Abstract:
Methods and apparatus for medical treating prostatic tissues are provided. In one embodiment, the method includes removing prostatic tissues adjacent the urethra and enlarging the lumen of the urethra, whereby the treatment conserves a natural wall of the urethra.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims benefit of U.S. Provisional Patent Application Ser. No. 60/883,686, filed on Jan. 5, 2007, which application is incorporated herein by reference in its entirety. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    1. Field of the Invention 
         [0003]    Embodiments of the present invention generally relate to methods and apparatus for destroying tissues in the body. Particularly, embodiments of the present invention generally relate to methods and apparatus for removing prostatic tissue. More particularly, embodiments of the present invention generally relate methods and apparatus for surgical enlargement of the urethra lumen with minimal while conserving the natural inner lining of the urethra. 
         [0004]    2. Description of the Related Art 
         [0005]    Benign prostatic hyperplasia (“BPH”) is a common medical condition experienced by men over 50 years old. BPH arises from the benign replication and growth of cells in the prostate. Hyperplastic enlargement of the prostate gland often leads to compression of the urethra, resulting in obstruction of the urinary tract and the subsequent development of symptoms including frequent urination, decrease in urinary flow, pain, discomfort, and dribbling. 
         [0006]    Traditional treatments of BPH include non-surgical and surgical treatments. Treatment with medication is usually recommended for mild cases of BPH. For more severe cases, surgery to resect the prostate is usually performed. Transurethral resection of the prostate (“TURP”) is commonly performed to remove a large portion of the prostate. In order to enlarge the diameter of the urethra, TURP removes the inner lining of the urethra and the surrounding prostatic tissue. Due the procedure&#39;s aggressive nature, one drawback of TURP is that too much tissue is removed, thereby causing cavitation. Another drawback is that substantial bleeding may occur from destruction of the inner lining, thereby causing formation of blood clots. 
         [0007]    Laser surgery is another common procedure performed to remove portions of the prostate. Although laser surgery causes less bleeding, it delivers light energy to the prostatic tissue by burning through the inner lining of the urethra. Another disadvantage of laser surgery is that it may not efficiently remove the desired volume of resection. For example, a typical laser may have a 1 mm diameter. In order to make a 1 cm diameter cut, a substantial number of laser fires must be executed. 
         [0008]    There is a need, therefore, for methods and apparatus for removing prostatic tissue with minimal damage to the inner lining of the urethra. 
       SUMMARY OF THE INVENTION 
       [0009]    Embodiments of the present invention generally relates to methods and devices for treating prostatic tissues. In one embodiment, a method of treatment includes removing prostatic tissues adjacent the urethra and enlarging the lumen of the urethra, whereby the treatment conserves a natural wall of the urethra. 
         [0010]    In another embodiment, a method of removing tissue of a prostate proximate a urethra having an inner lining. The method includes positioning a catheter in the urethra; inserting a mechanical debrider through the catheter; positioning the mechanical debrider in the prostate proximate the tissue to be removed; rotating the mechanical debrider against the tissue; and removing the prostatic tissue, thereby forming a cavity adjacent the inner lining of the urethra. 
         [0011]    In another embodiment, a medical device includes a catheter having a first channel and a second channel; a first medical tool positioned in the first channel; and a mechanical debrider positioned in the second channel, wherein the debrider includes an outer tube and a tissue removal member. 
         [0012]    In yet another embodiment, a medical device includes a catheter; an endoscope positioned in the catheter; and a mechanical debrider extending out of the catheter, wherein the debrider includes an outer tube and a tissue removal member. 
         [0013]    Embodiments of medical devices and treatment method disclose herein are particularly useful for treating benign prostate hyperplasia (BPH). However, it must be noted that the devices and treatment methods are suitable to remove other tissues such as tumor cells and cancer cells. Moreover, it is further contemplated that the devices and treatment methods may be used to treat other bodily tissues and is not limited to the prostate. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0014]    So that the manner in which the above recited features of the present invention can be understood in detail, a more particular description of the invention, briefly summarized above, may be had by reference to embodiments, some of which are illustrated in the appended drawings. It is to be noted, however, that the appended drawings illustrate only typical embodiments of this invention and are therefore not to be considered limiting of its scope, for the invention may admit to other equally effective embodiments. 
