Abstract:
Apparatus for creating a controlled pattern of ablation throughout the interior of an organ or body cavity while minimizing thermal damage to collateral tissue includes a microporous balloon mounted on a catheter. The balloon, bearing electrodes embedded in the surface, is inserted into the target body region and inflated, whereupon the electrodes come into contact with the interior of the targeted organ. Because of its microporous nature, fluids for cooling or various therapeutic purposes may pass through the surface of the balloon to the target site. Sensors monitor conditions such as temperature and impedance at the site, providing required feedback for delivery of RF energy for ablation, and administration of cooling and hydrating fluids. A second balloon or other means isolates the treatment area and controls the flow and accumulation of body fluids and treatment fluids minimizing adverse treatment effects from fluid accumulations, and anchoring the catheter in place.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     This Application is a Continuation-in-part of U.S. patent application Ser. No. 09/285,575, filed on Apr. 2, 1999; entitled “Treating Body Tissue by Applying Energy and Substances.” 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     This invention relates to treatment of tissue, particularly in the sphincters and other muscles of the digestive, circulatory, respiratory, urinary and reproductive systems. Such treatment can be performed using ablation, coating, expansion, plumping, shaping, shrinking, or related techniques. 
     2. Related Art 
     The circulatory, respiratory, urinary, reproductive and digestive systems of human beings, livestock and other mammals are subject to a number of disorders and diseases. Disorders in the circulatory system include aneurysms of the aortic arch, thoracic aorta and abdominal aorta. Disorders in the respiratory system include occlusion of the trachea and tumors and polyps in the hypopharynx, oropharynx, nasopharnyx and larynx. Disorders in the urinary system include incontinence and urinary neuropathy. Disorders of the reproductive system include obstruction of the vas deferens, obstruction of the fallopian tubes, uterine cysts and fibroids, prolapsed uterus, menorrhagia and tumors or cancerous tissue. Disorders in the digestive system include Barrett&#39;s esophagus, occlusion of the bile ducts, occlusion of the pancreatic ducts, tumors and cancerous tissue found in the stomach and related structures. Other disorders in the rectum and colon include hemorrhoids (external and internal), fecal incontinence, prolapsed rectal muscles, rectal muscle spasms, anal fissures, polyps, diverticulosus, diverticulitus and pilonital cysts. 
     Known methods for the treatment of these disorders include surgery, pharmaceutical remedies, chemotherapeutic regimens, radiation, photodynamic therapy and lifestyle modification. These methods only occasionally achieve the goal of successful treatment of known disorders. One problem in the known art is that these methods suffer from several drawbacks. 
     Drawbacks to surgical treatment include its highly invasive nature, associated risks, possible iatrogenic effects, and high cost. Drawbacks to pharmaceutical and chemotherapeutic treatments include their relative ineffectiveness (particularly in the oral cavity and adjacent respiratory structures) and associated side effects. Moreover, these approaches are contraindicated for many patients. Drawbacks to lifestyle modification include relatively poor patient compliance and relative ineffectiveness. Drawbacks to photodynamic therapy include its frequent unavailability and limited applicability. Drawbacks to radiation include side effects such as exhaustion, radiation burns, chronic dry mouth and permanent distortion of the taste buds. Accordingly, it would be advantageous to provide techniques for treatment of these disorders that are not subject to these known drawbacks. 
     The use of radio frequency (RF) to ablate tissue in the body (such as heart muscle tissue) is known in the art of cardiac treatment. However, known systems using RF energy are still subject to several drawbacks. One known problem in the art involves the creating a controlled pattern of ablation throughout the interior of an organ. For instance, it is sometimes desirable to apply RF energy to the entire interior of a body cavity such as a urinary bladder. While known systems allow RF energy to be applied to one part of a body cavity, followed by another part, they do not permit the RF energy to be simultaneously directed to the entire interior of a body organ. 
     A second problem in the known art of applying RF energy involves minimizing thermal damage to adjacent body tissues. Frequently, application of RF energy to targeted tissue results in collateral thermal damage to adjacent tissue because it is difficult to control the temperature of the adjacent structure. 
     A third problem in the known art is that it can be difficult to block the flow of bodily fluids and gases into an area of the body where tissue ablation is taking place. Bodily fluids can dissipate and detrimentally absorb the energy to be applied to the tissue to be ablated. Dissipation of bodily fluids detracts from the goal of successful tissue ablation and etching. 
     A fourth problem in the known art involves directing and positioning the electrodes in the body cavity or orifice. Difficulties in accurately positioning the electrodes in the target orifice detract from treatment. Frequently, unhealthy tissue can remain unablated while healthy tissue is removed. Difficulties in directing and positioning the electrodes are particularly problematic because one of the goals of treatment is to minimize collateral damage to healthy tissue and to completely ablate diseased tissue. 
     A fifth problem in the known art involves difficulty in the simultaneous use of complimentary technology. Known systems do not provide for optimal, simultaneous use of auxiliary tools for visualization, feedback technology and drug administration. 
     Accordingly, it would be advantageous to provide improved techniques for treatment of disorders in the bladder, esophagus, uterus, fallopian tubes and vas deferens, sinus cavities, aorta, larynx, pharynx and the sphincters and muscle tissue associated with these organs in humans, livestock and other mammals. For example, it would be advantageous to provide devices bearing different arrays of electrodes embedded in an inflatable microporous balloon. Such devices can be coupled to apparatus for drug administration and tissue visualization and mounted on a catheter that can be either manually or laproscopically inserted into a body orifice or organ. Such devices would allow medical or veterinary personnel to (1) provide for the controlled, such as uniform, application of energy throughout the interior of a body cavity, (2) visualize the tissue to be ablated or etched, (2) monitor and regulate the temperature of adjacent tissue, (3) seal off the area from fluids and gases that would disturb the area to be ablated, (4) ablate or otherwise treat diseased tissue while sparing healthy tissue and (5) provide for the localized administration of drugs to numb the area and treat the disorder. These advantages are achieved in an embodiment of the invention in which medical or veterinary personnel use a catheter that supports a multiple array of regularly spaced electrodes embedded in a balloon-like microporous sacs that can be inflated with saline or air. Temperature regulation is achieved by partially infusing the balloon with a circulating fluid whose temperature can be maintained so as to cool the surface of the balloon. Multiple controls for operation of individual electrodes, visualization and drug administration are mounted into the catheter, along with sensors that measure temperature, impedance and other properties. 
     SUMMARY OF THE INVENTION 
     The invention provides a method and system for treatment of body structures or tissue. The particular treatment can include one or more of, or some combination of ablation, coating, expansion, plumping, shaping, shrinking, or related techniques. The particular body structures or tissue can include one or more of, or some combination of regions, including the rectum, colon, esophagus, vagina, penis, larynx, pharynx, vas deferens, uterus, trachea, large intestine, small intestine, sinus, bladder, auditory canal, aortic arch, abdominal aorta, thoracic aorta and all associated sphincters as well as smooth and striated muscles. 
