Abstract:
A vapor delivery system and method is provided that includes a number of features. In one embodiment, a method comprises inserting a vapor delivery needle into tissue of a patient, activating a flow of vapor from a vapor generator through vapor delivery ports of the vapor delivery needle to cause condensed liquid to exit vapor delivery ports of the vapor delivery needle, generating vapor in the vapor generator, delivering a dose of vapor through the vapor delivery ports of the vapor delivery needle into the tissue, and after the dose of vapor is delivered, re-activating the flow of vapor from the vapor generator through the vapor delivery ports of the vapor delivery needle to prevent a vacuum from forming in the vapor delivery needle. Vapor therapy systems are also provided.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of U.S. Provisional Patent Application No. 61/914,282, filed Dec. 10, 2013, titled “VAPOR ABLATION SYSTEMS AND METHODS”, which is incorporated by reference in its entirety. 
     
    
     INCORPORATION BY REFERENCE 
       [0002]    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 
       [0003]    The present invention relates to devices and related methods for treatment of benign prostatic hyperplasia using a minimally invasive approach. 
       BACKGROUND 
       [0004]    Benign prostatic hyperplasia (BPH) is a common disorder in middle-aged and older men, with prevalence increasing with age. At age 50, more than one-half of men have symptomatic BPH, and by age 70, nearly 90% of men have microscopic evidence of an enlarged prostate. The severity of symptoms also increase with age with 27% of patients in the 60-70 age bracket having moderate-to-severe symptoms, and 37% of patients in their 70&#39;s suffering from moderate-to-severe symptoms. 
         [0005]    The prostate early in life is the size and shape of a walnut and prior to the enlargement resulting from BPH, weighs about 20 grams. Prostate enlargement appears to be a normal process. With age, the prostate gradually increases in size to twice or more its normal size. The fibromuscular tissue of the outer prostatic capsule restricts expansion after the gland reaches a certain size. Because of such restriction on expansion, the intracapsular tissue will compress against and constrict the prostatic urethra, thus causing resistance to urine flow. 
         [0006]    In the male urogenital anatomy, the prostate gland is located below the bladder and the bladder neck. The walls of the bladder can expand and contract to cause urine flow through the urethra, which extends from the bladder, through the prostate and penis. The portion of urethra that is surrounded by the prostate gland is referred to as the prostatic urethra. The prostate also surrounds the ejaculatory ducts which have an open termination in the prostatic urethra. During sexual arousal, sperm is transported from the testes by the ductus deferens to the prostate which provides fluids that combine with sperm to form semen during ejaculation. On each side of the prostate, the ductus deferens and seminal vesicles join to form a single tube called an ejaculatory duct. Thus, each ejaculatory duct carries the seminal vesicle secretions and sperm into the prostatic urethra. 
         [0007]    The prostate glandular structure can be classified into three zones: the peripheral zone, transition zone, and central zone. Peripheral zone PZ comprises about 70% of the volume of a young man&#39;s prostate. This sub-capsular portion of the posterior aspect of the prostate gland surrounds the distal urethra and 70 to 80% of cancers originate in the peripheral zone tissue. The central zone CZ surrounds the ejaculatory ducts and contains about 20-25% of the prostate volume. The central zone is often the site of inflammatory processes. The transition zone TZ is the site in which benign prostatic hyperplasia develops, and contains about 5-10% of the volume of glandular elements in a normal prostate, but can constitute up to 80% of such volume in cases of BPH. The transition zone consists of two lateral prostate lobes and the periurethral gland region. There are natural barriers around the transition zone, i.e., the prostatic urethra, the anterior fibromuscular stroma, and a fibrous plane between the transition zone and peripheral zone. The anterior fibromuscular stroma or fibromuscular zone is predominantly fibromuscular tissue. 
