CA2095516A1 - Urethral inserted applicator for prostate hyperthermia - Google Patents
Urethral inserted applicator for prostate hyperthermiaInfo
- Publication number
- CA2095516A1 CA2095516A1 CA 2095516 CA2095516A CA2095516A1 CA 2095516 A1 CA2095516 A1 CA 2095516A1 CA 2095516 CA2095516 CA 2095516 CA 2095516 A CA2095516 A CA 2095516A CA 2095516 A1 CA2095516 A1 CA 2095516A1
- Authority
- CA
- Canada
- Prior art keywords
- applicator
- catheter
- electrode
- temperature
- tissue
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/40—Applying electric fields by inductive or capacitive coupling ; Applying radio-frequency signals
- A61N1/403—Applying electric fields by inductive or capacitive coupling ; Applying radio-frequency signals for thermotherapy, e.g. hyperthermia
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1485—Probes or electrodes therefor having a short rigid shaft for accessing the inner body through natural openings
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- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Life Sciences & Earth Sciences (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Surgery (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Physics & Mathematics (AREA)
- Plasma & Fusion (AREA)
- Otolaryngology (AREA)
- Radiology & Medical Imaging (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Radiation-Therapy Devices (AREA)
- Thermotherapy And Cooling Therapy Devices (AREA)
- Electrotherapy Devices (AREA)
Abstract
A radiofrequency energy source (12) supplies electromagnetic energy to the applicator (14) which acts as an electrode. A control circuit (26) contains a comparator (42) which is connected to a temperature sensor (20) and a temperature reference device (44) for comparing the actual tissue temperature level with a desired temperautre level and provides control signals to the energy source (12) for controlling the output to the applicator. A second electrode (96) provides a current return for the heating current from applicator (14). A sheet or sheath of insulation material covers the applicator (14) insulating it from the tissue; the thickness of the sheet or sheath may be varied to provide uniform tissue heating along the length of the applicator.
Description
2 0 9 ~ ~ 16 PCI'/US91/08182 URETHRAL INSERTED APPLICATOR FOR PROSTATE HYPERTHERMIA
Backaround of the Invention Field: This invention relates to electromagnetic radiation antenna or electrode devices for medical hyperthermic purposes, and more particularly to a combined catheter and applicator for treating prostatomegaly such as benign prostatic hypertrophy, prostatitis, and prostate malignancy by urethral insertion.
State of the Art: Hyperthermia or indu¢ed high body temperature has been considered beneficial in treating various human diseases including many types of cancer.
~ore specifically, various types of malignant growths are considered by many researchers to have a relatively narrow hyperthermia treatment temperature range. Below a threshold temperature of about 41.5 degrees Celsius, thermal destruction of these malignancies is not possible, and, in fact, their growth may be stimulated. However, at temperatures above a range of about 43 to 45 degrees Celsius thermal damage to most normal body tissue cells occurs if exposure lasts for even a relatively short duration.
While some types of skin cancers are known to respond to direct application of surface heat, deeply located malignant growths, owing to normal blood flow body heat transfer properties of the body, were most difficult to heat to the desired temperature without damaging overlying healthy tissue. A solution to this problem has been the development of electromagnetic radiation (EM) heating devices for inducing hyperthermia. This form of treatment - is known as "diathermia".
EM heating-of subsurface growths from an exterior - - surface is ordinarily enabled by configuration and - placement of one or more applicators and by appropriate - selection of EM frequency, phase, and intensity.
Nevertheless, tissue growths inside of, or in close proximity to, heat sensitive tissue or organs, are much :. . ~ :.. .: .
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WO92/07621 2 ~ 9 5 S 1 6 PCT/US91/~1~
more effectively and safely heated by EM irradiating applicators positioned within the body as closely as possible to the growth requiring treatment.
The advantages of positioning EM applicators relatively close to the growth to be heated by radiation include improved heating control, more localized heating and consequently less possibility of overheating adjacent healthy tissue, and more direct treatment of the enlarged tissues causing the undesirable symptoms.
Close applicator access to certain types of diseased tissue growths is provided by surgical procedures for naturally occurring body passages such as the esophagus, larynx, prostate gland, and colon. Surgical procedures enlarge the passage by cutting away the passage tissue.
Some heating methods use small EM applicators placed over the tissue or in an incision to provide direct irradiation of the growth. An illustrative type of a body passage insertable EM applicator is described in ~nited States Patent No. 2,407,690 issued to Southworth. The Southworth type body passage EM applicators have been configured to cause a heating pattern that tends to be concentrated at the radiating tip of the applicator and which decreases at a usually exponential rate from such tip toward the radiation source.
Special and difficult problems often attend growths found along natural body passages. For example, diseased tissue tends to spread around and along the passage, often in a relatively thin layer. Typically, the diseased layer may be less than a centimeter thick and may extend as far as 6-10 centimeters along the passage. The use of Southworth tvpe applicators results in nonuniform irradiation heating-of the elongated growth. Thus, the temperature at the tip of the Southworth type applicator may have to be so hot that it kills surrounding healthy tissue in order to make the portion of the applicator toward the power supply hot enough to kill the growth.
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WO92/07621 2 0 9 ~ ~1 6 PCT/US91/081~
Ridged and non-flexible antenna rectal-inserted devices are known. Examples of ~uch devices are disclo~od in U. S. Patent No. 4,601,296 issued to Yerushalmi, and a 1980 article titled ~Microwave Applicators for Localized Hyperthermia Treatment of Cancer of the Prostate" by Mendecki et al., Int. J. Radiation Oncology, Biol. Phys., Vol. 6, pp. 1583 and 1588.
Also, helical coil designs have been used to heat tissue placed within the cylindrical opening of the device. Such devices are disclosed in U. S. Patent No.
4,527,550 issued July 1985 to Ruggera.
A body passage insertable applicator apparatus for EN
systems is known that includes a urethral inserted probe having a monopole antenna (Nicrowave Surgical Treatment of Diseases of Prostate, Harada et al., Urology, December 1985, Vol. XXVI, No. 6, pp. 572-576). This device of Harada has no position fixing device to reliably provide correct placement. It al80 does not include a temperature monitoring device to monitor the prostate tissue or a means of controlling the treated prostate tissue at a preset target temperature. The Harada device does not include a fluid drainage device to enable urine drainage for prolonged treatment. The Harada device is described as more of a microwave surgery device which applies a large amount of power to a short length of tissue for a short time to cause lethal damage to the tissue. If a longer length of tissue along the~ urethra is to be treated, multiple treatments of short, ad~acent lengths of tissue are required, with the antenna manually repositioned along the urethra between each treatment.
- Tissue temperatures far-above 50-C are intended in treated ' tissue to cause tissue coagulation of the'treated tissue.
This high uncontrolled temperature is noted by~Harada to -have caused "de~truction of the prostate itselfni-in animal experiments. "on histologic examination,' an extensive necrotic region with he~orrhage was noted -immediately after the procedure. n Although the Harada device and '' .:
.
., ., .. .... , .. .. .. , . .,, . .... , ~ . . , W092/07621 2 0S 3~ 1 6 PCT/US91/~1 procedure appeared to provide some benefit to some patients, the uncontrolled procedure and system presents undesirable possible risk to the patients. The difficulty in positioning, controlling, and the general use of the Harada devices appears not very practical since the suggested normal positioning is by "rectal examination or trans-abdominal echography".
Also known is a helical wound coil applicator having coaxial inner and outer conductors electrically connected at an EM input end to a conventional coaxial transmission line for transmitting high frequency EM from a source to the applicator. The applicator outer conductor is longitudinally split on opposite sides to form first and second outer conductor segments. The inner conductor is electrically connected to an applicator termination end of one of such segments. A dielectric media is disposed between the applicator inner and outer conductors, and the outer conductor and termination end are covered by a dielectric sheath. A substantially uniform, external electric tissue heating field is obtained along substantially the entire length of the applicator by exponentially increasing the thickness of the dielectric sheath over the termination end and making the thickness of the sheath over the termination end equal to at least half the outer diameter of the applicator. Those persons skilled in the art desiring further information concerning - this device are referred to U. S. Patent No. 4,658,836 issued April 21, 1987 to Paul F. Turner.
A principal feature distinguishing the present invention from the prior art devices is the provision of a urethral insertable EM applicator principally adapted for benign prostatic hyperplasia (BPH), which provides the generally cylindrical or longitudinally uniform EM heating pattern necessary to enable substantially uniform heating of BPH growths or other tissue diseases associated with the urinary tract.
. . .
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;, W0~2/07621 2 0 9 ~ ~ 16 PCT/US91/~182 Summarv of the Invention Accordingly, it i6 an ob;ect of the invention to provide an improved treat~ent of benign prostatic hyperplasia as well as other diseases of the prostate gland locally involved around the urethra.