     In a first aspect of the invention, positive pressure is used to inflate a balloon having a microporous membrane with a flowable substance, such as air or saline. Inflation of the balloon inside a targeted organ causes a set of electrodes, either embedded in or otherwise positioned with regard to, the microporous balloon to come into contact with either a portion of, or the entire interior of, the targeted organ. Negative pressure can deflate the balloon and allow the catheter to be removed from the body without damaging adjacent body structures. 
     In a second aspect of the invention, the electrodes are coupled to sensors that measure sympathetic and parasympathetic nervous activity in selected areas of the targeted region. These measurements are useful both in making diagnostic assessments as well as in determining treatment parameters. 
     In a third aspect of the invention, the electrodes are coupled to sensors that measure properties of the target region such as temperature and impedance. Measurement of these properties permits the use of feedback technique to control delivery of the RF energy and administration of fluids for cooling and hydrating the affected tissues. 
     In a fourth aspect of the invention, an environment proximate to or surrounding the targeted treatment region can be isolated or controlled by blocking the flow of gases or liquids using an inflatable balloon or other device positioned proximate to the tissue that is to be ablated. The inflatable balloon can also serve to anchor the catheter in place and prevent the catheter from being expelled from the body. The inflatable balloon can also insure that locally administered drugs remain in the area where most effective or needed. 
     In a fifth aspect of the invention, the catheter includes an optical path that can be coupled to external viewing apparatus. The position of the electrodes in the body can therefore be determined by fluoroscopic, fiber optic, or radioscopic techniques. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a diagram of a system for ablating tissue using a catheter and electrode assembly. 
     FIGS. 2A and 2B is a process flow diagram of a method for treatment for urinary incontinence in women. 
     FIGS. 3A and 3B is a process flow diagram of a method for another treatment of urinary incontinence in women. 
     FIGS. 4A and 4B is a process flow diagram of a method for treatment of incontinence in men. 
     FIGS. 5A and 5B is a process flow diagram of a method for treatment of an occluded fallopian tube. 
     FIGS. 6A and 6B is a process flow diagram of a method for treatment of an occluded vas deferens. 
     FIG. 7 is a process flow diagram of a method for treatment of Barrett&#39;s esophagus. 
     FIG. 8 is a process flow diagram for treatment of fecal incontinence. 
     FIG. 9 is a process flow diagram for treatment of a hemorrhoid or pilonital cyst. 
     FIG. 10 is a process flow diagram for treatment of an anal fissure. 
     FIGS. 11A and 11B is a process flow diagram for treatment of an aortic aneurysm. 
     FIG. 12 is a diagram of an alternative embodiment of the system of FIG.  1 . 
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
     System Elements 
     FIG. 1 is a block diagram of a system for ablating tissue associated with the circulatory, respiratory, reproductive, digestive, auditory and urinary systems along with their related sphincters and associated musculature using a catheter and electrode assembly. 
     A catheter and electrode assembly  100  for treating tissue includes a catheter  110 , an inflatable microporous balloon  120  and a control and delivery linkage  130 . 
     The catheter  110  includes a short, distal segment  111  and a proximal segment  112 . The distal segment includes a tapered tip  113  for easy insertion into an orifice or surgically created opening. The tapered tip  113  may be either flexible or rigid depending upon the orifice or opening into which the catheter  110  is to be inserted. The overall length of the shaft of the catheter  110  (including the inflatable, microporous balloon  120 ) from the tapered tip  113  to the junction where the catheter  110  is coupled to the control and delivery linkage  130  is about 65 centimeters. The diameter of the catheter  110  is about 0.4 centimeters. In an alternative embodiment, the length and diameter of the shaft of the catheter  110  may vary substantially depending upon application. 
     Taken together, the distal segment  111 , the inflatable, microporous balloon  120  and the proximal segment  112  are linearly contiguous and form one continuous unit. 
     The inflatable microporous balloon  120  includes multiple arrays of regularly positioned electrodes  121  embedded into the wall of the balloon. Each electrode  128  includes a metallic tube  122  defining a hollow lumen  123 , a temperature sensor  124  an impedance sensor  125  and a sensor for measuring nervous activity. In addition to ablating tissue by delivering RF energy, the electrodes are disposed to deliver at least one flowable substance to the area where ablation is to take place. In a preferred embodiment, the flowable substance includes saline with a concentration of less than about 10% NaCl, which aids in hydration of body structures. However, in alternative embodiments, the deliverable, flowable liquids include other substances, including anesthetic drugs, anti-inflammatory agents, chemotherapeutic agents, systemic or topical antibiotics, collagen and radioactive substances such as labeled traces. In alternative embodiments, the overall dimensions of the inflatable microporous balloon  120  can vary as long as they are responsive to the dimensions of the targeted tissue. For instance, the dimensions of an inflatable, microporous balloon  120  that is used to ablate tissue in a uterus will be larger than those of an inflatable microporous balloon that is used to ablate tissue in a fallopian tube. In other alternative embodiments, the shape and length of the electrodes may vary. 
     Exact positioning of the electrodes  121 ,  128  is achieved through the use of visualization apparatus couple and by inflating the balloon  120 . Inflation of the balloon  120  causes the embedded electrodes  121 ,  128  to be brought into contact with either a select portion or the entire surface of the targeted tissue. 
     Manipulating the control and delivery linkage  130  operates the assembly  100 . The control and delivery linkage  130  includes a port  131 , a second port  132 , three female couplings  133 ,  134  and  135 , a mechanical switch  136  and a handset  137 . 
     The port  131  can be coupled to a source of RF energy. The port  132  can be coupled to visualization apparatus, such as fiber optic devices, fluoroscopy equipment and related endoscopic apparatus, to allow internal viewing of the targeted tissue. The female coupling  133  can be connected to a syringe or other dive to which positive pressure can be applied to inflate the balloon  120 . In a preferred embodiment, female coupling  134  can be connected to biologically nonreactive tubing through which saline can be infused so that the saline can continually circulate through the microporous balloon  120  and the electrodes  121 ,  128 . Female coupling  135  can be connected to drug administration apparatus. Mechanical switch  136  allows for the activation of individual electrodes in a manner, the manner including selecting any of number, sequence, pattern and position, that is responsive to the judgment of medical or veterinary personnel. The port  131 , port  132 , female couplings  133 ,  134 ,  135  and mechanical switch  136  are all located immediately adjacent to the handset  137  to allow easy operation. 
     First Method of Operation 
     FIG. 2 is a process flow diagram of a method for treatment for urinary incontinence in women. 
     This method of operation is appropriate for the type of incontinence common to many post-menopausal parous women. In some women, the structure of the pelvic support of the bladder is damaged, either by parturition or urethral atrophy caused by estrogen deprivation. When this occurs, the urethra shortens, and the normal urethovesical angle is lost. The goals of this method of operation include producing uniform shrinkage of submuscosal tissue. This shrinkage helps restore the urethovesical angle that is important for closure of the urethral sphincter. 
