WO2015181403A1 - Apparatus for anastomosis - Google Patents

Abstract

The invention relates to a system for directly connecting the bladder (5) to the urethra (4), comprising: a first device (3) with rods (33); a second device (6) with rods (63); a first tube (1) designed for the devices so that said devices can be inserted into the urethra (4) until they reach the bladder or the end of the urethra, respectively; and at least one second tube (2; 82A, 82B) which can slide along the first tube. The rods are straight. The system comprises activation means, by means of which, in response to manipulation when the system is in use, a fluid is injected along at least the one second tube, applying a pressure that causes a mobile part (31, 61) of the devices (3, 6) to move, forcing the rods to move along channels (36, 66) until they attach to the inner wall of the bladder or urethra, attaching the first device (3) to the bladder (5) or the second device to the urethra. During the use of the system, and once the two devices have been attached to the bladder (5) and the urethra (4), they are secured to one another, connecting the bladder to the urethra. The invention also relates to a method for connecting a bladder to a urethra.

Description

 DESCRIPTION

ANASTOMOSIS DEVICE AND METHOD Field of technique

The present invention relates to the field of medical devices and, more particularly, to medical devices and methods for joining two hollow body parts or body cavities.

State of the art

Serious diseases that affect the prosthetic gland often lead to a radical prostatectomy, that is, a surgical operation in which the prosthetic gland is removed. In these circumstances, the surgeon must connect the two parts of the body that were previously indirectly connected to each other through the prosthetic gland. These two parts of the body are the urethra and the patient's bladder. Nowadays this is done by hand sewing the two parts. This surgical operation involves a hard and uncomfortable convalescence and often leads to complications that may even require an additional surgical operation. When such a suture is not completely sealed, a frequent complication is the leakage of urine (stored in the bladder) to the abdomen instead of flowing completely from the bladder to the urethra.

In order to facilitate the surgeon the task of connecting the urethra with the bladder, some devices and methods have been developed. For example, US Patent US8002780B2 describes a method of performing a vesicourethral anastomosis. This method does not avoid the need to suture by hand, and therefore the risks associated with the stitches are not exceeded. Patent application US201 1 / 0306994A1 describes an anastomosis device having a cylindrical support housing of decreasing cross section formed by elastic fingers, each of which holds a suture needle. Like the disclosure of document US8002780B2, it also does not overcome the risks associated with stitches and sutures.

Patent application US2010 / 0082049A1 describes a device and method for performing an anastomosis surgical intervention. The device is mechanically complex and has long sharp and curved hooks configured to engage with the bladder or urethra and, when deployed, they perforate the bladder wall or urethra respectively.

Patent application US2012 / 0245606A1 discloses an instrument for reconnecting a urethra and a bladder. This instrument is based on a two-part coupling assembly that is inserted into the abdomen through the urethra by means of two elongated coaxial members. The two-part coupling assembly consists of an upper ring assembly and a lower ring assembly, each formed in turn by two parts: the upper ring assembly has an upper central ring and an upper ring, while the lower ring assembly has a lower center ring and a lower ring. The two-part coupling assembly works as follows: Once the two parts that form the upper ring assembly are inserted through the urethra, the upper central ring is mounted on the upper ring and these two parts are engaged by the extension of several hooks of the upper central ring to guide structures of the upper ring. When fully deployed, the hooks extend radially outwardly from the upper ring and engage with the bladder wall, as illustrated in Figures 97 and 99B of US2012 / 0245606A1. In turn, once the two parts that form the lower ring assembly are also inserted through the urethra, the lower central ring is mounted on the lower ring and the two parts are also hooked by inserting curved hooks and stabs of the lower central ring on deployment surfaces in the lower ring. When fully deployed, the hooks extend radially outwardly from the lower ring and engage with the wall of the urethra, as illustrated in Figures 98 and 99B of US2012 / 0245606A1. Finally, the upper ring assembly and the lower ring assembly retract towards each other until the respective interconnecting elements engage with each other, thereby joining the bladder and urethra.