Another object of the invention is to provide an EM
applicator apparatus meeting the clinical requirements of high flexibility, sterilization, disposability, low cost, urinary drainage, and integral temperature monitoring along the perimeter of the urethral wall. The integral inflatable balloon section provides an automatic positioning of the applicator heating zone within the prostate tissue area. This section i8 intimately attached to the bladder enlarged neck opening. In this way, the applicator can be secured in place and will remain properly positioned during the treatment even though size and length of the urethral passage may change over the extended treatment period.
Yet another object of the invention is to provide an urethral insertable radiofrequency EM applicator which provides the generally cylindrical or longitudinally uniform EM heating pattern necessary to enable substantially uniform heating of BPH growths or other tissue diseases associated with the urinary tract.
A further object of the invention is to provide an urethral insertable EM applicator which can be positioned with respect to the prostate and maintained against movement therefrom during treatment.
Briefly stated, the urethral insertable radiofrequency EN applicator system includes a controlled source of EM connected to an electrical coiled conductor housed in a catheter. A temperature controller includes a sensor for determining the temperature ~ of the . surrounding tissue and generating control signals for the source of EM.
The catheter includes an applicator-positioning means for automatically positioning the coiled conductor ~ . .
. . . . :
W092/07621 PCT/US91/~1~
209S~16 ad;acent the pro~tate gland and for maintaining the position during the treat~ent. The electrical coil is suitably sheath.ed.~to provide an external, substantially uniform, electric tissue heating field to be radiated at nearly all transverse croæs sections along the applicator for æubstantially uniform tissue heating.
Advantages of the present invention are the provision of a low cost, disposable applicator which i8 detachably connected to a modified balloon type catheter for the treatment of BPH. BPH is usually treated by surgery with significant side effects. These side effects include hemorrhage, impotency, anesthetic complications, and technical failures. The use of the combined applicator catheter apparatus involves a treatment which requires no anesthesia or surgery and requires only a l or 2 hour office visit to accomplish in comparison with post surgical hospitalization.
Brief Description of the Drawings Other objects and features of the invention will become more readily apparent from the following detailed description when read in conjunction with the accompanying drawings, in which:
FIGURE 1 is a view of the urethral-insertable radiofrequency EM capacitive electrode applicator system showing the schematic diagram in block form;
FIGURE 2 is a functional schematic view of the temperature sensor and radiofrequency EM source control functional circuits;
30 . .. .. FIGURE 3 is an exploded view of the urethral : insertable EM applicator;--- FIGURE 4 i8 a transverse section of the urethral insertable EM.applicator taken as to line 4-4 of Figure 3;
FIGURE 5 i8 a vertical section of the pelvic region Or a human male b dy showing the positioning of the electrode applicator in treatment position within the pro-tate g1and and the b~lloon ln the blldder nec~;
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W092/07621 2 n 9 S ~ 1 6 PCT/US91/~1~
FI~URE 6 is an elevational view of a catheter of the invention showing the inflation of the balloon section;
FIGURE 7 is a view ~imilar to Figure 6 without the balloon inflated and showing the basic modified catheter S with a non-specific applicator section;
FIGURE 8 is a view of a wire braid or shield configuration of the applicator electrode;
FIGURE 9 is a view of a flexible conductive rubber of metallic plating configuration of the applicator electrode;
FIGURE lO is a view of a flexible multiple wire coil configuration of the applicator electrode wound in opposing directions;
. FIGURE ll is a view of a helical coil wire wrap configuration of the applicator electrode;
FIGURE 12 is a view of a wire mesh or screen configuration of the applicator electrode;
FIGURE 13 is a view of a m~ltiple wire coil wrap configuration of the applicator electrode;
FIGURE 14 is a view of a multiple flexible wire configuration of the applicator electrode;
FIGURE- 15 is a view of longitudinally stacked electrodes connected by independent wires to the controlling electromagnetic generator;
FIGURE 16 is a view of longitudinally stacked coil electrodes connected by independent wires to the controlling electromagnetic generator;
FIGURE 17 is a view of an applicator diagrammatically installed in the bladder and prostate to show the treatment positioning of the balloon and applicator; and FIGURE 18 is a cross-sectional view of the helical coil embodiment of the radiofrequency capacitive electrode applicator.
Detailed Description of a Preferred Embodiment Referring now to Figure l, the urethral insertable radiofrequency electromagnetic (EN) capacitive applicator ,. . . ... . . .
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WO92/07621 2 0 9 ~ ~ 1 6 PCT/US91/081~
system includes an electromagnetic energy source 12 having an oscillator for supplying a maximum of about 40 watts electrical power at a frequency of between 100 kHz to 300 MHz (typically 13, 27, or 40 MHz would be used since they are approved by the FCC for medical used), for example, to an electromagnetic electrode 14 through a connector means in the form of a connector cable 16 extending through a catheter 18 from electrode 14 to outside the catheter and a coaxial cable 17 connected to the end of connector cable 16. A suitable cable for both the connector cable 16 and coaxial cable 17 is a typical RG-178B cable or one of the equivalent size. The cables 16 and 17 could also be of other common types such as two twisted wires or even a single wire connected to the tip of electrode 14. The electrode 14 is an emitter of electromagnetic energy with such energy emitted from a flexible metallic surface such as a metal wire braid, a flexible conductive rubber sleeve, several wire strips, several metal sleeves or a helical coil mounted in a catheter 18 with the electrode soldered or electrically attached by direct contact to the tip of the electrically active conductor of connector cable 16, such as the inner conductor of a coaxial cable.
The catheter 18 is, for example, a size twelve French catheter modified as hereinafter described. With the particular applicators and radiofrequency EM energy described, a second electrode is needed to provide a current return path to EM source 12. Heating current flows from source 12 through cable 17 and connector cable 16 to applicator 14. The current flows from applicator 14, through the tissue to be heated, to second electrode 96 and then back through cable 98 to source 12. Current flow between applicator 14 and second electrode 96 is due to the capacitance between the two. The second metallic electrode 96 can either be contacting the patient or be separated by a dielectric media such as plastic, rubber, or air. For example, the second electrode can be inserted into the rectal passage to a position therein adjacent the ,, ,. . :
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W092/07621 2 ~ 9 S ~ 1 6 PCT/USg1/~1~
prostate gland, can be placed aqainst the skin ~urface in the pelvic region, or can be displaced away from the skin in the pelvic region. While second electrode 96 i8 8hOWn as a single electrode, it could take the form of several electrodes. Further, the second electrode 96 could be in the form of a table or other supporting surface for the '!, '.' . '' patient during treatment, and the return path indicated by cable 98 may merely be through the ground plane connections. In any situation, the metallic surface area of the second electrode 96 should be larger than that of the primary heating electrode applicator 14 placed within ~ -the prostate gland. In some cases, particularly where higher frequencies are used, the outer braided conductor of connector cable 16 can act as the second electrode. In such case, current would flow from applicator 14 through the adjacent tissue back along connector cable 16 and capacitively couple to the outer, return conductor which provides the return path to EM source 12.
The inserted radiofrequency EM applicator electrode 14 may be in the form of one of the following: -a) a helically wound metal coil; `
b) multiple wrapped coils co-located at the same zone;
c) a cylindrical sleeve made of multiple over lapping wires or a metallic cylinder;
d) multiple electrodes or coils stacked longitudinally and connected to individual transmission lines, wires, or coaxial cables to allow modification of the heat pattern length using either coherent or non-coherent phase energy into each coil;
e) straight but flexible electrode conductors rather than coiled conductors;
f) a coll with non-uniform conductor width or turns density along the coil length to modify the capacitive coupled current distribution from uniform to modify the heating distribution along the length; and - "~: ' ": -. ', . . ' . ' '':, ' '' ' . ' :
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g) an electrode or coil with dielectric material around the ele~trode or coil, but with the dielectric material modified or the thicknes~ of the dielectric material varied around the electrode or coil to modify the heating distribution along the length of the electrode or coil.
A separable insulated temperature sensor 20, shown by electrical schematic in Fig. 2, i8 inserted in a flexible tube 22, Fig. 1, during treatment. The tube is attached exteriorly of the catheter 18 adjacent to the antenna 14.
The temperature sensor measures the temperature of the tissue surrounding the catheter. The temperature sensor is connected by an insulated, four resistive lead cable 24 to a temperature sensor circuit and electromagnetic power source control circuit 26. The EM power source control circuit has its output connected to the EM energy source 12 for maintaining a power supply sufficient to maintain a tissue temperature between about 41.5 degree Celsius up to 50 degree Celsius. A control and display panel 28 is connected to the temperature sensor circuit and EM control circuit 26 for two way communication. The control and display panel 28 includes EM energy on/off switch buttons 30 and 32, and a temperature controller 34 for setting the desired operating temperature for the temperature sensor circuit and EN power control.