     A method  200  is performed using a catheter and electrode assembly  100 . 
     In a step  201 , the area around the urethral meatus is cleansed. The tapered tip of the catheter  110  is well lubricated and introduced into the urethral meatus in an upward and backward direction, in much the same way one would introduce a Foley catheter. Due to the potential for inducing pain, the outer opening of the urethra may be pretreated with a topical anesthetic before insertion. The choice of pharmaceutical agents to be infused prior to or during treatment will be responsive to judgments by medical personnel and may include lubricants, anesthetics, antispasmodics, anti-inflammatories, antibiotics or other agents. 
     In a step  202 , the catheter  110  is threaded through the urethra until the tapered tip  113  and the inflatable, microporous balloon  120  extend past the neck of the bladder. Strict aseptic technique is maintained during this step and all subsequent ones. 
     In a step  203 , viewing apparatus coupled to port  132  is used to examine the interior of the bladder, evaluate the positioning of the catheter  110  and determine which areas of the submucosal tissue are targeted for ablation and shrinkage. 
     In a step  204 , a syringe is connected to the female coupling  133  included in the control and delivery linkage  130 . 
     In a step  205 , the syringe is used to exert positive pressure and inflate the inflatable, microporous balloon  120  with air or liquid. Inflation of the balloon  120  serves several purposes. In addition to snugly positioning the electrode  121  against the wall of the bladder, the inflatable, microporous balloon  120  also helps anchor the catheter in place. In an alternative embodiment, a second balloon  120  is used to help seal off the bladder neck. 
     In a step  206 , inflation of the balloon  123  causes the set of electrodes to be brought into contact with the interior of the bladder. 
     In a step  207 , the position of the catheter and the balloon is checked again using the visual apparatus coupled through port  132 . Any correction to the position of the catheter  110  is made at this time, by repeating steps  202  through  206 . 
     In a step  208 , one or more electrodes  121 ,  128  are selected for activation. Since the goal of treatment includes uniform shrinkage of the submucosal tissue, the selected electrodes  121 ,  128  usually adhere to a uniform pattern. The number and pattern of selected electrodes is responsive to judgment of medical personnel. The mechanical switch  136  is used to select one or more electrodes  121 ,  128 . 
     In a step  209 , a source of RF energy is applied to port  131 . RF energy is provided to electrodes  121 ,  128  to shrink the targeted tissue. In a preferred embodiment, the RF energy has a frequency between 435 kilohertz and 485 kilohertz. The RF energy is received by the submucosal tissue immediately near the electrodes for period of time less than ten minutes. The duration of time and frequency of energy are responsive to judgments of medical personnel. Application of RF energy causes the involuntary sphincter to shrink so that urine does not seep through. 
     In a step  210 , one end of a piece of biologically nonreactive double-lumen tubing is attached to female coupling  134 ; the other end of the tubing is attached to a pump which is submerged in a bath of saline or other flowable substance that is maintained at a constant temperature. The saline or flowable substance is drawn through the holes in the electrodes  128  and the micropores of the balloon  120 , as needed, to lower the temperature of the region and prevent collateral thermal damage. Double lumen tubing permits constant circulation of the flowable substance throughout the bladder and balloon  120 . The nature, temperature and amount of flowable substance are responsive to judgments by medical personnel. 
     In a step  211 , all or most of the flowable liquid that has been circulating through the electrodes  128  and micropores of the balloon is siphoned off by the application of negative force to female coupling  137 . 
     In a step  212 , the inflatable, microporous balloon  120  is deflated by application of negative pressure on the syringe connected to female coupling  133 . 
     In a step  213 , the catheter  110  is withdrawn from the urethra. 
     Second Method of Operation 
     FIG. 3 is a process flow diagram of a method for another treatment for urinary incontinence in women. 
     This method of treatment is appropriate when incontinence is caused by inflammatory lesions of the muscosal tissue in the trigone area of the bladder. These lesions can cause uncontrollable detrusor contractions and unwanted passage of urine, often called urgency incontinence. The goals of this method include shrinkage of muscosal tissue and ablation of the lesions causing incontinence. 
     A method  300  is performed using a catheter and electrode assembly  100 . 
     In a step  301 , the area around the urethral meatus is cleansed. The tapered tip of the catheter  110  is well lubricated and introduced into the urethral meatus in an upward and backward direction, in much the same way one would introduce a Foley catheter. Due to the potential for inducing pain, the outer opening of the urethra may be pretreated with a topical anesthetic before insertion. The choice of pharmaceutical agents to be infused prior to or during treatment will be responsive to judgments by medical personnel and may include lubricants, anesthetics, antispasmodics, anti-inflammatories, antibiotics or other agents. 
     In a step  302 , the catheter  110  is threaded through the urethra until the tapered tip  113  and the inflatable, microporous balloon  120  extend past the neck of the bladder until the balloon  120  is in proximate contact with the trigone area of the bladder. Strict aseptic technique is maintained during this step and all subsequent ones. 
     In a step  303 , viewing apparatus coupled to port  132  is used to examine the interior of the bladder, search for lesions in the trigone area, evaluate the positioning of the catheter  110  and determine which areas of the mucosal tissue are targeted for ablation and shrinkage. 
     In a step  304 , a syringe is connected to the female coupling  133  included in the control and delivery linkage  130 . 
     In a step  305 , the syringe is used to exert positive pressure and inflate the inflatable, microporous balloon  120  with air or liquid. Inflation of the balloon  120  serves several purposes. In addition to snugly positioning the electrodes  121 ,  128  against the trigone area of the bladder, the inflatable microporous balloon  120  also helps anchor the catheter in place. In an alternative embodiment, a second balloon  1201  (FIG. 12) serves as a blocking element used to help seal off the bladder neck. 
     In a step  306 , inflation of the balloon  120  causes the set of electrodes to be brought into contact with most or all of the entire interior of the bladder wall, including the offending lesions of the trigone area. 
     In a step  307 , the position of the catheter and the balloon is checked once again using the visual apparatus coupled through port  132 . Any correction to the position of the catheter  110  is made at this time, by repeating steps  302  through  306 . 
     In a step  308 , one or more electrodes  121 ,  128  are selected for activation. Since the goals of treatment include uniform shrinkage of the mucosal tissue, the selected electrodes  121 ,  128  usually adhere to a uniform pattern. In some instances it may be desirable to shrink other interior areas of the bladder as well. In such instances, additional electrodes  121 ,  128  may be selected for activation. The number and pattern of selected electrodes is responsive to the judgments of medical or veterinary personnel. The mechanical switch  136  is used to select one or more electrodes  121 ,  128 . 
     In a step  309 , a source of RF energy is applied to port  131 . RF energy is provided to electrodes  121 ,  128  to shrink the targeted tissue. In a preferred embodiment, the RF energy has a frequency between 435 kilohertz and 485 kilohertz. The RF energy is received by the submucosal tissue immediately near the electrodes for period of time less than ten minutes. The duration of time and frequency of energy are responsive to judgments of medical personnel. Application of RF energy causes the involuntary sphincter to shrink so that urine does not seep through. 
