the fluid is selected from the group consisting of a cryogenic fluid, a heated liquid, and high temperature vapor.
• A system for male sterilization is also provided, comprising, a vapor delivery probe configured for transurethral introduction into or proximate to a duct of a male reproductive system, and a vapor source in fluid communication with the vapor delivery probe, the vapor source adapted to deliver a vapor media through the vapor delivery probe into the duct to modify the duct.
• In some embodiments, the condensable vapor has a temperature of approximately 60° to 100° C.
• In other embodiments, the system further comprises a source for introducing a second composition through the vapor delivery probe.
• In additional embodiments, the system further comprises a controller configured to control a vapor delivery interval.
• In other embodiments, the system further comprises at least one expandable member configured to contain the vapor media. The at least one expandable member can be an inflatable balloon, for example.
BRIEF DESCRIPTION OF THE DRAWINGS
• The novel features of the invention are set forth with particularity in the claims that follow. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which.
• FIG. 1 is a sectional schematic view the male reproductive tract and urogenital anatomy.
• FIG. 2A is a cut-away view of a patient's prostate and illustrating a method of introducing an endoscopic probe and vapor delivery tool according to the invention into a patient's prostatic urethra.
• FIG. 2B is a view of the patient's prostate as inFIG. 2A illustrating a subsequent step of inserting the vapor delivery tool into an ejaculatory duct and delivering a high-temperature condensable vapor therein.
• FIG. 3 is another schematic view of a patient's prostate illustrating a method of the invention wherein at least one expandable member is expanded in the prostatic urethra to retract, open and provide access to the ejaculatory ducts.
• FIG. 4 illustrates another method of the invention which includes expanding and expandable member in the prostatic urethra against to open terminations of the ejaculatory ducts to seal the flow of vapor from a vapor delivery tool.
DETAILED DESCRIPTION OF THE INVENTION
• Certain specific details are set forth in the following description and figures to provide an understanding of various embodiments of the invention. Certain well-known details, associated electronics and devices are not set forth in the following disclosure to avoid unnecessarily obscuring the various embodiments of the invention. Further, those of ordinary skill in the relevant art will understand that they can practice other embodiments of the invention without one or more of the details described below. Finally, while various processes are described with reference to steps and sequences in the following disclosure, the description is for providing a clear implementation of particular embodiments of the invention, and the steps and sequences of steps should not be taken as required to practice this invention.
• FIG. 1 illustrates an anatomical view of the male reproductive system. As shown inFIG. 1, theepididymis100, vas deferens104 (or ductus deferens) andejaculatory ducts106 form the sperm canal. Together they extend from thetestes108 to theprostatic urethra120. Thevas deferens104 is the continuation of the duct of theepididymis100, which ascends along the back border of the testes through the pelvis toward the base of theprostate122, where it is joined by theseminal vesicle124 to form theejaculatory ducts106. The vas deferens has walls of smooth muscle that provide peristaltic contractions to move sperm toward theampulla128—a portion of the vas deferens that is dilated near the base of theurinary bladder130.
• Theprostate gland122 is the largest accessory gland in the male reproductive system. Together with the testes andseminal vesicles124, the prostate's primary function is the production of semen. The prostate is a walnut-sized organ that surrounds theprostatic urethra120 that adds secretions to sperm during the ejaculation of semen. Superiorly, the base of theprostate122 is contiguous with thebladder neck136 and inferiorly itsapex140 adjoins the urogenital diaphragm. Theprostate120 can be rounded at the top and can narrow to form a blunt point atapex140. The prostate diameter in the broadest area can be about 4 cm.
• The two ejaculatory ducts, which carry sperm and the fluid secreted by theseminal vesicles124, pass obliquely through the back portion of theprostate122 and then narrow and converge toward theprostatic urethra120 which is angulated at the verumontanum144 (FIG. 2A). Theejaculatory ducts106 empty into the urethra at the slit-like openings148 (FIG. 2A). Theprostatic urethra120 then continues to the lower segment of theprostate122 and exits near itsapex140. During ejaculation, semen passes through theducts106 and exits the body via the penis150 (FIG. 1).
• Referring toFIGS. 2A and 2B, one method of the invention and related apparatus includes a system consisting of avapor source155 that is coupled to an elongated flexible vapor delivery probe orsleeve160. The delivery probe or sleeve can be configured for introduction into a duct of the male reproductive system. In one embodiment, thevapor source155 generates and delivers a heated vapor, for example water vapor, to a vapor-delivery lumen162 inprobe160. Vapor generation systems are described in the following U.S. patent application Ser. No. 10/681,625, filed Oct. 7, 2003; Ser. No. 11/158,930, filed Jun. 22, 2005; Ser. No. 11/244,329, filed Oct. 5, 2005; Ser. No. 11/329,381, filed Jan. 10, 2006; Ser. No. 12/167,155, filed Jul. 2, 2008 and Ser. No. 12/389,808, filed Feb. 20, 2009. Further details of suitable vapor generation parameters and equipment may be found in US Pat. Pub. No. 2004/0068306.