The temperature sensor circuit and EM control circuit 26, Fig. 1, includes the temperature 6ensor 20, Fig. 2, which may be a typical precalibrated thermistor sensor connected to a constant current source 38. An amplifier 40 is connected to the thermistor 20 for amplifying the thermistor output to a working level. A high gain comparator 42 has input terminals connected to the amplifier 40 and to a temperature setting potentiometer 44 of the temperature controller 34 located on the control and display panel 28, Fig. 1, for comparing the amplified thermistor output with a desired temperature reference voltage and outputting switch control signals. The high ,. . ..... ~ ,., -.. ~ . . - -:. . ~ : .
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WO92/0~621 2 n 9 ~ 5 16 PCT/US91/~1~
gain comparator 42, Fig. 2, has its output connected to the junction of a timer 46 and an electrically controlle,d pole of a double pole switch 48. A secondary temperature sensor 20, lead 24, and control circuit 26 can be added for a redundant monitor. This could be inserted into other tissue or in a second flexible tube 22.
The timer 46 is the EM power source control. The timer is triggered in response to the initial receipt of power from the comparator 42 for measuring a preselected treatment time, and at the end of the timing period cuts off the E~ power source. In addition, the pole of the switch 48 is manually controlled by the switch control on/off buttons 30 and 32. ~hen the switch is positioned on, as shown, a control signal is output on lead 50 to power on the E~ power source; conversely when the switch 48 is turned to the Off position, the EM power source is turned off. It should be noted the timer 46, comparator 42, temperature setting potentiometer 44, con~rol switch 48, and portions of the control circuit can be replaced by a small computer chip operating in an equivalent manner.
The catheter 18 of the combined catheter and applicator is, for example, a balloon type urological catheter having a flexible, plastic tubular body 52, Figs.
Backaround of the Invention Field: This invention relates to electromagnetic radiation antenna or electrode devices for medical hyperthermic purposes, and more particularly to a combined catheter and applicator for treating prostatomegaly such as benign prostatic hypertrophy, prostatitis, and prostate malignancy by urethral insertion.
State of the Art: Hyperthermia or indu¢ed high body temperature has been considered beneficial in treating various human diseases including many types of cancer.
~ore specifically, various types of malignant growths are considered by many researchers to have a relatively narrow hyperthermia treatment temperature range. Below a threshold temperature of about 41.5 degrees Celsius, thermal destruction of these malignancies is not possible, and, in fact, their growth may be stimulated. However, at temperatures above a range of about 43 to 45 degrees Celsius thermal damage to most normal body tissue cells occurs if exposure lasts for even a relatively short duration.
While some types of skin cancers are known to respond to direct application of surface heat, deeply located malignant growths, owing to normal blood flow body heat transfer properties of the body, were most difficult to heat to the desired temperature without damaging overlying healthy tissue. A solution to this problem has been the development of electromagnetic radiation (EM) heating devices for inducing hyperthermia. This form of treatment - is known as "diathermia".
EM heating-of subsurface growths from an exterior - - surface is ordinarily enabled by configuration and - placement of one or more applicators and by appropriate - selection of EM frequency, phase, and intensity.
Nevertheless, tissue growths inside of, or in close proximity to, heat sensitive tissue or organs, are much :. . ~ :.. .: .
., . ~. .. ~ :i, . ..
.. . .-. ~ i :. : - : : : .
. ... . .. : .. . . . .
., .. . :'. ; .' . ;, .
:...... :: :
. : .
WO92/07621 2 ~ 9 5 S 1 6 PCT/US91/~1~
more effectively and safely heated by EM irradiating applicators positioned within the body as closely as possible to the growth requiring treatment.
The advantages of positioning EM applicators relatively close to the growth to be heated by radiation include improved heating control, more localized heating and consequently less possibility of overheating adjacent healthy tissue, and more direct treatment of the enlarged tissues causing the undesirable symptoms.
Close applicator access to certain types of diseased tissue growths is provided by surgical procedures for naturally occurring body passages such as the esophagus, larynx, prostate gland, and colon. Surgical procedures enlarge the passage by cutting away the passage tissue.
Some heating methods use small EM applicators placed over the tissue or in an incision to provide direct irradiation of the growth. An illustrative type of a body passage insertable EM applicator is described in ~nited States Patent No. 2,407,690 issued to Southworth. The Southworth type body passage EM applicators have been configured to cause a heating pattern that tends to be concentrated at the radiating tip of the applicator and which decreases at a usually exponential rate from such tip toward the radiation source.
Special and difficult problems often attend growths found along natural body passages. For example, diseased tissue tends to spread around and along the passage, often in a relatively thin layer. Typically, the diseased layer may be less than a centimeter thick and may extend as far as 6-10 centimeters along the passage. The use of Southworth tvpe applicators results in nonuniform irradiation heating-of the elongated growth. Thus, the temperature at the tip of the Southworth type applicator may have to be so hot that it kills surrounding healthy tissue in order to make the portion of the applicator toward the power supply hot enough to kill the growth.
. ~ . . . . . . ...
- - . - . - - . :
. - .
.. .
. . ' ' . , ' .
WO92/07621 2 0 9 ~ ~1 6 PCT/US91/081~
Ridged and non-flexible antenna rectal-inserted devices are known. Examples of ~uch devices are disclo~od in U. S. Patent No. 4,601,296 issued to Yerushalmi, and a 1980 article titled ~Microwave Applicators for Localized Hyperthermia Treatment of Cancer of the Prostate" by Mendecki et al., Int. J. Radiation Oncology, Biol. Phys., Vol. 6, pp. 1583 and 1588.
Also, helical coil designs have been used to heat tissue placed within the cylindrical opening of the device. Such devices are disclosed in U. S. Patent No.
4,527,550 issued July 1985 to Ruggera.
A body passage insertable applicator apparatus for EN
systems is known that includes a urethral inserted probe having a monopole antenna (Nicrowave Surgical Treatment of Diseases of Prostate, Harada et al., Urology, December 1985, Vol. XXVI, No. 6, pp. 572-576). This device of Harada has no position fixing device to reliably provide correct placement. It al80 does not include a temperature monitoring device to monitor the prostate tissue or a means of controlling the treated prostate tissue at a preset target temperature. The Harada device does not include a fluid drainage device to enable urine drainage for prolonged treatment. The Harada device is described as more of a microwave surgery device which applies a large amount of power to a short length of tissue for a short time to cause lethal damage to the tissue. If a longer length of tissue along the~ urethra is to be treated, multiple treatments of short, ad~acent lengths of tissue are required, with the antenna manually repositioned along the urethra between each treatment.
- Tissue temperatures far-above 50-C are intended in treated ' tissue to cause tissue coagulation of the'treated tissue.
This high uncontrolled temperature is noted by~Harada to -have caused "de~truction of the prostate itselfni-in animal experiments. "on histologic examination,' an extensive necrotic region with he~orrhage was noted -immediately after the procedure. n Although the Harada device and '' .:
.
., ., .. .... , .. .. .. , . .,, . .... , ~ . . , W092/07621 2 0S 3~ 1 6 PCT/US91/~1 procedure appeared to provide some benefit to some patients, the uncontrolled procedure and system presents undesirable possible risk to the patients. The difficulty in positioning, controlling, and the general use of the Harada devices appears not very practical since the suggested normal positioning is by "rectal examination or trans-abdominal echography".
Also known is a helical wound coil applicator having coaxial inner and outer conductors electrically connected at an EM input end to a conventional coaxial transmission line for transmitting high frequency EM from a source to the applicator. The applicator outer conductor is longitudinally split on opposite sides to form first and second outer conductor segments. The inner conductor is electrically connected to an applicator termination end of one of such segments. A dielectric media is disposed between the applicator inner and outer conductors, and the outer conductor and termination end are covered by a dielectric sheath. A substantially uniform, external electric tissue heating field is obtained along substantially the entire length of the applicator by exponentially increasing the thickness of the dielectric sheath over the termination end and making the thickness of the sheath over the termination end equal to at least half the outer diameter of the applicator. Those persons skilled in the art desiring further information concerning - this device are referred to U. S. Patent No. 4,658,836 issued April 21, 1987 to Paul F. Turner.
A principal feature distinguishing the present invention from the prior art devices is the provision of a urethral insertable EM applicator principally adapted for benign prostatic hyperplasia (BPH), which provides the generally cylindrical or longitudinally uniform EM heating pattern necessary to enable substantially uniform heating of BPH growths or other tissue diseases associated with the urinary tract.
. . .
- - - . , - ~ .. . .
: ~.. .. ..
.... .