         [0008]    BPH is typically diagnosed when the patient seeks medical treatment complaining of bothersome urinary difficulties. The predominant symptoms of BPH are an increase in frequency and urgency of urination, and a significant decrease in the rate of flow during urination. BPH can also cause urinary retention in the bladder which in turn can lead to lower urinary tract infection (LUTI). In many cases, the LUTI then can ascend into the kidneys and cause chronic pyelonephritis, and can eventually lead to renal insufficiency. BPH also may lead to sexual dysfunction related to sleep disturbance or psychological anxiety caused by severe urinary difficulties. Thus, BPH can significantly alter the quality of life with aging of the male population. 
         [0009]    BPH is the result of an imbalance between the continuous production and natural death (apoptosis) of the glandular cells of the prostate. The overproduction of such cells leads to increased prostate size, most significantly in the transition zone which traverses the prostatic urethra. 
         [0010]    In early stage cases of BPH, pharmacological treatments can alleviate some of the symptoms. For example, alpha-blockers treat BPH by relaxing smooth muscle tissue found in the prostate and the bladder neck, which may allow urine to flow out of the bladder more easily. Such drugs can prove effective until the glandular elements cause overwhelming cell growth in the prostate. 
         [0011]    More advanced stages of BPH, however, can only be treated by surgical or less-invasive thermal ablation device interventions. A number of methods have been developed using electrosurgical or mechanical extraction of tissue, and thermal ablation or cryoablation of intracapsular prostatic tissue. In many cases, such interventions provide only transient relief, and these treatments often cause significant peri-operative discomfort and morbidity. 
         [0012]    In one thermal ablation method, RF energy is delivered to prostate tissue via an elongated RF needle being penetrated into a plurality of locations in a prostate lobe. The elongated RF needle is typically about 20 mm in length, together with an insulator that penetrates into the lobe. The resulting RF treatment thus ablates tissue away from the prostatic urethra and does not target tissue close to, and parallel to, the prostatic urethra. The application of RF energy typically extends for 1 to 3 minutes or longer which allows thermal diffusion of the RF energy to ablate tissue out to the capsule periphery. Such RF energy delivery methods may not create a durable effect, since smooth muscle tissue and alpha adrenergic receptors are not uniformly ablated around the prostatic urethra or within the transition zone. As a result, tissue in the prostate lobes can continue to grow and impinge on the urethra thus limiting long-term effectiveness of the treatment. 
       SUMMARY OF THE DISCLOSURE 
       [0013]    A method for providing vapor therapy is described, comprising inserting a vapor delivery needle into tissue of a patient, activating a flow of vapor from a vapor generator through vapor delivery ports of the vapor delivery needle to cause condensed liquid to exit vapor delivery ports of the vapor delivery needle, generating vapor in the vapor generator, delivering a dose of vapor through the vapor delivery ports of the vapor delivery needle into the tissue, and after the dose of vapor is delivered, re-activating the flow of vapor from the vapor generator through the vapor delivery ports of the vapor delivery needle to prevent a vacuum from forming in the vapor delivery needle. 
         [0014]    In some embodiments, the generating step further heating a heating element that surrounds a flow of fluid to inductively generate the vapor. 
         [0015]    In one embodiment, the method further comprises monitoring a parameter of the heating element with an electronic controller, and controlling the parameter at a set value with the electronic controller to insure consistent caloric content of the delivered vapor. In some embodiments, the parameter is a temperature of the heating element. In another embodiment, the parameter is an electrical impedance of the heating element. In an additional embodiment, the parameter is controlled to a first set point during the delivering step and controlled to a second set point during the activating and re-activating steps. 
         [0016]    In some embodiments, the flow of vapor in the activating and re-activating steps comprises a flow of vapor ranging from approximately 0.1-0.3 ml/min. 
         [0017]    In another embodiment, the inserting step comprises inserting the vapor delivery needle transurethrally into a prostate of the patient. 