• Now turning toFIGS. 2A and 2B, anaccess device165 such as a rigid or flexible endoscope can be navigated transurethrally to a region of theprostatic urethra120 until anatomical landmarks are identified, such as theverumontanum144 and/or the slit-like openings148 of theejaculatory ducts106. The access tool can include aviewing device166, such as the termination of fiber optic viewing means, a CCD or the like.
• InFIGS. 2A-2B, thevapor delivery probe160 can be advanced through a workingchannel170 inaccess device165 until a workingend175 ofprobe160 exits thedistal end178 of theaccess device165. The exiting of the delivery probe through the distal end can be observed by the viewing means166. In one embodiment, referring toFIGS. 2A-2B, the workingend175 ofvapor delivery probe160 can have a memory curved configuration so that its extension fromchannel170 can direct the end andvapor outlet180 into the slit-opening148 of anejaculatory duct106. In another embodiment, the workingend175 ofvapor delivery probe160 can include a pull wire for articulating the workingend175 for assisting in navigation.
• FIG. 2B illustrates further advancement of workingend175 ofprobe160 into the duct106 a distance ranging from about 5 mm to 20 mm. The workingend175 can have suitable markings for viewing by the viewing means166 to determine depth of penetration from the prostatic urethra intoduct106.
• As can be understood fromFIG. 2B, a next step of the method can include actuating thevapor source155 andcontroller185 to provide vapor (such as steam) into the probe. The steam can be produced in a handle portion ofvapor delivery probe160, or can be produced remotely by a vapor generator connected via a conduit coupled to thelumen162 in theprobe160. The vapor can then be introduced into theejaculatory duct106 throughoutlet180 in the distal end of the vapor delivery component or probe160. In another aspect of the invention, vapor delivery and condensation of the vapor can apply energy to the duct sufficient to ablate, shrink and/or seal the duct. The method applies energy that denatures collagen in the lumen wall which can shrink and occlude the lumen of theduct106. In one aspect of the invention, the vapor can have a temperature of at least 60° C., 70° C., 80° C., 90° C. or 100° C. The method further includes vapor delivery for an interval ranging from 0.1 second to 30 seconds, or alternatively, for an interval ranging from 1 second to 15 seconds.
• In general, a method of the invention for vapor delivery to occlude a duct of the male reproductive system comprises introducing a vapor delivery tool or needle into a reproductive duct, and applying at least 1 W, 5 W, 10 W or 50 W of energy from the tool by means vapor energy release to ablate, shrink and/or occlude a duct. The method can cause localized ablation of the duct, and the applied energy from vapor can be localized without substantial damage to the prostate glandular tissue, theprostatic urethra120 or nerves and other structures surrounding the prostate capsule.
• FIG. 3 shows another aspect of the invention wherein the method is similar to that ofFIGS. 2A-2B, and includes providing theaccess tool165 with anextendable member210 that extends from thedistal end178 thereof. In the embodiment ofFIG. 3, a seal can be formed or created in the urethra to contain the vapor within the urethra and to direct the vapor into the ejaculatory ducts. In one embodiment, theaccess tool165 and theextendable member210 each carry aninflatable balloon220A and220B, respectively, with a balloon inflation source225 such as a syringe for inflating the balloons. The balloons can be sufficiently large for occlusion of the urethra (e.g., from about 2 mm to 10 mm in diameter) and can be spaced apart from about 5 mm to 25 mm or more. The balloons can be made of any material known in the art of catheter balloons, for example silicone or urethane. As can be understood fromFIG. 3, the collapsed balloons can be maneuvered in collapsed configurations to either side of theopenings148 ofejaculatory ducts106, and then expanded as a means of retracting the lumen ofprostatic urethra120 for the purpose of retracting and opening the slit-like open terminations of theducts106. In another optional step, CO2 or another biocompatible gas can be introduced into theprostatic urethra120 between the occlusion balloons220A and220B to expand and open the slit-like terminations148 ofducts106 to facilitate insertion of the vapor delivery probe. Thereafter, thedistal end175 of thevapor delivery probe160 can be more easily advanced into eachduct106 sequentially for the delivery of vapor therein.
• FIG. 4 shows another aspect of the invention the method which is similar to that ofFIG. 3 with the additional step ofre-positioning balloon220B more proximally after the workingend175 of thevapor delivery tool160 has been advanced into aduct106. The expanded balloon as shown inFIG. 4 thus can seal theopening148 of the duct and prevent back-flow of vapor into theprostatic urethra120. In another embodiment and method, the extendablevapor delivery tool160 can carry its own occlusion balloon (not shown) at its workingend175 to maintain the delivered vapor within the treatedduct106.
• In another aspect of the invention, a method for male sterilization comprises introducing a thermal energy delivery member into duct of male reproductive system and applying energy from the member to ablate, seal and occlude the duct. Again, the energy delivery member can include means to deliver a heated vapor.