' ~ ' ' ' . ~
.. . . . . .
, ~ : . : , . ..
: . :
.: , . : - ~. , : , ,~ . , .
;, W0~2/07621 2 0 9 ~ ~ 16 PCT/US91/~182 Summarv of the Invention Accordingly, it i6 an ob;ect of the invention to provide an improved treat~ent of benign prostatic hyperplasia as well as other diseases of the prostate gland locally involved around the urethra.
Another object of the invention is to provide an EM
applicator apparatus meeting the clinical requirements of high flexibility, sterilization, disposability, low cost, urinary drainage, and integral temperature monitoring along the perimeter of the urethral wall. The integral inflatable balloon section provides an automatic positioning of the applicator heating zone within the prostate tissue area. This section i8 intimately attached to the bladder enlarged neck opening. In this way, the applicator can be secured in place and will remain properly positioned during the treatment even though size and length of the urethral passage may change over the extended treatment period.
Yet another object of the invention is to provide an urethral insertable radiofrequency EM applicator which provides the generally cylindrical or longitudinally uniform EM heating pattern necessary to enable substantially uniform heating of BPH growths or other tissue diseases associated with the urinary tract.
A further object of the invention is to provide an urethral insertable EM applicator which can be positioned with respect to the prostate and maintained against movement therefrom during treatment.
Briefly stated, the urethral insertable radiofrequency EN applicator system includes a controlled source of EM connected to an electrical coiled conductor housed in a catheter. A temperature controller includes a sensor for determining the temperature ~ of the . surrounding tissue and generating control signals for the source of EM.
The catheter includes an applicator-positioning means for automatically positioning the coiled conductor ~ . .
. . . . :
W092/07621 PCT/US91/~1~
209S~16 ad;acent the pro~tate gland and for maintaining the position during the treat~ent. The electrical coil is suitably sheath.ed.~to provide an external, substantially uniform, electric tissue heating field to be radiated at nearly all transverse croæs sections along the applicator for æubstantially uniform tissue heating.
Advantages of the present invention are the provision of a low cost, disposable applicator which i8 detachably connected to a modified balloon type catheter for the treatment of BPH. BPH is usually treated by surgery with significant side effects. These side effects include hemorrhage, impotency, anesthetic complications, and technical failures. The use of the combined applicator catheter apparatus involves a treatment which requires no anesthesia or surgery and requires only a l or 2 hour office visit to accomplish in comparison with post surgical hospitalization.
Brief Description of the Drawings Other objects and features of the invention will become more readily apparent from the following detailed description when read in conjunction with the accompanying drawings, in which:
FIGURE 1 is a view of the urethral-insertable radiofrequency EM capacitive electrode applicator system showing the schematic diagram in block form;
FIGURE 2 is a functional schematic view of the temperature sensor and radiofrequency EM source control functional circuits;
30 . .. .. FIGURE 3 is an exploded view of the urethral : insertable EM applicator;--- FIGURE 4 i8 a transverse section of the urethral insertable EM.applicator taken as to line 4-4 of Figure 3;
FIGURE 5 i8 a vertical section of the pelvic region Or a human male b dy showing the positioning of the electrode applicator in treatment position within the pro-tate g1and and the b~lloon ln the blldder nec~;
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FI~URE 6 is an elevational view of a catheter of the invention showing the inflation of the balloon section;
FIGURE 7 is a view ~imilar to Figure 6 without the balloon inflated and showing the basic modified catheter S with a non-specific applicator section;
FIGURE 8 is a view of a wire braid or shield configuration of the applicator electrode;
FIGURE 9 is a view of a flexible conductive rubber of metallic plating configuration of the applicator electrode;
FIGURE lO is a view of a flexible multiple wire coil configuration of the applicator electrode wound in opposing directions;
. FIGURE ll is a view of a helical coil wire wrap configuration of the applicator electrode;
FIGURE 12 is a view of a wire mesh or screen configuration of the applicator electrode;
FIGURE 13 is a view of a m~ltiple wire coil wrap configuration of the applicator electrode;
FIGURE 14 is a view of a multiple flexible wire configuration of the applicator electrode;
FIGURE- 15 is a view of longitudinally stacked electrodes connected by independent wires to the controlling electromagnetic generator;
FIGURE 16 is a view of longitudinally stacked coil electrodes connected by independent wires to the controlling electromagnetic generator;
FIGURE 17 is a view of an applicator diagrammatically installed in the bladder and prostate to show the treatment positioning of the balloon and applicator; and FIGURE 18 is a cross-sectional view of the helical coil embodiment of the radiofrequency capacitive electrode applicator.
Detailed Description of a Preferred Embodiment Referring now to Figure l, the urethral insertable radiofrequency electromagnetic (EN) capacitive applicator ,. . . ... . . .
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system includes an electromagnetic energy source 12 having an oscillator for supplying a maximum of about 40 watts electrical power at a frequency of between 100 kHz to 300 MHz (typically 13, 27, or 40 MHz would be used since they are approved by the FCC for medical used), for example, to an electromagnetic electrode 14 through a connector means in the form of a connector cable 16 extending through a catheter 18 from electrode 14 to outside the catheter and a coaxial cable 17 connected to the end of connector cable 16. A suitable cable for both the connector cable 16 and coaxial cable 17 is a typical RG-178B cable or one of the equivalent size. The cables 16 and 17 could also be of other common types such as two twisted wires or even a single wire connected to the tip of electrode 14. The electrode 14 is an emitter of electromagnetic energy with such energy emitted from a flexible metallic surface such as a metal wire braid, a flexible conductive rubber sleeve, several wire strips, several metal sleeves or a helical coil mounted in a catheter 18 with the electrode soldered or electrically attached by direct contact to the tip of the electrically active conductor of connector cable 16, such as the inner conductor of a coaxial cable.
The catheter 18 is, for example, a size twelve French catheter modified as hereinafter described. With the particular applicators and radiofrequency EM energy described, a second electrode is needed to provide a current return path to EM source 12. Heating current flows from source 12 through cable 17 and connector cable 16 to applicator 14. The current flows from applicator 14, through the tissue to be heated, to second electrode 96 and then back through cable 98 to source 12. Current flow between applicator 14 and second electrode 96 is due to the capacitance between the two. The second metallic electrode 96 can either be contacting the patient or be separated by a dielectric media such as plastic, rubber, or air. For example, the second electrode can be inserted into the rectal passage to a position therein adjacent the ,, ,. . :
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prostate gland, can be placed aqainst the skin ~urface in the pelvic region, or can be displaced away from the skin in the pelvic region. While second electrode 96 i8 8hOWn as a single electrode, it could take the form of several electrodes. Further, the second electrode 96 could be in the form of a table or other supporting surface for the '!, '.' . '' patient during treatment, and the return path indicated by cable 98 may merely be through the ground plane connections. In any situation, the metallic surface area of the second electrode 96 should be larger than that of the primary heating electrode applicator 14 placed within ~ -the prostate gland. In some cases, particularly where higher frequencies are used, the outer braided conductor of connector cable 16 can act as the second electrode. In such case, current would flow from applicator 14 through the adjacent tissue back along connector cable 16 and capacitively couple to the outer, return conductor which provides the return path to EM source 12.
The inserted radiofrequency EM applicator electrode 14 may be in the form of one of the following: -a) a helically wound metal coil; `
b) multiple wrapped coils co-located at the same zone;
c) a cylindrical sleeve made of multiple over lapping wires or a metallic cylinder;
d) multiple electrodes or coils stacked longitudinally and connected to individual transmission lines, wires, or coaxial cables to allow modification of the heat pattern length using either coherent or non-coherent phase energy into each coil;
e) straight but flexible electrode conductors rather than coiled conductors;
f) a coll with non-uniform conductor width or turns density along the coil length to modify the capacitive coupled current distribution from uniform to modify the heating distribution along the length; and - "~: ' ": -. ', . . ' . ' '':, ' '' ' . ' :
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g) an electrode or coil with dielectric material around the ele~trode or coil, but with the dielectric material modified or the thicknes~ of the dielectric material varied around the electrode or coil to modify the heating distribution along the length of the electrode or coil.
A separable insulated temperature sensor 20, shown by electrical schematic in Fig. 2, i8 inserted in a flexible tube 22, Fig. 1, during treatment. The tube is attached exteriorly of the catheter 18 adjacent to the antenna 14.
The temperature sensor measures the temperature of the tissue surrounding the catheter. The temperature sensor is connected by an insulated, four resistive lead cable 24 to a temperature sensor circuit and electromagnetic power source control circuit 26. The EM power source control circuit has its output connected to the EM energy source 12 for maintaining a power supply sufficient to maintain a tissue temperature between about 41.5 degree Celsius up to 50 degree Celsius. A control and display panel 28 is connected to the temperature sensor circuit and EM control circuit 26 for two way communication. The control and display panel 28 includes EM energy on/off switch buttons 30 and 32, and a temperature controller 34 for setting the desired operating temperature for the temperature sensor circuit and EN power control.