         [0018]    A vapor delivery system is also provided, comprising an elongate shaft configured to be inserted into a urethra of a patient, a vapor delivery needle comprising a plurality of vapor delivery ports, the vapor delivery needle being disposed within the elongate shaft and configured to be advanced generally transverse from the elongate shaft into a prostate of the patient when the elongate shaft is positioned within the urethra of the patient, a vapor generator coupled to the vapor delivery needle through vapor delivery ports of the vapor delivery needle to cause condensed liquid to exit vapor delivery ports of the vapor delivery needle, and an electronic controller operatively coupled to the vapor generator, the electronic controller being configured to activate a flow of vapor from the vapor generator through the vapor delivery ports of the vapor delivery needle to cause condensed liquid to exit the vapor delivery ports of the vapor delivery needle, deliver a dose of vapor from the vapor generator through the vapor delivery ports of the vapor delivery needle into the prostate, and after the dose of vapor is delivered, re-activate the flow of vapor from the vapor generator through the vapor delivery needle to prevent a vacuum from forming in the vapor delivery needle. 
         [0019]    In some embodiments, the vapor generator comprises an inductive vapor generator with a heating element surrounding a flow of fluid. 
         [0020]    In other embodiments, the electronic controller is further configured to monitor a parameter of the heating element and control the parameter at a set value to insure consistent caloric content of the delivered vapor. 
         [0021]    In one embodiment, the parameter is a temperature of the heating element. 
         [0022]    In another embodiment, the parameter is an electrical impedance of the heating element. 
         [0023]    In some embodiments, the parameter is controlled to a first set point when the electronic controller delivers the dose of vapor, and wherein the parameter is controlled to a second set point when the electronic controller activates and re-activates the flow of vapor. 
         [0024]    In another embodiment, the flow of vapor comprises a flow of vapor ranging from approximately 0.1-0.3 ml/min. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0025]    In order to better understand the invention and to see how it may be carried out in practice, some preferred embodiments are next described, by way of non-limiting examples only, with reference to the accompanying drawings, in which like reference characters denote corresponding features consistently throughout similar embodiments in the attached drawings. 
           [0026]      FIG. 1  shows one embodiment of a vapor delivery system. 
           [0027]      FIG. 2  is a close-up view of a distal portion of the vapor delivery system. 
           [0028]      FIG. 3  is a cross-sectional view of a shaft of the vapor delivery system. 
           [0029]      FIG. 4  illustrates the mass drawback that occurs when an idle process is not activated. 
           [0030]      FIG. 5  is a close-up view of the chart of  FIG. 4 . 
           [0031]      FIG. 6  illustrates the difference in calories delivered when an idle process is on vs. off. 
           [0032]      FIG. 7  illustrates the temperatures of the system vs. mass drawback when the idle process is activated. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0033]    In general, one method for treating BPH comprises introducing a heated vapor interstitially into the interior of a prostate, wherein the vapor controllably ablates prostate tissue. 
         [0034]    This method can utilize vapor for applied thermal energy of between 50 calories and 300 calories per each individual vapor treatment (and assumes multiple treatments for each prostate lobe) in an office-based procedure. The method can cause localized ablation of prostate tissue, and more particularly the applied thermal energy from vapor can be localized to ablate tissue adjacent the urethra without damaging prostate tissue that is not adjacent the urethra. 
         [0035]    The present disclosure is directed to the treatment of BPH, and more particularly for ablating transitional zone prostate tissue without ablating central or peripheral zone prostate tissue. In one embodiment, the present disclosure is directed to treating a prostate using convective heating in a region adjacent the prostatic urethra. The method of ablative treatment is configured to target smooth muscle tissue, alpha adrenergic receptors, sympathetic nerve structures and vasculature parallel to the prostatic urethra between the bladder neck region and the verumontanum region to a depth of less than 2 cm. 