     In a step  310 , one end of a piece of biologically nonreactive double-lumen tubing is attached to female coupling  134 ; the other end of the tubing is attached to a pump which is submerged in a bath of saline or other flowable substance that is maintained at a constant temperature. The saline or flowable substance is drawn through the holes in the electrodes  128  and the micropores of the balloon  120 , as needed, to lower the temperature of the region and prevent collateral thermal damage. Double lumen tubing permits constant circulation of the flowable substance throughout the bladder and balloon  120 . The nature, temperature and amount of flowable substance are responsive to judgments by medical personnel. 
     In a step  311 , all or most of the flowable liquid that has been circulating through the electrodes  128  and micropores of the balloon is siphoned off by the application of negative force to female coupling  137 . 
     In a step  312 , the inflatable, microporous balloon  120  is deflated by application of negative pressure on the syringe connected to female coupling  133 . 
     In a step  313 , the catheter  110  is withdrawn from the urethra. 
     Third Method of Operation 
     FIG. 4 is a process flow diagram of a method for treatment of incontinence in men. 
     Presently, incontinence in men accounts for only 15% of all adult incontinence. It is usually secondary to prostatic surgery for benign prostatic hypertrophy or prostatic carcinoma. If surgical damage to the external sphincter has been inflicted, complete incontinence can result. The goals of this method of operation include removing lesions caused by prostatic surgery, shrinking the sphincter, and resorting the urethovesical angle. 
     A method  400  is performed using a catheter and electrode assembly  100 . 
     In a step  401 , the tapered tip  113  of the catheter  110  is well lubricated. The area of the glans penis around the urinary meatus is washed with a cleansing agent such as benzalonium chloride. Due to the potential for inducing pain, the area surrounding the urinary meatus may be pretreated with a topical anesthetic before insertion; depending upon the circumstances, a muscle relaxant may be indicated. 
     The preferred size of the catheter  110  will be responsive to the orifice through which the catheter is inserted. The choice of pharmaceutical agents to be infused prior to or during treatment will be responsive to judgments by medical or veterinary personnel, and may include lubricants, anesthetics, antispasmodics, antiinflammatories, antibiotics or other agents. 
     In a step  402 , the catheter  110  is introduced into the urethra along the anterior wall. The catheter is advanced approximately 17.5-25 centimeters. Since the length from the bladder to the end of the glans penis varies, the distance that the catheter is advanced is responsive to the judgment of medical or veterinary personnel. 
     In a step  403 , viewing apparatus coupled to the port  132  may be used to examine both the voluntary and involuntary sphincter for evidence of lesions or other damage caused by prior surgery. The viewing apparatus is also used to evaluate the urethrovesical angle, position the catheter  110  and balloon  120 , and determine which areas are candidates for ablation and shrinkage. 
     In a step  404 , a syringe is connected to the female coupling  133  included in the control and delivery linkage  130 . 
     In a step  405 , the syringe is used to exert positive pressure and inflate the inflatable, microporous balloon  120  with air or liquid. Inflation of the balloon  120  serves several purposes. In addition to snugly positioning the electrodes  121 ,  128 , the inflatable microporous balloon  120  also helps anchor the catheter in place. In an alternative embodiment, a second balloon  1201  (FIG. 12) is used to help seal off the bladder neck. 
     In a step  406 , inflation of the balloon  120  causes the set of electrodes to be brought into contact with the interior of the bladder. 
     In a step  407 , the position of the catheter and balloon is checked again using the visual apparatus coupled through port  132 . Any correction to the position of the catheter  110  is made at this time by repeating steps  402  through  406 . 
     In a step  408 , one or more electrodes  121 ,  128  are selected for activation. Since the goals of treatment include uniform shrinkage of the sphincter, the selected electrodes  121 ,  128  usually adhere to a uniform pattern. In some instances it may be desirable to shrink other interior areas of the bladder as well. In such instances, additional electrodes  121 ,  128  may be selected for activation. The number and pattern of selected electrodes is responsive to the judgments of medical or veterinary personnel. The mechanical switch  136  is used to select one or more electrodes  121 ,  128 . 
     In a step  409 , a source of RF energy is coupled to port  13 . RF energy is provided to the electrodes so as to ablate the targeted portions of the bladder. In a preferred embodiment, the RF energy has a frequency between 435 kilohertz and 485 kilohertz. The RF energy is received by the tissue immediately near the electrodes. The tissue is heated for a short period of time until ablation occurs. Application of RF energy has the effect of ablating the offending lesions and shrinking the involuntary sphincter. This shrinkage results in repositioning of the urethrovesical angle in such a way that that urine does not seep through the sphincter. 
     In a step  410 , one end of a piece of biologically nonreactive double-lumen tubing is attached to female coupling  134 ; the other end of the tubing is attached to a pump which is submerged in a bath of saline or other flowable substance that is maintained at a constant temperature. The saline or flowable substance is drawn through the holes in the electrodes  128  and the micropores of the balloon  120 , as needed, to lower the temperature of the region and prevent collateral thermal damage. Double lumen tubing permits constant circulation of the flowable substance throughout the bladder and balloon  120 . The nature, temperature and amount of flowable substance are responsive to judgments by medical personnel. 
     In a step  411 , all or most of the flowable liquid that has been circulating through the electrodes  128  and micropores of the balloon is siphoned off by the application of negative force to female coupling  137 . 
     In a step  412 , the inflatable, microporous balloon  120  is deflated by application of negative pressure on the syringe connected to female coupling  133 . 
     In a step  413 , the catheter  110  and inflatable, microporous balloon  120  is withdrawn from the urethra. 
     Fourth Method of Operation 
     FIG. 5 is a process flow diagram for a method of treating an occluded fallopian tube. 
     Blockage of the fallopian tube is a frequent cause of infertility in women of reproductive years. Diagnosis of tubal blockage is generally made by hysteroslpingogram and diagnostic laparoscopy. The goals of this method of treatment include restoration of the fallopian tube patency. 
     A method  500  is performed using a catheter and electrode assembly  100 . 
     In a step  501 , the skin of the lower abdomen is cleansed and draped. A small surgical incision is made to allow the insertion of the catheter  110 . Strict aseptic technique is maintained during this step and all subsequent ones. Due to the potential for inducing pain, the surface of the skin may be pretreated with a topical anesthetic before insertion. A mild anesthetizing agent such as VerSed may be indicated. The choice of pharmaceutical agents to be infused prior to or during treatment will be responsive to judgments by medical or veterinary personnel and may include lubricants, anesthetics, antispasmodics, anti-inflammatories, antibiotics or other agents. 
     In a step  502 , both fallopian tubes are located. A second small incision is made in the wall of one the fallopian tubes to permit insertion of the catheter  110 . Care is taken not to abrade the ovaries or damage the broad ligament that supports the fallopian tube. 