The temperature sensor circuit and EM control circuit 26, Fig. 1, includes the temperature 6ensor 20, Fig. 2, which may be a typical precalibrated thermistor sensor connected to a constant current source 38. An amplifier 40 is connected to the thermistor 20 for amplifying the thermistor output to a working level. A high gain comparator 42 has input terminals connected to the amplifier 40 and to a temperature setting potentiometer 44 of the temperature controller 34 located on the control and display panel 28, Fig. 1, for comparing the amplified thermistor output with a desired temperature reference voltage and outputting switch control signals. The high ,. . ..... ~ ,., -.. ~ . . - -:. . ~ : .
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gain comparator 42, Fig. 2, has its output connected to the junction of a timer 46 and an electrically controlle,d pole of a double pole switch 48. A secondary temperature sensor 20, lead 24, and control circuit 26 can be added for a redundant monitor. This could be inserted into other tissue or in a second flexible tube 22.
The timer 46 is the EM power source control. The timer is triggered in response to the initial receipt of power from the comparator 42 for measuring a preselected treatment time, and at the end of the timing period cuts off the E~ power source. In addition, the pole of the switch 48 is manually controlled by the switch control on/off buttons 30 and 32. ~hen the switch is positioned on, as shown, a control signal is output on lead 50 to power on the E~ power source; conversely when the switch 48 is turned to the Off position, the EM power source is turned off. It should be noted the timer 46, comparator 42, temperature setting potentiometer 44, con~rol switch 48, and portions of the control circuit can be replaced by a small computer chip operating in an equivalent manner.
The catheter 18 of the combined catheter and applicator is, for example, a balloon type urological catheter having a flexible, plastic tubular body 52, Figs.
3 and 4, which is divided by a partition 54, Fig. 4, into a catheter drainage tube 56, a fluid isolated tube 58, and a fluid passage 60 for inflating balloon 76. The flexible tube 22 for the temperature sensor is attached exteriorly of the tubular body 52. The tubular body 52 has a ~sifurcated opening piece 62 having one side 64 for connecting the central drainage tube 56 to a waste receiving receptacle, and a second side 66 having an air - or fluid input-output valve 68 for connecting the air or - fluid passage 60 to a pressurized air or fluid supply source to inflate the balloon 76 after insertion into the - - bladder. This air or fluid supply source could simply be a syringe.
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WO92/07621 2 0 9 5 ~1~ PCT/US91/081 In operation, with the catheter properly positioned as described above, and the timer 46 and the temperature set dial set as desired, the EM oscillator 12 is turned on by RF switch 30 and the applicator 14 radiates power into the area of the prostate gland until the desired temperature is reached. When the desired temperature is reached, the comparator 42 outputs control signals to the oscillator to manipulate its EM output power to maintain the temperature substantially constant for the selected treatment time period. At the end of the treatment time, the oscillator i8 automatically turned off, but the oscillator can be turned off at any time using the EM off switch 32.
The transmission line, wire or coaxial cable forming connector cable 16, Fig. 3, passes through the fluid isolated tube 58 through outlets adjacent ends of the electrode or antenna-forming coil to connect to the electrode or antenna coil 14 as previously described. A
dielectric sheet 70 or tube, such as, for example, a silicone rubber, is placed and bonded over the metal electrode or spiral metal coil 14 to complete the applicator. The sheath 70 is the means for causing the external, electric tissue heating field to be substantially uniform along the length of the applicator and avoiding direct metallic contact between the metal portions of the electrode or antenna. It may be allowable - for such metal;surfaces to contact the tissues directly if sufficient protection is provided to assure that potentially dangerous currents at dc or freguencies below 100 kHz cannot flow into the tissues. Such low - frequencies can improperly stimulate muscle spasms, - cramping, and damage. The thickness of the preferred - dielectric sheath may be uniform or may be varied exponentially, if necessary, to obtain the uniform heating -field. The electrode or antenna coil 14 is positioned adjacent to the edge 74 of the inflatable balloon 76 toward the proximal end of the catheter from stop 72.
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Figure 4 shows the cross-section view 4-4 from Figure l of the body of the Foley oatheter applicator assembly 18. The Foley balloon is in open communication with the outlet of the air or fluid passage 60 which enables inflation and deflation of the balloon section. Thus, when the catheter is positioned 80 that the balloon when inflated is in the bladder, and then the catheter is pulled outwardly 80 that the inflated balloon is resting on the neck of the bladder, the applicator is properly positioned with respect to the prostate gland and will maintain its position free from movement for the duration of the hyperthermic treatment. Figure 4 shows the urine drainage passage 56 and the fluid dry passage 58 through which the connector cable 16 passes. The connector cable is preferably comprised of an outer conductor 16b and an inner conductor 16a separated by a dielectric 16c. At least one externally attached temperature probe receiving tube 22 is attached to the Foley catheter outer wall 52 enabling insertion of a temperature sensor 20.
Figure 5 is a cross-sectional representation of the insertion of the urethral inserted applicator electrode 14 in the urethra in the prostate gland. The coil style electrode 14 is represented as being positioned in the prostate because the balloon 76 has been inflated and secured against the bladder wall at the neck of the bladder opening into the urethra. Also, the second electrode 96 is represented with three alternate configurations, all shown in Figure 5. In one position, the second electrode 96 can be inserted into the rectal passage 97 and positioned approximately adjacent to the prostate gland. In a second position, it can be placed along the skin surface in the pelvic region, the position shown merely being an example. In a third position, second electrode 96 can be displaced away from the s~in in the pelvic region, again,-the position shown in Figure 5 merely being an example. Any of these second electrode positions can be used to provide a capacitively coupled .. ... . ~ .... ...
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current return path for the current flowing from electrode 14. The gecond electrode 96 provides a return current flow path to the EM source 12 via connecting cable 98.
The inflated balloon 76 is shown in the proper treatment position against the bladder wall.
As shown in Figure 6, the tip balloon 76 can be inflated or filled with water or air to enable securing it into place at the nec~ of the bladder. The balloon inflation and deflation is provided by the stopper valva 68 which is connected to the applicator body 18 by tube support 66.
Figure 7 shows the tip balloon 76 in the deflated mode for the insertion into or removal from the bladder and urethra. The balloon inflation and deflation is provided by the stopper valve 68 which is connected to the applicator body 18 by the tube support 66.
Figure 8 shows the configuration of a flexible conductive electrode applicator 14 comprised of multiple over lapping strands of wire forming an inner-twined braided cylinder.
Figure 9 shows the applicator 14 as a flexible conductive cylindrical electrode comprised of a conductive rubber or plated dielectric surface. This type of material is commercially available.
Figure 10 shows the applicator 14 as a flexible conductive electrode comprised of several crossing wires in a wrapped braid form where the wires are wound in a coiled or weaved fashion.
Figure 11 shows the applicator 14 as a flexible conductive electrode comprised of a single wire coil being wrapped along the full electrode length.
Figure 12 shows the applicator 14 as a flexible conductive electrode comprised of a wire grid or screen.
Figure 13 shows the applicator 14 as a flexible conductive electrode comprised of several non-overlapping wires which are wound in parallel coils along the same length section.
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These wires are connected with a common input wire and can be shorted together at the tip region if desired.
- Figure 15 shows the system connection configuration for applicator 14 when applicator 14 is in the form of a multiple sleeve, flexible, conductive electrode comprised of several conductive collars 80 stacked along the electrode length to enable separate zones of heating which are individually connected with the multiple wires or cables 82 through power control devices 88 and power divider 90 to the EM source connection cable 17. The use of separate wires to separate zones enables the connection to the EM source to be individually interrupted by the power control devices 88 which are power attenuators, amplifiers or switches. In this way, the heating can be diminished along selective portions of the heating length.
This would be useful, for example, if the prostate tissue to be treated is not as long as the electrode array.
Thus, by simply disconnecting the connection of the wire~
to the EM source which correspond to the electrodes where the heat is not desired, the heating length can be adapted to match the intended target tissue length. One connection wire 82 is connected to each of the conductive electrodes 80. The power control devices 88 are each connected to the power divider 90 which divides the power received from-the EM source connection cable 17.
Figure 16 shows the system connection configuration of the applicator 14 when applicator 14 is in the form of multiple coil sections forming a flexible conductive electrode comprised of several conductive collars 92 stacked along the electrode length t-o enable--separate zones of heating which are individually connected with the multiple wires or cables 82 through power control devices 88 and power divider 90 to the EM source connection cable 17. The use of these wires to separate zones enables the ,..... . .... ,. , ~. . . . . . ..... ~.