           [0015]      FIGS. 1 and 1A  illustrate an enlarged prostate constricting the urethra. 
           [0016]      FIGS. 2 and 2A  illustrate a surgical device inserted into the urethra according to one embodiment. 
           [0017]      FIGS. 3A-B  illustrate an embodiment of the surgical device. 
           [0018]    FIGS.  4  and  4 A-B illustrate operation of the surgical device. As shown in  FIGS. 4 and 4A , a guide needle extends out of a side port of a catheter of the surgical device.  FIG. 4B  illustrates another embodiment wherein the guide needle extends out of the front end of the catheter. 
           [0019]      FIGS. 5 and 5A  illustrate operation of the surgical device. As shown, a removal device is inserted through the cannula. 
           [0020]      FIGS. 6A-E  illustrate operation of the surgical device.  FIGS. 6A-B  illustrates operation of the removal device.  FIGS. 6C-E  illustrate a multi-step process of forming a cavity. 
           [0021]    FIGS.  7  and  7 A-B illustrate removal of tissue around the urethra. 
           [0022]      FIGS. 8 and 8A  illustrate an embodiment of a rotation controller. 
           [0023]      FIGS. 9A-C  illustrate inflation of a balloon in the lumen. 
           [0024]      FIGS. 10 and 10A  illustrate enlargement of the lumen after the procedure. 
           [0025]      FIGS. 11A-C  illustrate the process of positioning a stent in the lumen. 
           [0026]      FIGS. 12A-C  illustrate different views of a polyethylene urethral stent. 
           [0027]      FIGS. 13A-B  illustrate views of the lumen of the urethra before and after the surgical procedure. 
           [0028]      FIGS. 14A-B  illustrate views of the lumen of the urethra before and after the surgical procedure with placement of a stent. 
           [0029]      FIGS. 15A-E  illustrate views of another embodiment of a debrider. 
           [0030]      FIGS. 16A-C  illustrate the expansion process of the blades of the debrider shown in  FIGS. 15A-E . 
           [0031]      FIGS. 17A-D  illustrate views of another embodiment of a debrider.  FIGS. 17B-D  illustrate the expansion process of the blades of the debrider shown in  FIG. 17A . 
           [0032]      FIG. 18  illustrates an embodiment of a debrider with a built in RF probe. 
           [0033]      FIGS. 19 ,  20 ,  21 A-B illustrate operation of the debrider of  FIG. 18 . 
           [0034]      FIG. 22A  illustrates expansion of the lumen using a balloon.  FIG. 22B  illustrates implantation of a stent in the enlarged lumen. 
           [0035]      FIG. 23  illustrates a stent positioned in a lumen. 
           [0036]      FIGS. 24A-D  illustrates an embodiment of a device and process of removing a stent from the urethra. 
       
    
    
     DETAILED DESCRIPTION 
       [0037]      FIG. 1  shows an enlarged prostate  10  constricting the lumen  20  of the urethra  15 . The prostate  10  attaches near the bladder neck, and the urethra  15  extends from the bladder  25  and through the prostate  10 .  FIG. 1A  is an exploded view of the constricted urethra  15 . 
         [0038]    Embodiments of the present invention provide methods and apparatus for removal of prostatic tissue to alleviate the constriction on the urethra  15 . In one embodiment, the method begins with inserting a surgical device  100  into the urethra  15  and positioning the surgical device  100  at a desired location, see step  1  as illustrated in  FIGS. 2 and 2A . The surgical device  100  includes an expandable member such as an inflatable balloon  105  fitted to the outer surface of the front end of the device  100 . The balloon  105  may be inflated using a fluid such as air, water, and combinations thereof. The balloon  100  may be made from polyurethane or other suitable expandable material. The balloon  100  may be inflated to facilitate the exchange, insertion, or removal of a probe or other tools. In this respect, the balloon  100  may act as a dilator to expand the urethra  15  to the desired diameter. 