         [0036]    The system can include a vapor delivery mechanism that delivers vapor media, including water vapor. The system can utilize a vapor source configured to provide vapor having a temperature of at least 60-140° C. In another embodiment, the system further comprises a computer controller configured to deliver vapor for an interval ranging from 1 second to 30 seconds. 
         [0037]    In some embodiments, the system further comprises a source of a pharmacologic agent or other chemical agent or compound for delivery with the vapor. These agents include, without limitation, an anesthetic, an antibiotic or a toxin such as Botox®, or a chemical agent that can treat cancerous tissue cells. The agent also can be a sealant, an adhesive, a glue, a superglue or the like. 
         [0038]      FIG. 1  shows one embodiment of a vapor delivery system. Vapor delivery system  100  can have an elongate shaft  102  configured for insertion into the urethra of a patient and a handle portion  104  for gripping with a human hand. The vapor system  100  can include a vapor delivery needle  106  configured to extend from a distal portion of the elongate shaft  102 . In some embodiments, the vapor delivery needle  106  can be retracted within the shaft during insertion of the shaft into the urethra of the patient, and the vapor delivery needle can then be advanced from the shaft into the prostate tissue when the system is properly placed within the patient. In one embodiment, the vapor delivery needle extends outwards in a generally perpendicular direction to the elongate shaft. The vapor delivery needle can extend generally perpendicular to or transverse from the shaft, and can include one or more vapor delivery ports configured to deliver a flow of vapor media from a vapor source  250  through the vapor delivery needle  106  into prostate tissue. The vapor delivery needle can further include an aspiration source  320  configured to aspirate tissue and/or fluids from the patient (e.g., either through the vapor delivery ports or through separate aspiration ports in the vapor delivery needle), and can also include a fluid source  300  configured to deliver a fluid or cooling irrigation to the tissue before, during, and/or after vapor delivery. 
         [0039]    The vapor delivery system  100  of  FIG. 1  can include a plurality of actuation mechanisms  107 , such as triggers, buttons, or levers, configured to actuate the various functions of the system. For example, the actuation mechanism can be configured to extend/retract the vapor delivery needle, and start/stop the flow of vapor, aspiration, and/or the cooling irrigation. 
         [0040]    Vapor source  250  is provided for delivering a vapor media through the vapor delivery needle to ablate tissue. The vapor source can be a vapor generator that can deliver a vapor media, such as water vapor, that has a precisely controlled quality to provide a precise amount of thermal energy delivery, for example measured in calories per second. In some embodiments, the vapor source can comprise an inductive heating system similar in which a flow media is inductively heated to generate a condensable vapor. The controller  255  can be set to control the various parameters of vapor delivery, for example, the controller can be set to delivery vapor media for a selected treatment interval, a selected pressure, or selected vapor quality. Further details on the vapor delivery system, the vapor generator, and how vapor and fluid are delivered to tissue can be found in U.S. Pat. No. 8,273,079 and PCT Publication No. WO 2013/040209, both of which are incorporated by reference. In some embodiments, the electronic controller can also control the aspiration and/or cooling irrigation functions of the vapor delivery system. 
         [0041]      FIG. 2  shows a close-up view of a distal portion  109  of the shaft of vapor delivery system  100 , including the vapor delivery needle  106  extending beyond the shaft and exposing the vapor delivery ports  108 . The vapor delivery system  100  can further include one or more lumens  111  sized to accommodate an endoscope or camera to provide additional viewing and feedback to the physician during use. This endoscope or camera can provide a view of the distal portion of the shaft, including a view of the vapor delivery needle when deployed and inserted into tissue. 