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2~9J ~ 1 6 connection to the generator to be individually interrupted by the power control devices 88 which are power attenuators, amplifiers, or switches. In this way the heating can be diminished along selective portions of the heating length. This would be useful for example if the prostate tissue to be treated is not as long as the electrode array. Th~s, by simply disconnecting the connection of the wires to the generator which correspond to the electrodes where the heat is not desired, the heating lenqth can be adapted to match the intended target tissue lenqth. One connection wire 82 is connected to each of the conductive coils 92.
Figure 17 shuws the orientation of the applicator electrode 14 in the prostate gland and the balloon 72 inflated at the bladder opening. When the balloon is inflated, the Foley catheter assembly 18 can be manually pulled to position and secures the balloon at the bladder neck. This assures that the heating pattern is correctly positioned within the prostate qland which rests next to and attached to the bladder wall.
Fiqure 18 shows the cross-sectional view along the line 18-18 of Fiqure 4 of the applicator heating electrode or coil section 14. The outer conductor 16b of the EM
source connection cable 16 is shown passing within the Foley catheter body wall 52. The center conductor 16a is shown connected to the applicator electrode 14 by connecting wire 80. The coil configuration of electrode 14 can have varying conductor width to modify the heating current distribution as shown. The dielectric sheet layer 70 wrapped around and bonded to the electrode 14 normally is of uniform thickness, but can have varying thicknesses, as shown, to modify the coupling distribution of the heating currents passing from the-electrode 14 to the tissues through the dielectric capacitance provided by the dielectric layer 70. The balloon 76 is located at the distal end of the inserted electrode 14.
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wos2/o762l PCT/US91/~182 2095~16 Whereas this invention is here illu~trated and described with specific reference to embodiment6 thereof presently contemplated as the best mode of carrying out such invention in actual practice, it is to be understood that various changes may be made in adapting the invention - to different embodiments without departing from the broader inventive concepts disclosed herein and comprehended by the claims that follow.
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WO92/07621 2 0 9 5 ~1~ PCT/US91/081 In operation, with the catheter properly positioned as described above, and the timer 46 and the temperature set dial set as desired, the EM oscillator 12 is turned on by RF switch 30 and the applicator 14 radiates power into the area of the prostate gland until the desired temperature is reached. When the desired temperature is reached, the comparator 42 outputs control signals to the oscillator to manipulate its EM output power to maintain the temperature substantially constant for the selected treatment time period. At the end of the treatment time, the oscillator i8 automatically turned off, but the oscillator can be turned off at any time using the EM off switch 32.
The transmission line, wire or coaxial cable forming connector cable 16, Fig. 3, passes through the fluid isolated tube 58 through outlets adjacent ends of the electrode or antenna-forming coil to connect to the electrode or antenna coil 14 as previously described. A
dielectric sheet 70 or tube, such as, for example, a silicone rubber, is placed and bonded over the metal electrode or spiral metal coil 14 to complete the applicator. The sheath 70 is the means for causing the external, electric tissue heating field to be substantially uniform along the length of the applicator and avoiding direct metallic contact between the metal portions of the electrode or antenna. It may be allowable - for such metal;surfaces to contact the tissues directly if sufficient protection is provided to assure that potentially dangerous currents at dc or freguencies below 100 kHz cannot flow into the tissues. Such low - frequencies can improperly stimulate muscle spasms, - cramping, and damage. The thickness of the preferred - dielectric sheath may be uniform or may be varied exponentially, if necessary, to obtain the uniform heating -field. The electrode or antenna coil 14 is positioned adjacent to the edge 74 of the inflatable balloon 76 toward the proximal end of the catheter from stop 72.
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Figure 4 shows the cross-section view 4-4 from Figure l of the body of the Foley oatheter applicator assembly 18. The Foley balloon is in open communication with the outlet of the air or fluid passage 60 which enables inflation and deflation of the balloon section. Thus, when the catheter is positioned 80 that the balloon when inflated is in the bladder, and then the catheter is pulled outwardly 80 that the inflated balloon is resting on the neck of the bladder, the applicator is properly positioned with respect to the prostate gland and will maintain its position free from movement for the duration of the hyperthermic treatment. Figure 4 shows the urine drainage passage 56 and the fluid dry passage 58 through which the connector cable 16 passes. The connector cable is preferably comprised of an outer conductor 16b and an inner conductor 16a separated by a dielectric 16c. At least one externally attached temperature probe receiving tube 22 is attached to the Foley catheter outer wall 52 enabling insertion of a temperature sensor 20.
Figure 5 is a cross-sectional representation of the insertion of the urethral inserted applicator electrode 14 in the urethra in the prostate gland. The coil style electrode 14 is represented as being positioned in the prostate because the balloon 76 has been inflated and secured against the bladder wall at the neck of the bladder opening into the urethra. Also, the second electrode 96 is represented with three alternate configurations, all shown in Figure 5. In one position, the second electrode 96 can be inserted into the rectal passage 97 and positioned approximately adjacent to the prostate gland. In a second position, it can be placed along the skin surface in the pelvic region, the position shown merely being an example. In a third position, second electrode 96 can be displaced away from the s~in in the pelvic region, again,-the position shown in Figure 5 merely being an example. Any of these second electrode positions can be used to provide a capacitively coupled .. ... . ~ .... ...
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current return path for the current flowing from electrode 14. The gecond electrode 96 provides a return current flow path to the EM source 12 via connecting cable 98.
The inflated balloon 76 is shown in the proper treatment position against the bladder wall.
As shown in Figure 6, the tip balloon 76 can be inflated or filled with water or air to enable securing it into place at the nec~ of the bladder. The balloon inflation and deflation is provided by the stopper valva 68 which is connected to the applicator body 18 by tube support 66.
Figure 7 shows the tip balloon 76 in the deflated mode for the insertion into or removal from the bladder and urethra. The balloon inflation and deflation is provided by the stopper valve 68 which is connected to the applicator body 18 by the tube support 66.
Figure 8 shows the configuration of a flexible conductive electrode applicator 14 comprised of multiple over lapping strands of wire forming an inner-twined braided cylinder.
Figure 9 shows the applicator 14 as a flexible conductive cylindrical electrode comprised of a conductive rubber or plated dielectric surface. This type of material is commercially available.
Figure 10 shows the applicator 14 as a flexible conductive electrode comprised of several crossing wires in a wrapped braid form where the wires are wound in a coiled or weaved fashion.
Figure 11 shows the applicator 14 as a flexible conductive electrode comprised of a single wire coil being wrapped along the full electrode length.
Figure 12 shows the applicator 14 as a flexible conductive electrode comprised of a wire grid or screen.
Figure 13 shows the applicator 14 as a flexible conductive electrode comprised of several non-overlapping wires which are wound in parallel coils along the same length section.
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These wires are connected with a common input wire and can be shorted together at the tip region if desired.
- Figure 15 shows the system connection configuration for applicator 14 when applicator 14 is in the form of a multiple sleeve, flexible, conductive electrode comprised of several conductive collars 80 stacked along the electrode length to enable separate zones of heating which are individually connected with the multiple wires or cables 82 through power control devices 88 and power divider 90 to the EM source connection cable 17. The use of separate wires to separate zones enables the connection to the EM source to be individually interrupted by the power control devices 88 which are power attenuators, amplifiers or switches. In this way, the heating can be diminished along selective portions of the heating length.
This would be useful, for example, if the prostate tissue to be treated is not as long as the electrode array.
Thus, by simply disconnecting the connection of the wire~
to the EM source which correspond to the electrodes where the heat is not desired, the heating length can be adapted to match the intended target tissue length. One connection wire 82 is connected to each of the conductive electrodes 80. The power control devices 88 are each connected to the power divider 90 which divides the power received from-the EM source connection cable 17.
Figure 16 shows the system connection configuration of the applicator 14 when applicator 14 is in the form of multiple coil sections forming a flexible conductive electrode comprised of several conductive collars 92 stacked along the electrode length t-o enable--separate zones of heating which are individually connected with the multiple wires or cables 82 through power control devices 88 and power divider 90 to the EM source connection cable 17. The use of these wires to separate zones enables the ,..... . .... ,. , ~. . . . . . ..... ~.
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2~9J ~ 1 6 connection to the generator to be individually interrupted by the power control devices 88 which are power attenuators, amplifiers, or switches. In this way the heating can be diminished along selective portions of the heating length. This would be useful for example if the prostate tissue to be treated is not as long as the electrode array. Th~s, by simply disconnecting the connection of the wires to the generator which correspond to the electrodes where the heat is not desired, the heating lenqth can be adapted to match the intended target tissue lenqth. One connection wire 82 is connected to each of the conductive coils 92.