         [0039]    Referring now to  FIGS. 3A and 3B , the surgical device  100  includes a catheter  110  having at least two channels  111 ,  112 . A first channel  111  may be a central channel extending through the front end of the catheter  110 . The central channel  111  may be used to deliver a tool such as an endoscope. The endoscope may be used for visualization during the procedure. A second channel  112  in the catheter  110  exits the catheter through a side port  114 . The second channel  112  may be used to deliver a tool such as a cannula  120 . In one embodiment, the cannula  120  is fitted with a guide needle  125  for insertion into the prostatic tissue. Suitable materials for the guide needle  125  include a flexible memory metal. As shown, the tip  127  of the guide needle  125  may be angled to direct a tool, such as a debrider, in the desired direction when it leaves the guide needle  125 . The degree of the angle may be any desired angle such that the tool may be advanced in the proper direction. For example, the tip  127  may have an angle such that the debrider may turn sufficiently after leaving the cannula  120  and proceed in a direction substantially parallel to the catheter  110 .  FIG. 3A  shows the guide needle  125  retracted in the second channel  112 .  FIG. 3B  shows the guide needle  125  in the advanced position. In another embodiment, the cannula  120  may be rotatable. In this respect, the angle of departure of the debrider may be controlled and adjusted. In yet another embodiment, the needle tip  127  may be straight for a straightforward advancement in the prostate  10 . In yet another embodiment, the second channel  112  in the catheter  110  may be angled such that the guide needle  125  is already positioned in the proper direction when it exits the catheter  110 . It must be noted that additional channels (central or side channels) may be provided in the catheter to accommodate additional tools or other requirements. For example, one or more channels may be used to deliver a fluid to operate a tool. 
         [0040]    Step  2  of the procedure includes advancing the guide needle  125  through the side port  112  and at least partially into the prostatic tissue, as illustrated in  FIGS. 4 and 4A . It can be seen that the guide needle  125  only creates a small hole in the urethral wall. The cannula  120  and the guide needle  125  are now in position to deliver another tool. In another embodiment, the guide needle  125  may exit the catheter  110  through the front end, as illustrated in  FIG. 4B . The guide needle  125  may be inserted through a second central channel adjacent the central channel  111  housing the endoscope, or the central channel housing the endoscope after the endoscope is retrieved. 
         [0041]    In Step  3 , a debrider  130  is inserted through the guide needle  125  and into the prostatic tissue  10 , as illustrated in  FIGS. 5 and 5A . The direction of the debrider&#39;s movement is dictated by the angle of the tip  127  of the guide needle  125 . The distance of travel of the debrider  130  may be controlled by an operator at the other end of the catheter  110 . In one embodiment, the debrider  130  is a mechanical debrider that is operated to remove prostatic tissue in its path. Other suitable debriders include, but not limited to, laser, RF catheter probe, mechanical aspirator, microwave probe, and combinations thereof. 
         [0042]    In step  4 , the debrider  130  is actuated to remove portions of the prostatic tissue. Referring now to  FIGS. 6A-B , an embodiment of the debrider  130  includes a longitudinal body  132  disposed inside an outer tube  135 . The longitudinal body  132  may have an auger portion  137  disposed on an outer surface and a removal member such as a blade  140  that is slidable in the outer tube  135 . The debrider  130  may be equipped with one or more blades  140 . To actuate the debrider  130 , the tube  135  is initially inserted through the guide needle  125  to a desired distance. Thereafter, the blade  140  and the auger portion  137  are extended out of the outer tube  135 . The longitudinal body  132  is then rotated to apply torque to the blade  140  and the auger portion  137 . Rotation and advancement of the free end of the blade  140  removes prostatic tissue in its path of rotation to form a cavity  150 . In this respect, the debrider  130  may be operated to remove portions of the prostatic tissue adjacent the urethra  15 . The blade  140  may be advanced to any distance to form the desired cavity size  150 . During operation, a groove in the auger portion  137  pulls some of the loosened tissue into the outer tube  135  for removal. Additionally or alternatively, the longitudinal body  132  may be reciprocated back and forth to remove the loosened tissue. In another embodiment, the guide needle  125  may be provided with aspiration and/or suction to facilitate tissue removal. 