         [0042]    As described above in reference to  FIG. 1 , the vapor delivery system can be connected to a vapor source  250 , an aspiration source  320 , a fluid or irrigation source  300 , a light source  140 , and an electronic controller  255  configured to control generation and delivery of vapor from the vapor source, through a lumen of the shaft, through the vapor delivery needle, and into tissue. In some embodiments, the electronic controller can be disposed on or in the vapor delivery system, and in other embodiments the electronic controller can be disposed separate from the system. The fluid or irrigation source can provide a fluid, such as saline, through a separate lumen in the shaft to provide irrigation and flushing to tissue during insertion of the system and during vapor delivery to tissue. In some embodiments, the irrigation can be used to clear blood and debris from tissue lumens to increase visibility. The irrigation can also provide cooling to the urethra of the patient, both via direct contact of the irrigation fluid with the urethra as well as cooling the shaft of the vapor delivery system as the fluid flows from the irrigation source through the shaft and into contact with the tissue. Urethral flush can be used during the lesion formation. In one embodiment, the flush rate can be approximately 80 mL/minute, or ranging from 20 to 400 mL/minute. Changes in flush rate will change the amount of tissue cooling (depth) into the urethra and prostate, which can affect lesion size. 
         [0043]      FIG. 3  provides a cross sectional view of elongate shaft  102  of vapor delivery system  100  from  FIGS. 1-2 . Lumen  148  can be configured to accommodate the vapor delivery needle described above and in  FIGS. 1-2 , to allow for the vapor delivery needle to be advanced from the shaft during vapor delivery. Lumen  111  formed within tube  112  can have a diameter ranging from about 2 to 5 mm for accommodating various endoscopes or cameras  118 , while at the same time providing an annular space  138  for allowing an irrigation fluid to flow within lumen  111  and outwardly from the shaft into the urethra. As can be seen in  FIG. 3 , the lumen  111  is dimensioned to provide a space  138  for fluid irrigation flow around the endoscope  118 . In some embodiments, the annular space  138  can be a separate concentric lumen around the endoscope for irrigation fluid flow. The annular space  138  allows for flow of irrigation fluid from the vapor delivery system into the urethra, and also provides cooling to the shaft and adjacent urethra when vapor is delivered from the vapor delivery needle (disposed in lumen  148 ) into tissue. Material  144  in  FIG. 3  can conduct heat from the vapor delivery needle to the irrigation fluid flowing in annular space  138 , or alternatively, can conduct cooling from the irrigation fluid to the vapor delivery needle, to prevent over-heating of the patient (particularly the urethra) during vapor therapy. 
         [0044]    During vapor ablation therapy, referring to  FIGS. 1-3 , vapor travels from the vapor source  250  to the patient through the vapor delivery needle  106 . The length of the vapor delivery needle allows for some condensation of the vapor as it travels through the needle towards the vapor delivery ports. Condensation of vapor in the vapor delivery needle can result to in many undesirable behaviors of the vapor delivery system. This issue can be particularly problematic between doses of vapor therapy. For instance, as the vapor in the vapor delivery needle starts to condense following a vapor therapy shot or dose, the volume of vapor is reduced to the volume of water, and therefore a vacuum is created in the needle. This vacuum can then pull material, such as blood, tissue, or fluid, from the urethra into the needle tip through the vapor delivery ports. Upon reactivating the therapy, this material is ejected from the needle prior to new vapor being delivered into the tissue. The ejected material can exit the needle at high velocities, and is often observed as “spitting water” in the tissue or as it exits the needle. Additionally, materials drawn back into the needle can potentially plug vapor delivery ports and/or the vapor delivery needle between vapor shots or doses, which can result in uneven distribution of vapor and therefore misshaped lesions. 
         [0045]    Furthermore, the amount of cooling and condensation that takes place between therapy shots is a function of time between shots, and therefore contributes to variability in the following therapy shot. If the system is allowed to sit, and cool, for an extended period of time, the following therapy shot may produce fewer calories than if consecutive shots were applied quickly. 