     In a step  503 , viewing apparatus coupled to port  132  is used to examine the interior walls of the fallopian tube, search for occlusions, evaluate the position of the catheter  110  and balloon  120 , and determine which areas are targeted for ablation. 
     In a step  504 , a syringe is connected to the female coupling  133  included in the control and delivery linkage  130 . 
     In a step  505 , the syringe is used to exert positive pressure and inflate the inflatable, microporous balloon  120  with air or liquid. Inflation of the balloon  120  serves several purposes. First, in some instances, it is possible that simple inflation of the balloon will be sufficient to dilate an occluded region. Inflation of the balloon  120  also causes the electrodes  121 ,  128  to be positioned snugly against the walls of the fallopian tube. Moreover, the inflatable microporous balloon  120  also helps anchor the catheter in place. 
     In a step  506 , inflation of the balloon  120  causes the set of electrodes to be brought into contact with the offending occlusions and blockages. 
     In a step  507 , the position of the catheter and the balloon is checked once again using the visual apparatus coupled through port  132 . Any correction to the position of the catheter  110  is made at this time, by repeating steps  503  through  506 . 
     In a step  508 , one or more electrodes  121 ,  128  are selected for activation. Unlike the previous methods, the selected electrodes  121 ,  128  need not adhere to a uniform pattern. The number and pattern of selected electrodes is responsive to the judgments of medical or veterinary personnel. 
     In a step  509 , a source of RF energy is applied to port  131 . RF energy is provided to electrodes  121 ,  128  to shrink the targeted tissue. In a preferred embodiment, the RF energy has a frequency between 435 kilohertz and 485 kilohertz. The RF energy is received by the tissue immediately near the electrodes for period of time less than ten minutes. The duration of time and frequency of energy are responsive to judgments of medical personnel. 
     In a step  510 , one end of a piece of biologically nonreactive double-lumen tubing is attached to female coupling  134 ; the other end of the tubing is attached to a pump which is submerged in a bath of saline or other flowable substance that is maintained at a constant temperature. The saline or flowable substance is drawn through the holes in the electrodes  128  and the micropores of the balloon  120 , as needed, to lower the temperature of the region and prevent collateral thermal damage. Double lumen tubing permits constant circulation of the flowable substance throughout the bladder and balloon  120 . The nature, temperature and amount of flowable substance are responsive to judgments by medical or veterinary personnel. 
     In a step  511 , all or most of the flowable liquid that has been circulating through the electrodes [ 121 ]  128  and micropores of the balloon is siphoned off by the application of negative force to female coupling  137 . 
     In a step  512 , the inflatable, microporous balloon  120  is deflated by application of negative pressure on the syringe connected to female coupling  133 . 
     In a step  513 , the catheter  110  is removed from the fallopian tube and the incision in the fallopian tube is repaired. 
     In a step  514 , the catheter  110  is withdrawn from the incision where it was initially introduced into the body. 
     Steps  501  through  514  may be repeated, if necessary, to treat occlusions on the other fallopian tube. 
     Fifth Method of Operation 
     FIG. 6 is a process flow diagram of a method for treatment of an occluded vas deferens. 
     Obstruction of the vas deferens accounts for about 3% of male infertility. Obstruction may be congenital or acquired. Congenital obstruction may be an isolated abnormality or may be associated with cystic fibrosis. Acquired obstruction of the vas deferens may be caused by tuberculosis and gonorrhea. The goals of the method of operation include removal of the obstruction and restoration of fertility. 
     A method  600  is performed using a catheter and electrode assembly  100 . 
     In a step  601 , the skin of the lower abdomen is cleaned and draped. A small surgical incision is made to allow the insertion of the catheter  110 . Strict aseptic technique is maintained during this step and all subsequent ones. Due to the potential for inducing pain, the surface of the skin may be pretreated with a topical anesthetic before insertion. A mild anesthetizing agent such as VerSed may be indicated. The choice of pharmaceutical agents to be infused prior to or during treatment will be responsive to judgments by medical personnel and may include lubricants, anesthetics, antispasmodics, anti-inflammatories, antibiotics or other agents. 
     In a step  602 , both of the vas deferens are located. A second small incision is made into the wall of one the vas deferens to permit insertion of the catheter  110 . Care is taken not to abrade the seminal vesicles or supporting structures. 
     In a step  603 , viewing apparatus coupled to port  132  is used to examine the interior walls of the vas deferens, search for occlusions, evaluate the position of the catheter  110  and balloon  120 , and determine which areas are targeted for ablation. 
     In a step  604 , a syringe is connected to the female coupling  133  included in the control and delivery linkage  130 . 
     In a step  605 , the syringe is used to exert positive pressure and inflate the inflatable, microporous balloon  120  with air or liquid. Inflation of the balloon  120  serves several purposes. First, in some instances, it is possible that simple inflation of the balloon will be sufficient to dilate an occluded region. However, if this is not sufficient, inflation of the balloon  120  also causes the electrodes  121 ,  128  to be positioned snugly against the walls of the vas deferens. Moreover, the inflatable microporous balloon  120  also helps anchor the catheter in place. 
     In a step  606 , inflation of the balloon  120  causes the set of electrodes to be brought into contact with the offending occlusions and blockages. 
     In a step  607 , the position of the catheter and the balloon is checked once again using the visual apparatus coupled through port  132 . Any correction to the position of the catheter  110  is made at this time, by repeating steps  603  through  606 . 
     In a step  608 , one or more electrodes  121 ,  128  are selected for activation. Unlike the previous methods, the selected electrodes  121 ,  128  need not adhere to a uniform pattern. The number and pattern of selected electrodes is responsive to the judgments of medical or veterinary personnel. The mechanical switch  136  is used to select one or of the electrodes  121 ,  128 . 
     In a step  609 , a source of RF energy is applied to port  131 . RF energy is provided to electrodes  121 ,  128  to shrink the targeted tissue. In a preferred embodiment, the RF energy has a frequency between 435 kilohertz and 485 kilohertz. The RF energy is received by the tissue immediately near the electrodes for period of time less than ten minutes. The duration of time and frequency of energy are responsive to judgments of medical personnel. Application of RF energy has the effect of ablating the offending occlusions. 
     In a step  610 , one end of a piece of biologically nonreactive double-lumen tubing is attached to female coupling  134 ; the other end of the tubing is attached to a pump which is submerged in a bath of saline or other flowable substance that is maintained at a constant temperature. The saline or flowable substance is drawn through the holes in the electrodes  128  and the micropores of the balloon  120 , as needed, to lower the temperature of the region and prevent collateral thermal damage. Double lumen tubing permits constant circulation of the flowable substance throughout the bladder and balloon  120 . The nature, temperature and amount of flowable substance are responsive to judgments by medical or veterinary personnel. 
     In a step  611 , all or most of the flowable liquid that has been circulating through the electrodes  128  and micropores of the balloon is siphoned off by the application of negative force to female coupling  137 . 
     In a step  612 , the inflatable, microporous balloon  120  is deflated by application of negative pressure on the syringe connected to female coupling  133 . 