         [0043]    In one embodiment, the balloon  105  is inflated during the operation of the debrider  130 . Expansion of the balloon  105  forces additional prostatic tissue toward the debrider  130  and into the path of rotating blade  140 , see  FIGS. 6A-B . In this respect, maximum tissue removal may be achieved because some of the prostatic tissue that would not have been in the path of the rotating blade  140  may now be removed. 
         [0044]    In another embodiment, the prostatic tissue may be removed in multi-step fashion. Referring now to  FIGS. 6C-E , the debrider  130  is initially used to form a small cavity  151  in the prostate  10 . Then, the debrider  130  and the guide needle  125  are retrieved. The surgical device  100  is advanced a short distance such that the successive cavity  152  will overlap with the previous cavity  151 . The guide needle  125  is then inserted through the urethral wall followed by the debrider  130 . The second cavity  152  is then formed. Thereafter, the guide needle  125  and the debrider  130  are retrieved. This process may be repeated until the desired length of cavity is formed, for example, to form a third cavity  153 . 
         [0045]    At step  5 , the surgical device  100  may be used to form one or more cavities  151  adjacent the urethra  15 .  FIG. 7  shows one embodiment of multiple tubular cavities  151  formed around the urethra  15 .  FIG. 7A  is a close up view of the tubular cavities  151 .  FIG. 7B  is a cross-sectional view of  FIG. 7  taken at the urethra  15 . Although the Figures show the tubular cavities  151  are positioned circumferentially, it must be noted that any suitable number or combination of tubular cavities may be formed. For example, tubular cavities  151  may be formed at 0, 90, 180, and 270 degrees around the urethra  15 . In another example, two or more tubular cavities  151  may be spaced circumferentially around the urethra  15 . 
         [0046]      FIGS. 8 and 8A  show the control end  108  of the surgical device  100 . In one embodiment, the control end  108  is equipped with a rotation controller  155  adapted to rotate the catheter  100  to the proper position for insertion of the guide needle  125  into the prostate  10 . The controller  155  may be marked with numbers to indicate the angle of rotation. The rotation controller  155  may be used to facilitate formation of one or more tubular cavities  151  around the urethra  15 . 
         [0047]    After the desired quantity of prostatic tissue has been removed, the guide needle  125  and the debrider  130  are retracted back into the side passage  112 . At step  6 , the balloon  105  is then inflated to enlarge the lumen  20  of the urethra  15 . This process is shown in  FIGS. 9A-C . The inflated balloon  105  helps to maintain the urethra  15  in a dilated state. During debriding of the prostatic tissue, bleeding may occur within that cavity  151 . One added benefit of the balloon inflation is that the balloon  105  may tamponage the bleeding. Thus, one embodiment of the present invention includes inflating a balloon  105  to tamponage bleeding. 
         [0048]    At step  7 , the surgical device  100  is removed from the urethra  15 , as illustrated in  FIGS. 10 and 10A . It can be seen now that the constricted portion of the urethra  15  has been enlarged and dilated. Additionally, because the cavities  151  are formed adjacent the urethra  15 , the procedure preserved the inner lining of the urethra  15 . Further, the cavities  151  reduce the compression pressure from the prostate  10  previously acting on the urethra  15  to help maintain the lumen  20  of the urethra  15  in the enlarged state. 