         [0046]    According to one embodiment, to mitigate the drawback and cooling issues, an “Idle” feature can be implemented in the vapor delivery system  100  of  FIGS. 1-3 . When the idle feature is enabled, the vapor delivery system can be configured via the controller  255  to pump a very small amount of vapor (e.g., 0.1-0.3 ml/min) from the vapor source  250  through the vapor delivery needle  106  at all times between therapy shots. The vapor can be pumped through the internal lumen of the needle and out of the vapor delivery ports. Furthermore, the vapor source can be maintained at a heated temperature, such as 90-100 degrees Celsius, and preferably 100 degrees Celsius, to prevent the vapor field from collapsing. This idle feature results in a constant positive pressure field in the vapor delivery needle  106 , and prevents any vacuum that might draw material into the needle. Furthermore, this allows for minimal “spitting” of water upon initiation of following therapy shots, and reduces shot to shot variably in calorimetric output. 
         [0047]    In some embodiments, the idle feature is first activated after the system has been primed, and the doctor has performed one test therapy shot outside of the patient. Following this initial activation, the idle feature can be always on between therapy shots. In one embodiment, idle is only interrupted if the system determines there is a problem in the heating element or in the water path in the needle. This may be evident given abnormal temperature behavior in the heating coil, or given high pressure readings. In one embodiment, software could allow for manual activation and deactivation of the idle feature. 
         [0048]      FIG. 4  shows the mass drawback that occurs between treatments when the idle feature is disabled. For this measurement, the vapor delivery system was mounted above a small container of water resting on a gram scale. The vapor delivery needle was held under the water level at all times, and the change in weight of the container measured the weight of vapor injected into the water, and the suctioning of water back into the delivery needle during the time between vapor injections. Mass line  400  indicates the weight of the container. The mass line  400  is seen to decrease between therapy shots  402 , indicating that water, fluid, blood, or tissue would be drawn back into the vapor delivery needle between therapy shots. The vapor outlet temperature  410  and vapor source temperature  412  are also shown plotted in  FIG. 4 . 
         [0049]      FIG. 5  is zoomed into the time between the third and fourth treatment shots  402  of  FIG. 4 . During the 30 seconds between these two shots, approximately 0.7 mL of fluid is drawn back into the tool, which is a typical level of drawback when the idle feature is disabled. The sharp rise in mass at the beginning of the treatment represents this fluid being rapidly expelled from the vapor delivery system. 
         [0050]      FIG. 6  demonstrates the effect of the idle feature on the consistency of calories delivered to tissue with the vapor shots. With the idle feature turned off or disabled (line  404 ), the measured calories vary within approximately a 30 calorie range, depending on the delay since the previous therapy shot. With the idle feature turned on or enabled (line  406 ), the measured calories are very consistent, and varies no more than 5 calories regardless of the delay between therapy shots. 
         [0051]    Drawback testing was conducted on 30 delivery tools for a total of 44 trials (one batch was tested once with old therapy setting and then again with new therapy settings but idle settings remained the same throughout). This testing involved suspending the vapor delivery system and shooting it into a cup of water on a scale. The mass on the scale can then be used to determine if water/vapor is being expelled from the tool (increase in mass) or drawn back into the tool (decrease in mass). This mass data was logged and then plotted on top of the generator data such as temperature and RF power.  FIG. 7  shows an example of this plot for one vapor delivery system with idle active between therapy shots. As can be seen, the mass (line  400 ) generally increases slightly between therapy shots  402 , indicating that very little, if any, water is being drawn back into the vapor delivery needle of the system. Additionally, the vapor source temperature  410  and outlet temperature  412  remain very consistent during Idling. 
         [0052]    Table I shows some additional metrics for the data represented above. Each table contains the minimum, mode, and maximum of each parameter, as well as the percentage of data points that fall within 5 units (° C. or psi) of the mode and within 10 units of the mode. 
         [0000]    
       
