Ureteric bridging with a fully coated stent - a new therapy option for severed ureter

Introduction: Ureteral injury is one of the most serious complications of gynecologic and colorectal surgeries. It is often associated with significant morbidity. Since 2012, we investigated in our clinic a new technique for ureter reconstruction- use of the Allium Ureteric Stent (URS) a metal self-expanding stent which is made of nitinol and covered with a biocompatible, biostable Elast-Eon polymer to make it a nonpermeable tube. These properties contribute for a healing process of the ureter lesion without any subsequent treatment. The stent is inserted minimally invasively using a cystoscope or ureterorenoscope under radiological control using the Seldinger technique. Before using a stent of cours, it has to be diagnosed whether there is a complete missing ureter part which has to be fully bridged and whether a subsequent treatment is necessary Materials and Methods: - Retrospective study. - 11 patients with ureter injury were treated during 05/2016 - 01/2020 use of Allium Ureter Stent (120x10mm, 200x9mm). Insertion was performed 11x retrograde, 4x antegrade under radiological control - 4 had a severed ureter - A “rendezvous maneuver” had to be done. - 11 cases- ureterorenoscopes was used in order to connect the severed ureter. - Mean surgery time was 36min (21-57min). - Average bridging distance was 1.8cm (1.1-6.2cm). - Average inpatient stay was 2 days. - Follow-up after 2, 4 and 12 weeks - The stent was removed after 4 months. Results: - healing rate of 90.5% - There were no complications using URS and grasping forceps. - No leakages, discontinuities or scarred strictures were detected. - Infection or incrustation of the stent was not detected during stent insertion nor during follow up period. - Patient satisfaction was very high. Conclusion: Using a fully coated polymeric stent is a good option for treating a damaged ureter. Due to the stent properties wound healing was significantly improved and complete healing was achieved without strictures and subsequent interventions in 90.5%. Long-term studies has to be done.