         [0049]    In another embodiment, an optional urethral stent  160  may be installed in the urethra  15  to maintain the dilated state. Potential bleeding caused by the debrider  130  may push the enlarged portion of the lumen  20  back, thereby constricting it. The urethral stent  160  may be temporarily installed to prevent the enlarged lumen  20  from constriction by the bleeding. An exemplary stent suitable for use is a mesh tube. In  FIG. 11A , the urethral stent  160  is positioned around the front end of the surgical device  100  and the balloon  105  for insertion into the urethra  15 . Thereafter, the balloon  105  is inflated to expand the urethral stent  160  against the inner wall of the urethra  15 , as shown in  FIG. 11B . After expansion, the balloon  105  is deflated and the surgical device  100  is removed, leaving behind the expanded urethral stent  160 , as shown in  FIG. 11C . In one embodiment, the temporary stent  160  may be installed for 1-14 days; preferably, about 2-8 days; more preferably, 3-5 days. The stent  160  may be expanded to a size that is larger than the constricted diameter. Other suitable stents include nitinol stents and polyethylene urethral stent.  FIGS. 12A-B  show the polyethylene urethral stent  165  positioned in the enlarged lumen  20  of the urethra  15 .  FIG. 12C  shows a close up view of the polyethylene urethral stent  165 . In one embodiment, the polyethylene urethral stent  165  has tapered ends  166  to facilitate insertion or removal. 
         [0050]      FIGS. 13A-B  illustrate the prostate  10  before and after the surgical procedure. It can be seen in  FIG. 13B  that the surgical procedure according to one embodiment has enlarged the lumen  20  of the urethra  15  while conserving the natural wall  22  of the urethra  15 . 
         [0051]      FIGS. 14A-B  illustrate the prostate  10  before and after the surgical procedure according to another embodiment. It can be seen in  FIG. 14B  that the surgical procedure has successfully enlarged the lumen  22 , installed a stent  160 , and conserved the natural wall  22  of the urethra  15 . 
         [0052]      FIGS. 15A-E  illustrate another embodiment of a mechanical debrider  230 . The debrider  230  includes a longitudinal body  232  movably disposed within an outer tube  235 . The outer tube  235  may be inserted through the cannula  120  and the guide needle  125 . The longitudinal body  232  includes a passage  236  extending therethrough and an auger shaped outer portion  237 . A removal member such as a blade  240  may be inserted through the passage  236  of the longitudinal body  232 . As shown, the removal member includes four blades  240  connected at the front end using a pointed tip  242 . As shown in the cross-sectional view of  FIG. 15D , at least one angle edge  245  may be formed on one side of the blade  240  for cutting through the tissue. The blades  240  may be manufactured from flexible memory metal. The blades  240  are adapted to flex radially outward after exiting the passage  236 . As shown in  FIGS. 16A-C , the diameter of the removal member  240  may be adjusted to control the volume of tissue cavity to be created. In one embodiment, the diameter of the removal member  240  is determined by the length of the blades  240  extending beyond the passage  236 . In  FIG. 16B , a short blade extension L 1  expands the removal member  240  to a small diameter. In  FIG. 16C , a longer extension L 2  expands the removal member  240  to a larger diameter. During operation, the diameter of the removal member  240  may be increased in a stepwise fashion to gradually increase the size of the tissue cavity, or the diameter of the removal member  240  may be constant and the removal member is advanced forward to increase the size of the tissue cavity, or combinations thereof. 