However, this instrument has some drawbacks. The upper ring assembly consists of two parts that need to be coupled with each other. For this reason, the hooks of the upper central ring not only serve as a hook with the bladder wall, but also as a hook with the upper ring to form the upper ring assembly. As a consequence, these hooks need to be sharp, long and robust enough to support both the bladder wall and the upper center ring of the upper ring assembly. Similarly, the hooks of the lower central ring not only serve as a hook with the wall of the urethra, but also as a hook with the lower ring to form the lower ring assembly. As a consequence, these hooks need to be long, curved and sharp enough to hold both the urethra wall and the ring lower center of the lower ring assembly. Consequently, when deployed, the protruding hooks easily pierce the wall of the bladder and urethra, resulting in pain, infection and damage in general to the respective organ. The above proposals require complex mechanisms, which have many miniature parts connected by means of joints or other connection means, which can be easily broken due to their inherent hard handling. As a result, the manufacture of these devices becomes very expensive. What's more, the above proposals require sharp and curved hooks that pierce the walls of the urethra and bladder. Subsequent perforations lead to bleeding into the abdominal cavity. Furthermore, in the aforementioned disclosures it is necessary that the hooked device remains inside the patient's body for several weeks. This implies the risk of damaging by perforation any other organ, vessel, etc. of the patient if, for example, the patient does not remain completely at rest.

Last but not least, none of the proposals provide any clue as to how to remove the device from the patient once it is assumed that the urethra and bladder are completely connected. Only document US2012 / 0245606A1 suggests the use of a resorbable material, in such a way that the removal of the device is not required. However, this solution involves keeping the device inside the patient's body for approximately twelve weeks. Such a long time prolongs the risk of pain, infection and unforeseen difficulties. In summary, there is a need for an improved device to reconnect the urethra with the bladder, which overcomes the disadvantages of prior art assemblies.

Description of the invention An object of the present invention is the provision of a system and method for directly connecting a bladder with a urethra, in which there is no need to suture by hand (eg, sewing).

In accordance with one aspect of the present invention, a system (or instrument, assembly or device) for connecting a urethra with a bladder is provided. The system for directly connecting a bladder with a urethra comprises: a first device that it comprises a first plurality of rods; a second device comprising a second plurality of rods; a first tube configured to mount on one of its ends the first device or the second device, the first tube being configured to be introduced into the urethra until the end that the first device has mounted on it reaches the bladder neck or until that the end of the second device mounted thereon reaches the distal end of the urethra; at least a second tube of smaller diameter than the diameter of the first tube, the at least one second tube being able to slide along the first tube. The first plurality of rods and the second plurality of rods are straight, the system further comprising activation means located in the at least one second tube, these activation means being configured for, in response to its manipulation when the system is being used , injecting a fluid along the at least one second tube, thereby applying a pressure that causes the displacement of a moving part of the first device or second device, thereby forcing the first plurality of rods or second plurality of rods respectively, it moves along corresponding channels of the device, until the rods engage with the internal wall of the bladder or the corresponding urethra, thereby respectively engaging the first device with the bladder or the second device with the urethra. The first device and the second devices are configured to, during the use of the system, and once these are respectively engaged with the bladder and urethra, be fixed with each other, thereby connecting the bladder with the urethra.

Preferably, the first device comprises a first bushing and a second bushing, where the first carries the first plurality of rods and the second has the channels along which the rods are designed to move. The channels are curved outward to allow straight rods to bend until they engage with the inner wall of the bladder.

Preferably, the second device comprises a first bushing and a second bushing, where the first carries the first plurality of rods and the second has the channels along which the rods are designed to move. The channels are curved outward to allow straight rods to bend until they engage with the inner wall of the urethra.

Preferably, the first device further comprises a third part configured to connect the first device with the outer tube before its insertion into the urethra and to connect the first device with the second device once both They are inserted in the patient.