• In another aspect of the invention, the method can include accessing a vas deferens through a skin incision and then penetration through the wall of the vas deferens.
• In general, a method of occluding ejaculatory ducts comprises inserting a tool working end transurethrally to a region proximate a termination of a duct, the working end including a fluid-delivery channel, and delivering a flowable media through the channel into the duct to cause occlusion thereof. The method can include delivering a drug with the flowable media. The method can further include delivering vapor through the channel and allowing the vapor to condense within the duct thereby applying heat to the duct. The method can include delivering a polymer or other occluding agent with the vapor. Stated alternatively, another method of the invention includes providing a vapor that carries a second composition, which can comprise a pharmacologic agent, a sealant, a glue or adhesive, a collagen composition, a polymer plug material, a fibrin or albumin or a particulate.
• In another method and apparatus corresponding to the invention, the tool for accessing the urethra can include means for expanding and retracting the urethra with a non-condensable gas, such as CO2, to allow simplified access for a tool into aduct106. In one embodiment, the tool includes first and second axially spaced apart expandable members, such as occlusion balloons. The tool includes means to deliver a gas or a vapor from an outlet between the expandable members.
• In one embodiment, the apparatus further includes a small diameter extendable member that can be directed and advanced into a lumen of a vas at least 1 mm, 5 mm, or 10 mm to deliver a treatment fluid, such as vapor, into the lumen of a duct.
• Another method of the invention comprises introducing a device working end into a targeted site in the duct and actuating a heat emitter in the working end to occlude the lumen. The heat emitter can be at least one of an electrode, a light energy emitter, an ultrasound emitter, a resistive heating element, a microwave emitter, or an inductively heated emitter. The method can include transurethral introduction or can be inserted through a puncture or incision into the lumen of a reproductive duct.
• Another method of the invention comprises introducing a device working end into a targeted region of anejaculatory duct106 or vas deferens and actuating a cooling or cryogenic means carried by the working end to modify the lumen. The method includes the cooling or cryogenic means injecting a flow media into the lumen in order to damage, occlude and seal the lumen.
• In general, one system embodiment comprises a catheter or probe device configured for treating a reproductive duct that includes an elongated flexible member having an interior passageway extending to an outlet in a working end thereof, the member configured for transurethral introduction into the lumen of an ejaculatory duct, wherein the interior passageway in fluid communication with a vapor source capable of delivering a vapor media into the lumen of the duct to modify the duct. The device includes a vapor source that delivers a condensable vapor. The condensable vapor can have a temperature of at least 60° C., 70° C., 80° C., 90° C. or 100° C. The system further includes a controller for controlling a vapor delivery interval. In another embodiment, the system further includes an aspiration source for applying aspiration forces through the interior passageway of the catheter. The system optionally includes a source for introducing a second composition through the interior passageway. As described above, the source can carry a pharmacologic agent, a sealant, a glue or adhesive, a collagen composition, a polymer plug material, a fibrin or albumin or a particulate.
• In another aspect of the invention, the introduction of the vapor probe and the delivery of vapor can be accomplished under any suitable type of imaging. In one method, the steps can be viewed by means of ultrasound or x-ray imaging. In one method, the probe introduction and energy delivery methods of the invention can be imaged by ultrasound means utilizing a trans-rectal ultrasound system commercialized by Envisioneering Medical Technologies, for example.
• As for additional details pertinent to the present invention, materials and manufacturing techniques may be employed as within the level of those with skill in the relevant art. The same may hold true with respect to method-based aspects of the invention in terms of additional acts commonly or logically employed. Also, it is contemplated that any optional feature of the inventive variations described may be set forth and claimed independently, or in combination with any one or more of the features described herein. Likewise, reference to a singular item, includes the possibility that there are plural of the same items present. More specifically, as used herein and in the appended claims, the singular forms “a,” “and,” “said,” and “the” include plural referents unless the context clearly dictates otherwise. It is further noted that the claims may be drafted to exclude any optional element. As such, this statement is intended to serve as antecedent basis for use of such exclusive terminology as “solely,” “only” and the like in connection with the recitation of claim elements, or use of a “negative” limitation. Unless defined otherwise herein, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. The breadth of the present invention is not to be limited by the subject specification, but rather only by the plain meaning of the claim terms employed.