         [0053]      FIGS. 17A-D  show another embodiment of a mechanical debrider  330 . The debrider  330  includes a longitudinal body  332  movably disposed within an outer tube  335 . The outer tube  335  may be inserted through the cannula  120  and the guide needle  125 . The longitudinal body  332  includes a passage  336  extending therethrough and an auger shaped outer portion  337 . The removal member includes four blades  340  connected to the longitudinal body  332  at one end and the pointed tip  342  at another end. A cable  345  extending through the passage  336  is inserted between the blades  340  and connected to the pointed tip  342 . The diameter of the removal member  340  may be adjusted by extending or retracting the cable  345 . In  FIG. 17B , the entire length of the blades  340  is extended beyond the outer tube  335 . To expand the removal member  340 , the cable  345  is retracted relative to the longitudinal body  332  to pull the pointed tip  342  towards the outer tube  335  is shown in  FIG. 17C . The retraction causes the blades  340  to expand radially. As shown in  FIG. 17D , when more cable  345  is retracted, the expansion increases. Thus, the diameter of the removal member  340  may be controlled by controlling the extent of the cable  345  retraction. In another embodiment, a shaft or other conveying member may be used instead of a cable to control the expansion. 
         [0054]    In another embodiment, a radio frequency (RF) probe  430  with a built-in aspiration device may be used to remove the prostatic tissue around the urethra  15 .  FIG. 18  shows an exemplary RF probe  430  suitable for use with the various embodiments the surgical procedure described herein. The RF probe  430  is connected to a RF generator  438  and includes a longitudinal probe body  432  and a probe head  434  having an outer auger portion  437 . The longitudinal body  432  is movable within an outer tube. In  FIG. 19 , the RF probe  430  is inserted into the prostate  10  through the cannula  120 . As shown, the probe head  434  has extended out of the outer tube  435 . After insertion, RF energy  439  is transmitted through the probe body  432  to the probe head  434  to treated the prostatic tissue, as shown in  FIG. 20 . At the same time, the RF probe  430  may be rotated  433  to activate the auger portion  437 . Rotation  433  of the auger portion  437  draws the treated tissue into the outer tube  435 , thereby creating the tissue cavity.  FIG. 21A  shows the zone  410  of tissue that may be affected by the RF energy  439 .  FIG. 21B  shows the cavity  450  that may be created. 
         [0055]      FIG. 22A  shows the RF probe  430  retracted into the surgical device  400 . After the cavity  450  has been created, a balloon  405  may be inflated to enlarge the lumen  20  of the urethra  15 . In  FIG. 22B , a urethral stent  465  may be implanted, at least temporarily, to maintain the enlarged lumen  20 . 
         [0056]    In another embodiment, the mechanical debrider and an energy probe may be used in combination. For example, after the mechanical debrider has created a cavity, a RF probe, a laser probe, or other suitable energy deliverable probe may be inserted into the prostate to apply RF, heat, or other suitable energy to treat the targeted tissue. The energy applied may assist with the control of hemostasis. In another example, the energy probe may be inserted before the mechanical probe to apply energy to the prostatic tissue. Then, the mechanical debrider may be inserted to remove the heat treated tissue. In yet another embodiment, energy may be applied before and after deployment of the mechanical debrider. Additionally, energy may also be applied during operation of the debrider. In yet another embodiment, the mechanical debrider may be attached to a RF energy source such that RF energy may be applied through the debrider. In yet another embodiment, the debrider may be fitted with a laser probe such that heat energy may be delivered from the debrider. 
         [0057]      FIGS. 23-24  illustrate a method and device for removing a temporary stent  565 .  FIG. 23  illustrates a stent positioned in the enlarged lumen  20  of the urethra  15 . In  FIG. 24A , a stent removal device  570  is inserted into the urethra  15  and the front end is positioned just before the stent  570 . The stent removal device  570  includes a catheter  510  having an expandable member such as a balloon  505  positioned at its front end. The device  570  further includes a second balloon  575  that is delivered by a conveying member  580  such as a cannula, as shown in  FIG. 24B . After the first balloon  505  is properly positioned, the second balloon  575  is transported through the stent  565  and positioned behind the stent  565 . Thereafter, both balloons  505 ,  575  are inflated to enlarge the lumen  20  of the urethra  15 , as shown in  FIG. 24C . In  FIG. 24D , the second balloon  575  is pulled toward the first balloon  505 , which also pulls the stent  565  toward the first balloon  505 . After the stent  565  makes contact with the first balloon  505 , the two balloons  505 ,  575  and the stent  565  may be retrieved and removed together from the urethra  15 . 