         
               
             
               
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
               
             
           
               
                 TABLE I 
               
             
             
               
                   
               
               
                 Metrics of Temperature and Pressure Data during Idling 
               
             
          
           
               
                   
                 Units 
                 Data Excluded (s) 
                 Min 
                 Mode 
                 Max 
                 % in Mode +/− 5 
                 % in Mode +/− 10 
               
               
                   
                   
               
             
          
           
               
                 Coil 
                 ° C. 
                 0 
                 90 
                 102 
                 153 
                 90.6% 
                 97.0% 
               
               
                 Temp 
                   
                 4 
                 90 
                 102 
                 138 
                 94.8% 
                 99.0% 
               
               
                   
                   
                 30 
                 90 
                 102 
                 119 
                 97.3% 
                 99.9% 
               
               
                 Outlet 
                 ° C. 
                 0 
                 69 
                 98 
                 219 
                 74.8% 
                 77.8% 
               
               
                 Temp 
                   
                 4 
                 69 
                 98 
                 218 
                 82.7% 
                 85.45%  
               
               
                   
                   
                 30 
                 69 
                 98 
                 128 
                 99.7% 
                 99.9% 
               
               
                 Water 
                 psi 
                 0 
                 −0.5 
                 0 
                 28.1 
                 99.5% 
                 99.6% 
               
               
                 Pressure 
                   
                 4 
                 −0.5 
                 0 
                 10.4 
                  100% 
                  100% 
               
               
                   
                   
                 30 
                 −0.5 
                 0 
                 7.0 
                  100% 
                  100% 
               
               
                   
               
             
          
         
       
     
         [0053]    Overall, the results look very good. The 0 second delay data (Table I) shows that there are no instances of temperatures or pressures that are outside of the bounds that are monitored during the idle process. 
         [0054]    The 4 second delay data (Table I) shows the possible temperature and pressure conditions that could be present when a treatment is activated. For vapor generator temperature, 99% of the data points fall within 10° C. of the mode (102° C.). For water pressure, 100% of the data points fall within 10 psi of the mode (0 psi). For outlet temperature, there is a bit more spread, with only 85% of the data falling within 10° C. of the mode (98° C.) and temperatures reaching as high as 218° C. 
         [0055]    By excluding the high temperatures and pressures that sometimes linger following a treatment, the 30 second delay data (Table I) show the temperature and pressure conditions that are created by the idle process as opposed to just those experienced during idling. There are no instances of the temperature or pressure increasing or decreasing substantially in an uncontrolled and undesirable fashion. For all three parameters, over 97% of the data points fall within 5 units of the mode and 99.9% of the data points fall within 10 units of the mode. 
         [0056]    The use of the idle feature between therapy vapor shots may be combined with control mechanisms during therapy and/or during idle to further insure consistent energy delivery from shot to shot. For example, the power output of the RF generator or source that creates the vapor may be servo controlled to a constant value so that the energy delivered to the heating element is constant and independent of impedance changes in the delivery tool. 
         [0057]    In another embodiment, a parameter of the vapor heating element may be monitored and controlled to a fixed value. In one example, the temperature of the inductive coil of the vapor source in which vapor is generated is monitored and controlled at a constant value during therapy by adjusting RF power in real time. The vapor heating element temperature may also be monitored during idle, and controlled to a set temperature, for example 100° C. A preferred method for monitoring temperature may be the measurement of heating element impedance (equal to rms Voltage divided by rms current at the RF generator output). Impedance of the heating element increases with temperature, and may more accurately represent the average temperature of the heating element than a thermometer (e.g., thermocouple) measuring temperature at one point on the heating element. In this embodiment, RF power is adjusted to maintain impedance at one set point during therapy shots and at a second set point during idle. 
         [0058]    Although particular embodiments of the present invention have been described above in detail, it will be understood that this description is merely for purposes of illustration and the above description of the invention is not exhaustive. Specific features of the invention are shown in some drawings and not in others, and this is for convenience only and any feature may be combined with another in accordance with the invention. A number of variations and alternatives will be apparent to one having ordinary skills in the art. Such alternatives and variations are intended to be included within the scope of the claims. Particular features that are presented in dependent claims can be combined and fall within the scope of the invention. The invention also encompasses embodiments as if dependent claims were alternatively written in a multiple dependent claim format with reference to other independent claims.