Figure 17 shuws the orientation of the applicator electrode 14 in the prostate gland and the balloon 72 inflated at the bladder opening. When the balloon is inflated, the Foley catheter assembly 18 can be manually pulled to position and secures the balloon at the bladder neck. This assures that the heating pattern is correctly positioned within the prostate qland which rests next to and attached to the bladder wall.
Fiqure 18 shows the cross-sectional view along the line 18-18 of Fiqure 4 of the applicator heating electrode or coil section 14. The outer conductor 16b of the EM
source connection cable 16 is shown passing within the Foley catheter body wall 52. The center conductor 16a is shown connected to the applicator electrode 14 by connecting wire 80. The coil configuration of electrode 14 can have varying conductor width to modify the heating current distribution as shown. The dielectric sheet layer 70 wrapped around and bonded to the electrode 14 normally is of uniform thickness, but can have varying thicknesses, as shown, to modify the coupling distribution of the heating currents passing from the-electrode 14 to the tissues through the dielectric capacitance provided by the dielectric layer 70. The balloon 76 is located at the distal end of the inserted electrode 14.
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wos2/o762l PCT/US91/~182 2095~16 Whereas this invention is here illu~trated and described with specific reference to embodiment6 thereof presently contemplated as the best mode of carrying out such invention in actual practice, it is to be understood that various changes may be made in adapting the invention - to different embodiments without departing from the broader inventive concepts disclosed herein and comprehended by the claims that follow.
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Claims (20)
1. An electromagnetic capacitive coupling applicator apparatus for treatment of benign prostatic hyperplasia comprising:
a catheter means for insertion of the applicator into the urethra;
an applicator means attached to the catheter means, said applicator means including a cable and connector means for connecting the applicator to a source of electromagnetic energy sufficient to elevate the temperature of tissue surrounding the applicator to a preselected temperature and for maintaining the preselected temperature during treatment;
positioning means for positioning the catheter in the urethra so that the applicator means attached to the catheter means is positioned adjacent the prostate tissue to be treated; and a temperature sensor supporting means attached to the catheter means for supporting a temperature sensing means in operative association with the applicator of the applicator means for measuring the temperature of the tissue surrounding the applicator.
a catheter means for insertion of the applicator into the urethra;
an applicator means attached to the catheter means, said applicator means including a cable and connector means for connecting the applicator to a source of electromagnetic energy sufficient to elevate the temperature of tissue surrounding the applicator to a preselected temperature and for maintaining the preselected temperature during treatment;
positioning means for positioning the catheter in the urethra so that the applicator means attached to the catheter means is positioned adjacent the prostate tissue to be treated; and a temperature sensor supporting means attached to the catheter means for supporting a temperature sensing means in operative association with the applicator of the applicator means for measuring the temperature of the tissue surrounding the applicator.
2. An electromagnetic capacitive coupling applicator apparatus for treatment of benign prostatic hyperplasia comprising:
a catheter means for insertion into the urethra including a fluid free tube, a temperature sensor supporting tube, and an applicator support portion adjacent to the first end of the fluid free tube;
an applicator means including a wire or coaxial cable mounted in the fluid free tube and an applicator mounted on the applicator support portion and connected to the wire or coaxial cable for capacitively coupling electromagnetic energy into tissue adjacent to the applicator;
a temperature sensor means including a temperature sensor inserted in the temperature supporting tube for monitoring the temperature of tissue adjacent to the applicator;
an electromagnetic energy generating means connected to the applicator means for supplying electromagnetic energy thereto;
a control means including a target temperature reference comparison means for setting a selected reference temperature to which the tissue is to be heated and a comparator connected to the tissue temperature sensor means and temperature reference means for producing generator energy level control signals; and said electromagnetic energy generating means being connected to the control means and responsive to the control signals for supplying electromagnetic energy to the applicator means sufficient for elevating the tissue temperature to the selected reference temperature and maintaining the tissue at the selected temperature during treatment by the control of generator energy applied to the applicator.
a catheter means for insertion into the urethra including a fluid free tube, a temperature sensor supporting tube, and an applicator support portion adjacent to the first end of the fluid free tube;
an applicator means including a wire or coaxial cable mounted in the fluid free tube and an applicator mounted on the applicator support portion and connected to the wire or coaxial cable for capacitively coupling electromagnetic energy into tissue adjacent to the applicator;
a temperature sensor means including a temperature sensor inserted in the temperature supporting tube for monitoring the temperature of tissue adjacent to the applicator;
an electromagnetic energy generating means connected to the applicator means for supplying electromagnetic energy thereto;
a control means including a target temperature reference comparison means for setting a selected reference temperature to which the tissue is to be heated and a comparator connected to the tissue temperature sensor means and temperature reference means for producing generator energy level control signals; and said electromagnetic energy generating means being connected to the control means and responsive to the control signals for supplying electromagnetic energy to the applicator means sufficient for elevating the tissue temperature to the selected reference temperature and maintaining the tissue at the selected temperature during treatment by the control of generator energy applied to the applicator.
3. An electromagnetic capacitive coupling applicator apparatus according to Claim 2 wherein the applicator includes a helical coil type electrode which is installed on a catheter means and connected to a coaxial cable.
4. An electromagnetic capacitive coupling applicator apparatus according to Claim 2 wherein the applicator means includes a flexible wire bundle or braid type electrode which is installed on a catheter means and connected to a coaxial cable.
5. An electromagnetic capacitive coupling applicator apparatus according to Claim 2 wherein the applicator means includes a flexible electrically conductive sleeve which is installed on a catheter means and connected to a coaxial cable.
6. An electromagnetic capacitive coupling applicator apparatus according to Claim 2 wherein the applicator means includes an elongated coil and a sheath of dielectric material covering the elongated coil sufficiently for producing electromagnetic energy levels along the elongated coil whereby the tissue temperature is substantially uniform along the elongated coil which is installed on a catheter means and connected to a coaxial cable.
7. An electromagnetic capacitive coupling applicator apparatus according to Claim 2 wherein the catheter means includes an inflatable balloon means for maintaining the positioning of the catheter mounted coil applicator means during treatment of the prostate.
8. An electromagnetic coupling applicator apparatus according to Claim 2 wherein the electrically conductive applicator means is an electrode in direct electrical contact with the tissue to be heated which is installed on a catheter means and connected to a coaxial cable.
9. An electromagnetic capacitive coupling applicator apparatus according to Claim 7 wherein the inflatable balloon catheter means for maintaining the positioning of the catheter mounted coil applicator during treatment includes a fluid drainage tube, an inflatable balloon mounted exteriorly thereof and adjacent to a first end of the fluid drainage tube, and a pressurized air or fluid source connected to the balloon whereby when the fluid drainage tube is positioned within a bladder opening and the balloon inflated, the balloon engages the bladder opening for fixing the location of the applicator.
10. An electromagnetic capacitive coupling applicator apparatus according to Claim 2 wherein the temperature sensor means includes an elongated tube adjacent the applicator means for measuring the temperature of the tissue adjacent thereto which is installed on a catheter means for insertion of the apparatus into the prostate.
11. A urethral inserted applicator for benign prostatic hyperplasia treatment by heating the prostate tissue surrounding the urethra with electromagnetic energy comprising:
a multi-tube urinary catheter, said catheter having an insertion tip end for insertion into the urethra, a fluid dry tube close at the insertion tip end, and an isolated open ended tube for urine drainage;
an outwardly capacitively coupling electrode means including an electrode and a wire or coaxial cable, the electrode connected to the wire or the center conductor of the coaxial cable, wherein the electrode is mounted on the catheter and the wire or coaxial cable is positively enclosed by the fluid dry tube housed within the catheter, dielectric insulation means covering the electrode means for preventing direct contact of the electrode with the tissue; and a multi-tube urinary catheter, said multi-tube urinary catheter having a first fluid dry closed end tube for housing the coaxial cable, and an isolated open ended tube for urine drainage, whereby the isolated open ended tube isolates fluid drainage from the conductors of the wire or coaxial cable and the electrode.
a multi-tube urinary catheter, said catheter having an insertion tip end for insertion into the urethra, a fluid dry tube close at the insertion tip end, and an isolated open ended tube for urine drainage;
an outwardly capacitively coupling electrode means including an electrode and a wire or coaxial cable, the electrode connected to the wire or the center conductor of the coaxial cable, wherein the electrode is mounted on the catheter and the wire or coaxial cable is positively enclosed by the fluid dry tube housed within the catheter, dielectric insulation means covering the electrode means for preventing direct contact of the electrode with the tissue; and a multi-tube urinary catheter, said multi-tube urinary catheter having a first fluid dry closed end tube for housing the coaxial cable, and an isolated open ended tube for urine drainage, whereby the isolated open ended tube isolates fluid drainage from the conductors of the wire or coaxial cable and the electrode.