         [0058]    Several advantages of the embodiments of the present invention may be readily apparent to one of ordinary skill in the art. One advantage of the devices and treatment methods disclosed herein is conservation of the inner lining of the urethra, which minimizes bleeding, improves the recovery process, reduces post-operative pain, and eliminates the potential for post-surgical scar which may lead constriction of the urethra. Another advantage of the disclosed embodiments is increased tissue reduction. Yet another advantage is the treatment methods would be suitable for outpatient treatment, wherein the patient may return home after the procedure is completed. As a result of less tissue destruction, a temporary stent may be implanted to maintain the lumen and allow the patient to control urination after the surgical procedure. The potential for less post-operative complication also increases likelihood for use as an outpatient procedure. 
         [0059]    In one embodiment, a method of removing a tissue of a prostate proximate a urethra having an inner lining includes positioning a catheter in the urethra; inserting a mechanical debrider through the catheter; positioning the mechanical debrider in the prostate proximate the tissue to be removed; rotating the mechanical debrider against the tissue; and removing the prostatic tissue, thereby forming a cavity adjacent the inner lining of the urethra. 
         [0060]    In another embodiment, the method of removing tissue includes applying thermal energy to the tissue. In yet another embodiment, the thermal energy is applied before rotation of the debrider. In yet another embodiment, the thermal energy is applied after rotation of the debrider. In yet another embodiment, the thermal energy is applied during rotation of the debrider. In yet another embodiment, the method includes positioning an energy probe in the tissue to apply the thermal energy. In yet another embodiment, the thermal energy comprises one of RF energy, laser, and combinations thereof. In yet another embodiment, the thermal energy is applied through the debrider. 
         [0061]    In yet another embodiment, the method includes expanding an expandable member in the urethra. In yet another embodiment, the expandable member is expanded during rotation of the mechanical debrider. In yet another embodiment, the expandable member is expanded after removing the prostatic tissue. In yet another embodiment, the expandable member is also expanded during rotation of the mechanical debrider. In yet another embodiment, the expandable member comprises an inflatable balloon. 
         [0062]    In another embodiment, a medical device includes a catheter; an endoscope positioned in the catheter, and a mechanical debrider extending out of the catheter, wherein the debrider includes an outer tube and a tissue removal member. 
         [0063]    In one or more of the embodiments described herein, the catheter includes an inflatable balloon. 
         [0064]    In one or more of the embodiments described herein, the debrider further includes a spiral groove disposed on a outer portion. 
         [0065]    In one or more of the embodiments described herein, rotation of the spiral groove draws a loosened tissue into the outer tube. 
         [0066]    In one or more of the embodiments described herein, the removal member includes one or more blades for cutting a tissue. 
         [0067]    In one or more of the embodiments described herein, the one or more blades comprise a flexible metal. 
         [0068]    In one or more of the embodiments described herein, the one or more blades are adapted to flex radially outward. 
         [0069]    In one or more of the embodiments described herein, a medical device includes an expandable member. In yet another embodiment, the expandable member comprises an inflatable balloon. In yet another embodiment, the medical device includes a third channel for supplying a fluid to the expandable member. 
         [0070]    In one or more of the embodiments described herein, a medical device includes a tissue removal member having an adjustable diameter. In another embodiment, the debrider further includes a conveying member having a central passage. In another embodiment, the tissue removal member is movable in the central passage. In another embodiment, a length of the tissue removal member extending out of the central passage is controllable to adjust the diameter of the tissue removal member. In another embodiment, the medical device includes a cable attached to an end of the removal member. In another embodiment, the cable is retractable within the central passage to adjust a diameter of the tissue removal member. In another embodiment, the conveying member includes an auger portion. 
         [0071]    While the foregoing is directed to embodiments of the present invention, other and further embodiments of the invention may be devised without departing from the basic scope thereof, and the scope thereof is determined by the claims that follow.