     In a step  613 , the catheter  110  is removed from the vas deferens and the incision in the wall of the vas deferens is repaired. 
     In a step  614 , the catheter  110  is withdrawn from the incision where it was initially introduced into the body. 
     In a step  615 , the incision where the catheter  110  was introduced is repaired. 
     Steps  601  through  615  may be repeated, if necessary, to treat occlusions on the remaining vas deferens. 
     Sixth Method of Operation 
     FIG. 7 is a process flow diagram of a method for treatment of Barrett&#39;s esophagus. 
     Barrett&#39;s esophagus often accompanies gastroesophegeal reflux disorder. It is diagnosed by esophagoscopy, which reveals the presence of columnar cell lining the lower esophagus. Adjacent peptic strictures may or may not coincide. Patients with Barrett&#39;s esophagus require close follow-up because these abnormal tissues often develop into adenocarcinoma. 
     In a step  701 , the tapered tip  113  of the catheter  110  is inserted into the oral cavity. Due to the potential for inducing pain or a gag reflex, the oral cavity is preferably pretreated with lidocaine spray or other topical anesthetic before insertion; depending upon the circumstances, a muscle relaxant may be indicated. In an alternative embodiment, the tapered tip  113  of the catheter  110  is inserted into a surgically created stoma. 
     The preferred size of the catheter  110  will be responsive to the orifice through which the catheter is inserted. The choice of pharmaceutical agents to be infused prior to or during treatment will be responsive to judgments by medical personnel, and may include lubricants, anesthetics, antispasmodics, anti-inflammatories, antibiotics or other agents. 
     In a step  702 , the catheter  110  is threaded through the throat into the lower esophagus. Precautions are preferably taken to ensure that the catheter  110  is not threaded through the trachea into the lungs. 
     In a step  703 , the catheter  110  is positioned near the Barrett&#39;s esophagus. 
     In a step  704 , viewing apparatus coupled to the port  132  may be used to position the catheter  110 , examine the region, and determine which specific tissues are targeted for ablation. Healthy tissue composed of white squamous cells is distinguished from unhealthy pink columnar cells indicative of Barrett&#39;s esophagus. 
     In a step  705 , a syringe is connected to the female coupling  133 . 
     In a step  706 , the syringe is used to exert positive pressure and inflate the balloon  120  with a flowable substance, such as air or liquid. Inflation of the balloon  120  serves several purposes. In addition to positioning the electrodes  121 ,  128 , the balloon  120  also helps anchor the catheter  110  and prevents gas or liquids arising in the stomach from contaminating the region. 
     In a step  707 , inflation of the balloon  120  causes the set of electrodes to be brought into contact with the interior of the lower esophagus. 
     In a step  708 , one or more electrodes  121 ,  128  are selected for activation. Since the treatment goals include ablation of the columnar cells, electrodes that are proximate to these cells are selected. The mechanical switch  136  is used to select one more electrodes  121 ,  128 . 
     In a step  709 , A source of RF energy is coupled to port  131 . RF energy is provided to the electrodes so as to ablate the targeted columnar cells. In a preferred embodiment, the RF energy has a frequency between 435 kilohertz and 485 kilohertz. The tissue immediately near the electrodes receives the RF energy. The strength and duration of time the energy is applied are responsive to judgments by medical personnel. In alternative embodiments, the electrodes may deliver other forms of energy, such as heat, microwaves, infrared or visible laser energy. In other alternative embodiments, the electrodes are controlled by a feedback technique using at least one sensor  126  such as an impedance or temperature sensor. 
     To perform ablation, the tissue is heated for a short period of time until ablation occurs. Application of RF energy causes cell death by dehydration or denaturation of cellular proteins. 
     To perform expansion, plumping, or shaping, the tissue is suffused with a flowable substance, such as a gas or liquid, a collagen, or another substance that can be absorbed by the body structure or tissue. The flowable substance can be exuded from the catheter, either using a separate flow line, or using the electrodes themselves. In a preferred embodiment, the tissue is heated for a short time, and thereafter cooled, so as to cause the flowable substance to crosslink or otherwise transform into a bulking, plumping, or shaping agent. 
     To perform coating, the flowable substance can be exuded so as to adhere to (or be adsorbed by) an epithelial layer of cells. In a preferred embodiment, the tissue is heated for a short time, and thereafter cooled, so as to cause the flowable substance to crosslink or otherwise transform into a solid mass coating or covering the epithelial layer. 
     To perform shrinking, the tissue is suffused with the flowable substance, with the flowable substance being selected so as to act as a receiving antenna or dielectric for the RF energy. RF energy is applied, which is differentially absorbed by the flowable substance; this causes the flowable substance to heat and to shrink the tissue it suffused, either by cell death, dehydration, or denaturation of cellular proteins. 
     In a step  710 , one end of a piece of biologically nonreactive double-lumen tubing is attached to female coupling  134 ; the other end of the tubing is attached to a pump which is submerged in a bath of saline or other flowable substance that is maintained at a constant temperature. The saline or flowable substance is drawn through the holes in the electrodes  128  and the micropores of the balloon  120 , as needed, to lower the temperature of the region and prevent collateral thermal damage. Double lumen tubing permits constant circulation of the flowable substance throughout the bladder and balloon  120 . The nature, temperature and amount of flowable substance are responsive to judgments by medical or veterinary personnel. 
     In a step  711 , all or most of the flowable liquid that has been circulating through the electrodes  128  and micropores of the balloon is siphoned off by the application of negative force to female coupling  137 . 
     In a step  712 , the inflatable microporous balloon is deflated by application of negative pressure on the syringe connected to female coupling  133 . 
     In a step  713 , the catheter  110  is withdrawn from the oral cavity. In an alternative embodiment, the catheter  110  is withdrawn from a stoma. 
     Seventh Method of Operation 
     FIG. 8 is a process flow diagram of a method for treatment of fecal incontinence. 
     A method  800  is performed using a catheter and electrode assembly  100 . This method requires the use of four to eight electrodes and a blunt tapered tip  113 . 
     In a step  801 , the rectum and surrounding area are washed with a cleansing agent such as benzalonium chloride. A topical anesthetic may be applied to prevent pain associated with insertion; depending upon the circumstances, a muscle relaxant may be indicated. The tapered tip  113  of the catheter  110  is inserted into the rectum. 
     The preferred size of the catheter  110  will be responsive to the orifice through which the catheter is inserted. The choice of pharmaceutical agents to be infused prior to or during treatment will be responsive to judgments by medical personnel, and may include lubricants, anesthetics, antispasmodics, anti-inflammatories, antibiotics or other agents. 
     In a step  802 , the catheter  110  is threaded into the rectum. 
     In a step  803 , the catheter  110  is positioned near the area to be ablated. In the preferred embodiment, viewing apparatus such as an anoscope coupled to the port  132  may be used to examine the region and determine which specific tissues are targeted for ablation. It is important to distinguish between the voluntary and involuntary sphincter because fecal incontinence is frequently caused by defects in the involuntary sphincter. 