Preferably, the second device further comprises a third part configured to prevent the first socket from moving beyond a maximum and to connect the second device with the first device once both are inserted into the patient.

In a possible embodiment, there is a single second tube and the activation means located in the second tube comprise a grooved part and a conduit. The grooved part is configured to, after receiving a certain pressure received from said conduit, press a corresponding part of the first device or second device, as a consequence of which the plurality of rods moves along the corresponding channels . In an alternative embodiment, the system comprises two second concentric tubes, where one of them is connected to the first device and the other tube is connected to the second device. The activation means comprise a first and second holes located in the tube that is connected to the second device and a third and fourth holes located in the tube that is connected to the first device. The first and second holes are configured to actuate / release the rods that engage the urethra along a respective channel and the third and fourth holes are configured to actuate / release the rods that engage the bladder along a respective channel Rod drive / release occurs as a result of the pressure exerted by a fluid. In a possible embodiment, the system further comprises an endoscope configured to insert said first and second devices through a urethra and / or to extract said devices through a urethra.

In another possible embodiment, the use of the system described above is provided in a surgical treatment.

In another possible embodiment, a system is provided for use in a surgical method comprising attaching a bladder to a urethra. In another possible embodiment, a system is provided for use in a surgical method comprising attaching the bladder to the urethra. The system comprises a first plurality of rods; a second device comprising a second plurality of rods; a first tube configured to mount on one of its ends the first device or the second device, the first tube being configured to be introduced into the urethra until the end that the first device has mounted on it reaches the bladder neck or until that the end of the second device mounted thereon reaches the distal end of the urethra; a second tube of smaller diameter than the diameter of the first tube, the second tube being able to slide along the first tube until the second tube is aligned with the first respective device or second device. The first plurality of rods and the second plurality of rods are straight, the system also comprising activation means located in the second tube, these activation means being configured to, in response to handling when the system is being used, inject a fluid along the second tube, thereby applying a pressure that causes the displacement of a moving part of the first device or second device, thereby forcing the first plurality of rods or respective second plurality of rods to move along corresponding channels of the device, until the rods engage with the internal wall of the bladder or the corresponding urethra, thereby respectively engaging the first device with the bladder or the second device with the urethra. The first device and the second devices are configured to, during the use of the system, and once these are respectively engaged with the bladder and urethra, be fixed with each other, thereby connecting the bladder with the urethra.

In another possible embodiment, a method of directly connecting a bladder with a urethra is provided. The method comprises the steps of: fixing a first device to one end of a first tube, where the first device comprises a first plurality of straight rods; insert a second tube inside the first tube; insert the first tube, which has the first device attached to it, and the second tube, into a urethra until they reach the neck of a bladder; activate the second tube until the first plurality of rods hooks with the bladder wall; separate the first tube from the bladder and remove it from the urethra; fixing a second device to the end of the first tube, where the second device comprises a second plurality of straight rods; insert the first tube into the urethra until it reaches the distal end of the urethra; activate the second tube until the second plurality of rods hooks with the wall of the urethra; connect the first device with the other one, thus directly connecting the bladder and urethra; decouple the first tube from the second device and remove the first tube and the second tube from the urethra, thereby leaving the assembly formed by the first device coupled with the second device inside the patient's abdominal cavity. Alternatively, the Devices can be inserted along the urethra instead by means of that second tube, by means of two concentric tubes that are connected, respectively, jointly, with the first and second devices. This double concentric tube system also serves to activate the rods by means of four non-return valves (two for the urethra rods and two for the bladder) that act as a hydraulic cylinder. In this case, the double concentric tube remains inside the patient until the surgeon decides to remove the assembly formed by the two devices. This extraction is very simple, as it does not need the insertion of the first tube, but is done by manipulating the non-return valves (fluid insertion).