Claims (27)

What is claimed is:

1. A male sterilization method comprising:

advancing a vapor delivery tool into or proximate to a duct of a male reproductive system; and

delivering vapor media through the vapor delivery tool into the duct to occlude the duct.

2. The method ofclaim 1 further comprising, prior to the advancing step:

introducing the vapor delivery tool into or proximate to a patient's prostate.

3. The method ofclaim 2 wherein the introducing step further comprises transurethrally introducing the vapor delivery tool into or proximate to the patient's prostate.

4. The method ofclaim 3 wherein the introducing step further comprises introducing an endoscope through the patient's urethra to the prostate; and

introducing the vapor delivery tool through a channel in the endoscope.

5. The method ofclaim 1 further comprising manipulating a distal end of the vapor delivery tool into or proximate to the duct.

6. The method ofclaim 1 wherein the advancing step comprises advancing the vapor delivery tool through a skin incision.

7. The method ofclaim 3 further comprising forming a seal in the patient's urethra to contain the vapor media.

8. The method ofclaim 7 wherein the seal directs the vapor media into the duct.

9. The method ofclaim 7 wherein the step of forming the seal includes expanding an expandable member.

10. The method ofclaim 7 wherein the step of forming the seal includes expanding an expandable portion of the vapor delivery tool.

11. The method ofclaim 1 wherein the vapor media damages a wall of the duct.

12. The method ofclaim 1 wherein the vapor media denatures collagen in the wall of the duct.

13. The method ofclaim 1 wherein the vapor media has a temperature of at least 60° C.

14. The method ofclaim 1 wherein the vapor media has a temperature between approximately 60° C. and 100° C.

15. The method ofclaim 1 wherein the vapor media is delivered for an interval ranging from approximately 0.1 second to 30 seconds.

16. The method ofclaim 1 wherein the vapor media carries a second composition.

17. The method ofclaim 16 wherein the second composition comprises a pharmacologic agent.

18. The method ofclaim 16 wherein the second composition comprises a sealant.

19. The method ofclaim 1 wherein the duct is an ejaculatory duct.

20. The method ofclaim 1 wherein the duct is a ductus deferens.

21. A system for male sterilization comprising:

a vapor delivery probe configured for introduction into or proximate to a duct of a male reproductive system, the vapor delivery probe including a distal end configured to be advanced outwardly from the probe; and

a vapor media source in fluid communication with the vapor delivery probe, the vapor media source adapted to deliver a vapor media through the vapor delivery probe into the duct.

22. The system ofclaim 21 wherein the vapor delivery probe is sized and configured for transurethral introduction into or proximate the duct.

23. The system ofclaim 21 wherein the distal end further comprises a shape memory material configured provide a memory curved shape when advanced outwardly from the probe.

24. The system ofclaim 21 wherein condensable vapor has a temperature of approximately 60° to 100° C.

25. The system ofclaim 21 further comprising a controller configured to control a vapor delivery interval.

26. The system ofclaim 21 further comprising at least one expandable member configured to contain the vapor media.

27. The system ofclaim 26 wherein the at least one expandable member is an inflatable balloon.

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