     In a step  804 , a syringe is connected to the female coupling  133 . 
     In a step  805 , the syringe is used to exert positive pressure and inflate the inflatable, microporous balloon  120  with air or liquid. Inflation of the balloon  120  serves several purposes. In addition to positioning the electrodes  121 ,  128 , the balloon also helps anchor the catheter  110  and prevents gas, liquid or fecal matter from contaminating the region. In an alternative embodiment, a second balloon is used to help seal off the area from contaminants. 
     In a step  806 , inflation of the balloon  120  cause the set of electrodes to be brought into contact with the interior walls of the sphincter. 
     In a step  807 , one or more electrodes  121 ,  128  are selected for activation. The number and pattern of selected electrodes is responsive to the judgment of medical or veterinary personnel. The mechanical switch  136  is used to select the electrodes  121 ,  128 . 
     In a step  808 , RF energy is provided to the electrodes so as to ablate the targeted tissue. In a preferred embodiment, the RF energy has a frequency between 435 kilohertz and 485 kilohertz. The RF energy is received by the tissue immediately near the electrodes. The tissue is heated for a short period of time until ablation occurs. Application of RF energy causes cell death by dehydration and denaturation of cellular proteins. The strength and duration of time the energy is applied are responsive to judgments by medical personnel. In alternative embodiments, the electrodes may deliver other forms of energy, such as heat, microwaves, infrared or visible laser energy. In other alternative embodiments, the electrodes are controlled by a feedback technique using at least one sensor  126  such as an impedance or temperature sensor. 
     In a step  809 , one end of a piece of biologically nonreactive double-lumen tubing is attached to female coupling  134 ; the other end of the tubing is attached to a pump which is submerged in a bath of saline or other flowable substance that is maintained at a constant temperature. The saline or flowable substance is drawn through the holes in the electrodes  128  and the micropores of the balloon  120 , as needed, to lower the temperature of the region and prevent collateral thermal damage. Double lumen tubing permits constant circulation of the flowable substance throughout the bladder and balloon  120 . The nature, temperature and amount of flowable substance are responsive to judgments by medical or veterinary personnel. 
     In a step  810 , all or most of the flowable liquid that has been circulated through the electrodes  128  and balloon is siphoned of by the application of negative force to female coupling  134 . 
     In a step  811 , the balloon  120  is deflated by negative pressure on the syringe connected to female coupling  133 . 
     In a step  812 , the catheter  1   10  is withdrawn from the rectum. 
     Eighth Method of Operation 
     FIG. 9 is a process flow diagram of a method for treatment of a hemorrhoid. 
     A method  900  is performed using a catheter and electrode assembly  100 . 
     In a step  901 , the tapered tip  113  of the catheter  110  is well lubricated. The rectum and surrounding area are washed with a cleansing agent such as benzalonium chloride. Due to the potential for inducing pain, the area surrounding the rectum may be pretreated with a topical anesthetic before insertion; depending upon the circumstances, a muscle relaxant may be indicated. 
     The preferred size of the catheter  110  will be responsive to the orifice through which the catheter is inserted. The choice of pharmaceutical agents to be infused prior to or during treatment will be responsive to judgments by medical personnel, and may include lubricants, anesthetics, antispasmodics, anti-inflammatories, antibiotics or other agents. 
     In a step  902 , the catheter  110  is introduced into the rectum and advanced along the walls of the sphincter. Since hemorrhoids and pilonital cysts may occur anywhere along this passage, the distance that the catheter is introduced is responsive to the judgment of medical or veterinary personnel. 
     In a step  903 , the catheter  110  is positioned near the internal hemorrhoid, external hemorrhoid or cyst that is targeted for ablation. In the preferred embodiment, viewing apparatus coupled to the port  132  may be used to examine the region and determine which specific tissues are targeted for ablation. 
     In a step  904 , a syringe is connected to the female coupling  133 . 
     In a step  905 , the syringe is used to exert positive pressure and inflate the inflatable, microporous balloon  120  with air or liquid. Inflation of the balloon  120  serves several purposes. In addition to positioning the electrodes  121 ,  128 , the balloon  120  also helps anchor the catheter  110 , seal off the region and prevent contamination with fecal matter. In an alternative embodiment, a second balloon is used to help seal off the area from contaminants. 
     In a step  906 , inflation of the balloon  120  causes the set of electrodes  121 ,  128  to be brought into contact with the interior wall of the sphincter. Any corrections in the positioning of the catheter  110  are made at this time, using the anoscope coupled to port  132 . 
     In a step  907 , one or more electrodes  121 ,  128  are selected for activation. The number and pattern of selected electrodes is responsive to the judgment of medical or veterinary personnel. The mechanical switch  136  is used to select the electrodes  121 ,  128 . 
     In a step  908 , a source of RF energy is applied to port  131 . RF energy is provided to electrodes  121 ,  128  so as to ablate the targeted portions of the rectum and anus. In a preferred embodiment, the RF energy has a frequency between 435 kilohertz and 485 kilohertz. The tissue immediately near the electrodes receives the RF energy. The tissue is heated for a short period of time until ablation occurs. In an alternative embodiment, the electrodes are controlled by a feedback technique using at least one sensor  126  such as an impedance or temperature sensor. 
     In a step  909 , one end of a piece of biologically nonreactive double-lumen tubing is attached to female coupling  134 ; the other end of the tubing is attached to a pump which is submerged in a bath of saline or other flowable substance that is maintained at a constant temperature. The saline or flowable substance is drawn through the holes in the electrodes  128  and the micropores of the balloon  120 , as needed, to lower the temperature of the region and prevent collateral thermal damage. Double lumen tubing permits constant circulation of the flowable substance throughout the bladder and balloon  120 . The nature, temperature and amount of flowable substance are responsive to judgments by medical or veterinary personnel. 
     In a step  910 , all or most of the flowable liquid that has been circulating through the electrodes  128  and balloon is siphoned of by the application of negative force to female coupling  134 . 
     In a step  911 , the balloon  120  is deflated by negative pressure on the syringe connected to female coupling  133 . 
     Steps  905  through  911  are repeated as necessary until all hemorroids or cysts are removed. 
     In a step  912 , the catheter  110  is withdrawn from the rectum. 
     Ninth Method of Operation 
     FIG. 10 is a process flow diagram of a method for treatment of an anal fissure. 
     A method  1000  is performed using a catheter and electrode assembly  100 . 
     In a step  1001 , the tapered tip  113  of the catheter  110  is well lubricated. The rectum and surrounding area are washed with a cleansing agent such as benzalonium chloride. Due to the potential for inducing pain, the area surrounding the rectum may be pretreated with a topical anesthetic before insertion; depending upon the circumstances, a muscle relaxant may be indicated. 
     The preferred size of the catheter  110  will be responsive to the orifice through which the catheter is inserted. The choice of pharmaceutical agents to be infused prior to or during treatment will be responsive to judgments by medical or veterinary personnel, and may include lubricants, anesthetics, antispasmodics, antiinflammatories, antibiotics or other agents. 