Preferably, the method further comprises the steps of: after the assembly formed by the connected devices has been kept inside the patient for some time, introducing through the urethra the first tube and the second tube inside the first tube until they reach the set; couple the tubes with the assembly; pull the two tubes until the assembly leaves the urethra. Alternatively, in the case where the concentric double tube system has been used, the extraction is performed as explained, without the need to use the tube first.

In a possible embodiment, an endoscope is used for insertion. It can also be used for extraction, in which case the first tube is inserted through the endoscope, but not the second tube, which is not used.

The system and method outweigh the risks associated with the points. In particular, perforation and damage of the urethra, bladder and other organs or vessels of the patient is avoided.

Additional advantages and features of the invention will be apparent from the following detailed description and will be pointed out in particular in the appended claims.

Brief description of the drawings

To complete the description and in order to provide a better understanding of the invention, a set of drawings is provided. Such drawings form an integral part of the description and illustrate an embodiment of the invention, which should not be construed as restricting the scope of the invention, but only as an example of how the invention can be carried out. The drawings comprise the following figures: Figure 1A shows a part of a system for connecting a urethra with a bladder according to an embodiment of the present invention. In particular, a first part of the system is being introduced into a bladder. Figure 1 B shows how a first part of the system engages with the patient's bladder. Figure 1C shows how a second part of the system is introduced into the patient's urethra. Figure 1D shows how a first part and a second part of the system are connecting with each other. Figure 1 E shows a phase or stage in which the two tubes have been reintroduced into the urethra in order to finally remove the patient's system.

 Figure 2A shows the first outer tube or tube, according to a possible embodiment of the invention. Figures 2B and 2C show different views of the second tube or inner tube, according to a possible embodiment of the invention.

 Figure 3A shows a possible embodiment of the outer tube and the device for engaging with the bladder. Figure 3B shows a view of the bottom bushing of the device of Figure 3A. Figures 3C-3F show how the lower bushing is activated and how the rods engage with the bladder.

 Figures 4A, 4B and 4C show the shape adopted by the rods of the device of Figures 3A-3F according to a possible embodiment of the invention.

 Figure 5A shows a view of the outer surface of the device of Figure 3A. Figure 5B shows the lower bushing of the device of Figure 3A.

Figure 6A shows a possible embodiment of the outer tube and the device for engaging with the urethra. Figure 6B shows a view of the bottom bushing of the device of Figure 6A. Figures 6C, 6D, 6E and 6F show how the lower bushing is activated and how the rods engage with the urethra. Figure 6G shows the assembly formed by the two connected devices, the first tube and the second tube. Figure 6H shows the assembly formed by the two connected devices once the tubes have been removed from the urethra. Figure 61 shows how the inner tube is placed next to the assembly in order to remove the assembly from the patient's body. Figure 6J shows how the rods of the second device (the rods hooked with the urethra) leave the channels and become straight. Figure 6K shows how the inner tube is pushed distally. Figure 6L shows how the inner tube is located near the first device (device engaged with the bladder), in particular the first socket of the first device. Figure 6M shows how the inner tube is pulled back, causing the rods to become straight. Figures 6N and 60 show how the set is extracted along the penis.

 Figures 7A to 7C illustrate an alternative way to remove the device, using an endoscope.

Figures 8A to 8E illustrate an alternative system for insertion and removal of the device for connecting a urethra with a bladder, in accordance with another embodiment of the present invention.

Description of a way of carrying out the invention

Next, an instrument or assembly for connecting a urethra with a bladder for male patients to whom the prosthetic gland has been removed is described, as a result of which there is a gap or cavity between the urethra and the bladder. The bladder (in which urine is stored) needs to be connected to the urethra (which in turn conducts urine to the penis). The urethral anastomosis system is described as follows.

In the context of the present invention, the terms "proximal" and "distal" refer, respectively, to the senses closer to and further from the manipulator (ie, the surgeon) of the anastomosis system. In other words, the distal portion of the system is inserted as far as possible into a patient and the proximal portion of the system, when inserted into a patient, remains closer to the manipulator. Sometimes, the distal portion of the system remains at least partly outside the patient.

