Ureteral injury during surgery is one of the most common complications. Since 2012, a fully sheathed stent has been used in our clinic for partial ureteral lesions (n=84). This stent seals the ureter and allows the wound area to be lent out with a healing rate of 90.5% without subsequent surgery. The stent is inserted minimally invasively using a cystoscope or ureterorenoscope under radiological control using the seldinger technique. It had to be clarified whether complete ureteral cuts with a missing ureter section could also be bridged and whether subsequent interventions would be necessary or whether the prerequisites for secondary treatment would be improved.

7 patients with severed divided ureter were treated from 05/2016 - 12/2018 with fully sheathed stents (ureter stent 120x10mm, 200x9mm, Allium). Insertion was performed 6x retrograde, 1x antegrade under radiological control. In order to restore ureteral continuity by stent, a rendevous maneuver took place in 2 cases. In 5 cases the severed ureter could be found by means of ureterorenoscopes. after insertion of a terumo wire the sealing stent could be inserted in seldinger technique. The position, continuity and sealing of the stent in the ureter were documented by radiological contrast imaging. In 3 cases an additional typical ureter stent were inserted in the sealing stent - stent-in-stent technique - was used to guarantee good urine drainage. Mean surgery time was 36min (21-57min). The average distance to be bridged was 1.6cm (1.1-4.8cm). The average inpatient stay was 2 days. The stent was removed after 4 months.

Stent removal was carried out without any problems using URS and grasping forceps. No leakages, discontinuities or scarred strictures were detected by retrograde imaging and URS. In two cases, the sealed, bridged ureter was also supplied during subsequent interventions (ovarian cancer recurrence, vascular bypass). In these cases, bridging was shown to be a sufficiency. Follow-up examinations took place after 2, 4 and 12 weeks. Ultrasound was used to check the kidney and stent position. In addition, wound healing could be checked by elastography and power-mode sonography. Infection or incrustation of the stent was not detected during this period.  Patient satisfaction is very high due to the good stent tolerability.

By bridging the ureter it is possible to establish a continuity of the urine flow. A abdominal, robotic or laparoscopy for end-to-end anastomosis, neoimplantation or ileum interposition is therefore not necessary. Classical drains such as dj or nephrostomy do not always lead to complete draining. The minimally invasive bridging stent placement represents a new therapy option. If no irradiated or pre-operated tissue is present, the ureter can heal without further therapy. The simple insertion of the stent is advantageous. The nitinol coating prevents ingrowth, improves wound healing and makes it easy to remove the stent. An incrustation is also greatly reduced by the nitinol. Elastographically, it could be shown that scarring is prevented. This reduces or prevents subsequent stricture formation. Due to the skeletal structure of the stent, the ureter is dilated with low radial force without damaging itself. Removal is easy using a ureterorenoscope and grasping forceps.
Based on the shown results, it seems reasonable to prefer a primary bridging splinting of the ureter to a more invasive approach. Bridging splinting of the ureter in radiogen or iatrogen-damaged ureter is another new good therapy option. in both cases, only long-term studies will confirm the results.

Ureteral bridging for primary care or for temporary continuity and / or draining appears possible by means of fully sheathed stentes. Due to the nitinol coating and the sealing function of the stent, wound healing was significantly improved and complete healing was achieved without strictures and subsequent interventions. Long-term studies follow.