     In a step  1002 , the catheter  110  is introduced into the rectum and advanced along the walls of the sphincter. The distance that the catheter is introduced is responsive to the judgment of medical or veterinary personnel. 
     In a step  1003 , the catheter  110  is positioned near an anal fissure. In the preferred embodiment, viewing apparatus coupled to the port  132  may be used to examine the region and determine which specific tissues are targeted for ablation and where collagen should be deposited. 
     In a step  1004 , a syringe is connected to the female coupling  133 . 
     In a step  1005 , the syringe is used to exert positive pressure and inflate the balloon  120  with air or with a liquid. Inflation of the balloon  120  serves several purposes. In addition to positioning the electrodes  121 ,  128 , the balloon  120  also helps anchor the catheter. In an alternative embodiment, a second balloon  1201  is used to seal off the area from contaminants. 
     In a step  1007 , inflation of the balloon  120  causes the set of electrodes to be brought into contact with the sphincter. 
     In a step  1008 , one or more electrodes  121 ,  128  are selected for activation. The number and pattern of selected electrodes is responsive to the judgment of medical and veterinary personnel. The mechanical switch  136  is used to select the electrodes  121 ,  128  for activation. 
     In a step  1009 , collagen is deposited into the fissure. 
     In a step  1010 , a source of RF energy is coupled to port  131 . RF energy is provided to the electrodes  121 ,  128  so as to harden the collagen for filling the fissure. In a preferred embodiment, the RF energy has a frequency between 435 kilohertz and 485 kilohertz. The RF energy is received by the tissue immediately near the electrodes. The tissue is heated for a short period of time until the collagen is sufficiently hardened. In an alternative embodiment, the electrodes are controlled by a feedback technique using at least one sensor  126  such as an impedance or temperature sensor. 
     In a step  1011 , other flowable substances are provided through the holes in the electrodes  121 ,  128 , if needed to immediately cool down the region and prevent collateral thermal damage. The nature, temperature and amount of the flowable substance are responsive to judgments by medical or veterinary personnel. 
     In a step  1012 , most or all of the saline and other flowable substances are siphoned off by application of negative force to the female coupling  134 . 
     In a step  1013 , the balloon  120  is deflated by negative pressure on the syringe connected to female coupling  133 . 
     In a step  1014 , the catheter  110  is withdrawn from the rectum. 
     Tenth Method of Operation 
     FIG. 11 is a process flow diagram of a method for treating of an aortic aneurysm. 
     An aortic aneurysm involves destruction of all three layers of the aortic wall. Thinning of the wall increases the diameter of the aorta, which in turn affects the pressure on the wall. Unless treated, the likelihood of rupture increases. Although often successful, surgical treatment for aortic aneurysm is frequently avoided because it&#39;s associated high morbidity. Research has shown that application of RF energy to the wall of the aorta increases the density of the wall. This increase in density has the reverse effect: the diameter of the aortic decreases, which in turn decreases the pressure on the aortic wall. The goals of this method of treatment include the increasing the density of the aortic wall. 
     A method  1100  is performed using a catheter and electrode assembly  100 . 
     In a step  1101 , the chest and/or abdominal region are cleansed and draped. 
     In a step  1102 , a small surgical incision is made in the chest cavity to allow the insertion of the catheter  110 . Strict aseptic technique is maintained during this step and all subsequent ones. Due to the potential for inducing pain, the surface of the skin may be pretreated with a topical anesthetic before insertion. A mild anesthetizing agent such as VerSed may be indicated. The choice of pharmaceutical agents to be infused prior to or during treatment will be responsive to judgments by medical personnel and may include lubricants, anesthetics, antispasmodics, antiinflammatories, antibiotics or other agents. 
     In a step  1103 , the aorta is located. A second small incision is made into the wall of the aorta to permit insertion of the catheter  110 . Care is taken not to abrade or damage adjacent structures. 
     In a step  1104 , viewing apparatus is coupled to port  132 . This viewing apparatus is used to examine the interior walls of the aorta, search for aneurysms (including dissecting aneurysms), evaluate the position of the catheter  110  and balloon  120 , and determine which areas are targeted for application of RF energy. 
     In a step  1105 , a syringe is connected to the female coupling  133  included in the control and delivery  130 . 
     In a step  1106 , the syringe is used to exert positive pressure and inflate the balloon  120  with air or with a liquid. Inflation of the balloon  120  serves several purposes. Inflation of the balloon  120  causes the electrodes  121 ,  128  to be positioned snugly against the aortic walls. Moreover, the inflatable, microporous balloon  120  also helps anchor the catheter in place. 
     In a step  1107 , inflation of the balloon  120  causes the set of electrodes to be brought into contact with the damaged aortic wall. 
     In a step  1108 , the position of the catheter and the balloon is checked once again using the visual apparatus coupled through port  132 . Any correction to the position of the catheter  110  is made at this time, by repeating steps  503  through  1103  through  1107 . 
     In a step  1109 , one or more electrodes  121 ,  128  are selected for activation. The number and pattern of selected electrodes is responsive to the judgment of medical and veterinary personnel. The mechanical switch  136  is used to select the electrodes  121 ,  128  for activation. 
     In a step  1110 , a source of RF energy is coupled to port  131 . RF energy is provided to the electrodes  121 ,  128  so as to harden the collagen for filling the fissure. In a preferred embodiment, the RF energy has a frequency between 435 kilohertz and 485 kilohertz. The RF energy is received by the tissue immediately near the electrodes for a period of time less than ten minutes. The duration of time and frequency of energy are responsive to judgments of medical personnel. 
     In a step  1111 , one end of a piece of biologically nonreactive double-lumen tubing is attached to female coupling  134 ; the other end of the tubing is attached to a pump which is submerged in a bath of saline or other flowable substance that is maintained at a constant temperature. The saline or flowable substance is drawn through the holes in the electrodes  128  and the micropores of the balloon  120 , as needed, to lower the temperature of the region and prevent collateral thermal damage. Double lumen tubing permits constant circulation of the flowable substance throughout the bladder and balloon  120 . The nature, temperature and amount of flowable substance are responsive to judgments by medical or veterinary personnel. 
     In a step  1112 , all or most of the flowable liquid that has been circulating through the electrodes  128  and micropores of the balloon is siphoned off by the application of negative force to female coupling  134 . 
     In a step  1113 , the inflatable, microporous balloon  120  is deflated by application of negative pressure on the syringe connected to female coupling  133 . 
     In a step  1114 , the catheter  110  is removed from the aorta and the incision in the aorta is repaired. 
     In a step  1115 , the catheter  110  is withdrawn from the incision where it was initially introduced into the body. 
     In a step  1116 , the initial incision in the wall of the chest or abdomen is repaired. 
     Alternative Embodiments 
     Although preferred embodiments are disclosed herein, many variations are possible which remain within the concept, scope and spirit of the invention, and these variations would become clear to those skilled in the art after perusal of this application.