12. A urethral inserted applicator according to Claim 11, wherein the multi-tube urinary catheter further includes a second fluid dry closed end tube, and an electromagnetic field compatible temperature sensor inserted in the second fluid dry closed tube for sensing the temperature of prostate tissue.
13 A urethral inserted applicator according to Claim 11 wherein the electrode type capacitively coupling electrode means includes multiple electrode sections, such as conductive cylinders or wrapped coils, co-located at the prostate when inserted, said multiple electrodes attached to and stacked longitudinally along a catheter and connected to individual wires or coaxial cables for allowing modification of the heat pattern length with non-equal current flow through the wires.
14. A urethral inserted applicator according to Claim 11 wherein the coil electrode has progressively increasing conductor width toward the insertion tip end of the catheter.
15. A urethral inserted applicator according to Claim 11 wherein the coil electrode has different turn ratios per unit length.
16. A urethral inserted applicator according to Claim 11 wherein the thickness of the dielectric insulation means covering the applicator varies along the length of the applicator electrode.
17. A urethral inserted applicator according to Claim 11 wherein the coil type outwardly radiating antenna means includes multiple wrapped coils co-located at the prostate when inserted, said multiple coils attached to and stacked longitudinally along a catheter and connected to individual coaxial cables for allowing modification of the heat pattern length using either coherent or non-coherent phase energy.
18. A system for controlling hyperthermia for benign prostatic hyperplasia comprising:
a flexible urethral catheter for insertion into the urethra, said catheter having an applicator means thereon for applying electromagnetic energy to tissues of a prostate gland surrounding the urethra to thereby cause heating of said tissues and an electromagnetic field compatible temperature sensor for measuring the temperature of the heated tissues;
an electromagnetic generating means for producing electromagnetic energy having a preselected frequency, said electromagnetic generating means being connected to the applicator means and the opposing polarity generator wire being connected to a second electrode providing a current return path to the generator to supply the electromagnetic energy to the applicator means; and a comparator means interconnecting the electromagnetic generating means and electromagnetic field compatible temperature sensor for comparing the measured temperature level to a preselected reference temperature level and output control signals to the electromagnetic energy generating means for controlling the supply of electromagnetic energy to the applicator means to control the tissue temperature.
a flexible urethral catheter for insertion into the urethra, said catheter having an applicator means thereon for applying electromagnetic energy to tissues of a prostate gland surrounding the urethra to thereby cause heating of said tissues and an electromagnetic field compatible temperature sensor for measuring the temperature of the heated tissues;
an electromagnetic generating means for producing electromagnetic energy having a preselected frequency, said electromagnetic generating means being connected to the applicator means and the opposing polarity generator wire being connected to a second electrode providing a current return path to the generator to supply the electromagnetic energy to the applicator means; and a comparator means interconnecting the electromagnetic generating means and electromagnetic field compatible temperature sensor for comparing the measured temperature level to a preselected reference temperature level and output control signals to the electromagnetic energy generating means for controlling the supply of electromagnetic energy to the applicator means to control the tissue temperature.
19. A system for controlling hyperthermia for benign prostatic hyperplasia according to Claim 18 wherein the second electrode is inserted into the rectum adjacent to the prostate gland and is a dielectrically insulated metallic cylinder with a diameter larger than the urethra inserted electrode.
20. A system for controlling hyperthermia for benign prostatic hyperplasia according to Claim 18 wherein the second electrode is an electrically conductive material placed in contact or close contact with the skin tissue surface adjacent to the prostate tissue.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US609,373 | 1990-11-05 | ||
| US07/609,373 US5249585A (en) | 1988-07-28 | 1990-11-05 | Urethral inserted applicator for prostate hyperthermia |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA2095516A1 true CA2095516A1 (en) | 1992-05-06 |
Family
ID=24440526
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA 2095516 Abandoned CA2095516A1 (en) | 1990-11-05 | 1991-11-04 | Urethral inserted applicator for prostate hyperthermia |
Country Status (5)
| Country | Link |
|---|---|
| EP (1) | EP0556284A1 (en) |
| JP (1) | JPH06501410A (en) |
| AU (1) | AU9027191A (en) |
| CA (1) | CA2095516A1 (en) |
| WO (1) | WO1992007621A1 (en) |
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN116328189A (en) * | 2023-04-11 | 2023-06-27 | 广州壹美科技有限公司 | Face fat-reducing shaping instrument |
Families Citing this family (10)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US5370675A (en) * | 1992-08-12 | 1994-12-06 | Vidamed, Inc. | Medical probe device and method |
| US5562720A (en) * | 1992-05-01 | 1996-10-08 | Vesta Medical, Inc. | Bipolar/monopolar endometrial ablation device and method |
| US5443470A (en) * | 1992-05-01 | 1995-08-22 | Vesta Medical, Inc. | Method and apparatus for endometrial ablation |
| ES2081241B1 (en) * | 1992-12-04 | 1996-10-01 | Soriano Jose Sanchez | IMPROVEMENTS IN DIATERMY EQUIPMENT. |
| US6123083A (en) * | 1997-08-29 | 2000-09-26 | Urologix, Inc. | Device and method for treatment of a prostate while preventing urethral constriction due to collagen rich tissue shrinkage |
| CA2400526C (en) * | 2000-02-17 | 2013-04-23 | Yoram Palti | Method and apparatus for destroying dividing cells |
| GB0526033D0 (en) | 2005-12-21 | 2006-02-01 | Bioeos Ltd | Method |
| DE102007010075B4 (en) * | 2007-02-28 | 2012-01-19 | Wei Jiang | Catheter for the treatment of benign prostatic hypertrophy or hyperplasia |
| DE102007010076B4 (en) * | 2007-02-28 | 2011-06-01 | Jiang, Wei | Catheter system for the treatment of benign prostatic hypertrophy or hyperplasia |
| CN109953814A (en) * | 2017-12-25 | 2019-07-02 | 四川锦江电子科技有限公司 | A kind of combined type ablation sting device |
Family Cites Families (9)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JPS5957650A (en) | 1982-09-27 | 1984-04-03 | 呉羽化学工業株式会社 | Probe for heating body cavity |
| JPS60119962A (en) | 1983-12-01 | 1985-06-27 | オリンパス光学工業株式会社 | Electrode apparatus for body cavity |
| CA1244889A (en) * | 1983-01-24 | 1988-11-15 | Kureha Chemical Ind Co Ltd | Device for hyperthermia |
| IL78756A0 (en) | 1986-05-12 | 1986-08-31 | Biodan Medical Systems Ltd | Catheter and probe |
| US5003991A (en) * | 1987-03-31 | 1991-04-02 | Olympus Optical Co., Ltd. | Hyperthermia apparatus |
| EP0415997A4 (en) * | 1988-05-18 | 1992-04-08 | Kasevich Associates, Inc. | Microwave balloon angioplasty |
| US4967765A (en) * | 1988-07-28 | 1990-11-06 | Bsd Medical Corporation | Urethral inserted applicator for prostate hyperthermia |
| FR2639238B1 (en) | 1988-11-21 | 1991-02-22 | Technomed Int Sa | APPARATUS FOR SURGICAL TREATMENT OF TISSUES BY HYPERTHERMIA, PREFERABLY THE PROSTATE, COMPRISING MEANS OF THERMAL PROTECTION COMPRISING PREFERABLY RADIOREFLECTIVE SCREEN MEANS |
| US5007437A (en) * | 1989-06-16 | 1991-04-16 | Mmtc, Inc. | Catheters for treating prostate disease |
-
1991
- 1991-11-04 CA CA 2095516 patent/CA2095516A1/en not_active Abandoned
- 1991-11-04 AU AU90271/91A patent/AU9027191A/en not_active Abandoned
- 1991-11-04 WO PCT/US1991/008182 patent/WO1992007621A1/en not_active Application Discontinuation
- 1991-11-04 JP JP4500922A patent/JPH06501410A/en active Pending
- 1991-11-04 EP EP92900026A patent/EP0556284A1/en not_active Withdrawn
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN116328189A (en) * | 2023-04-11 | 2023-06-27 | 广州壹美科技有限公司 | Face fat-reducing shaping instrument |
| CN116328189B (en) * | 2023-04-11 | 2024-01-30 | 广州壹美科技有限公司 | Face fat-reducing shaping instrument |
Also Published As
| Publication number | Publication date |
|---|---|
| EP0556284A4 (en) | 1994-01-12 |
| AU9027191A (en) | 1992-05-26 |
| EP0556284A1 (en) | 1993-08-25 |
| WO1992007621A1 (en) | 1992-05-14 |
| JPH06501410A (en) | 1994-02-17 |
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