In the context of the present invention, the term "lower" is used to refer to a portion of the system that is located proximally with respect to another portion of the system. And the term "superior" is used to refer to a portion of the system that is located distally with respect to another portion of the system.

Figures 2A to 61 show possible embodiments and possible implementations of the parts that form the system for connecting a urethra with a bladder. Figures 1 A to 1 E represent different phases or stages of using the system to connect a urethra with a bladder.

In Fig. 1 A, a first outer tube or tube 1 is illustrated, which serves as a support and guide for the anastomosis device or assembly. Figure 2A shows the first outer tube or tube 1. A second tube or inner tube 2, whose diameter is smaller than the diameter of the first tube 1, is also shown in FIG. Figures 2B and 2C show different views of the second tube or inner tube 2. The second tube 2 serves as a guide for the anastomosis device or assembly and as an activator for the parts of the system that enable the function of connecting the assembly (the connection of the bladder with the urethra). In addition, this second tube 2 is the one that allows urine to escape from the bladder when the prosthetic gland has removed and the direct connection between the bladder and the urethra has not yet healed completely (that is, during the use of the anastomosis system). The second tube 2 is inserted longitudinally into the first tube 1. The first tube 1, which supports the second tube 2 inside, is inserted into the urethra 4 until the distal end of the tubes 1 2 reaches the bladder 5. The tubes 1 2 are made of any biocompatible material. In a preferred embodiment, the outer tube or first tube 1 is made of a polymer. In a preferred embodiment, the inner tube or second tube 2 is made of a polymer, except its front part, which is made of silicone. Before the introduction of the first tube (outer tube) 1 into the patient's urethra, a device 3 is arranged or fixed at its distal end. The device 3 can be fixed with the outer tube 1 because both are properly designed. as for its shape and size: As shown for example in Figure 5A, the outer surface of the device 3 has two parts 37 38 of different diameter and protrusions 39 on the part having a smaller diameter 37. This allows the coupling with the outer tube 1, whose inner wall has a pattern such that the different diameters of the device 3 fit together. This pattern can be seen in Figure 2A. The coupling is achieved by turning the tube 1 clockwise with respect to the device 3. The coupling means are conventional. This is preferably a coupling of the type called bayonet coupling.

FIGS. 3A-3F show a possible embodiment of the device 3. In a preferred embodiment, the device 3 comprises two corresponding pieces or bushings 31 32: a first piece or first sleeve or bottom piece or bottom sleeve 31 and a second piece or second sleeve or upper part or upper bushing 32. The device 3 also comprises a plurality of rods 33 which are held in the first piece or first bushing or lower workpiece or lower bushing 31. When the rods 33 are in a relaxed and natural state, that is, before use to engage with the bladder, the rods 33 are straight. Figure 4A shows a possible embodiment of a rod 33 in its original (straight) state. As will be explained later, the straight rods are forced to bend when the device 3 is activated. Figure 4B shows the rod of Figure 4A when the device is being used, that is, when the rod 33 has partially curved . Figure 4C shows the rod of Figures 4A and 4B, when it has been fully curved for engagement with the patient's bladder. The rods are preferably of a unitary construction, that is, each rod is formed by a single element having a straight portion. Preferably, the rods have a circular section. These are made of a biocompatible material, preferably of technical plastic or stainless steel. In a preferred embodiment, there are six rods, but the number of rods may vary. For example, in other embodiments there may be four, eight or a different number of rods.

Returning to Figure 3A, a view of the device 3 is shown, which represents the device 3 before its introduction into the patient's urethra. The lower bushing 31 is coupled with the upper bushing 32. The rods 33 are completely straight (which is their natural position) and their free ends are located at the beginning of corresponding channels or tracks 36 in the inner part of the upper bushing 32 Figure 3B shows the lower bushing 31 coupled with the upper bushing 32 outside the patient. The device 3 also comprises a third piece 35, which is a block or stop to prevent the lower bushing 31 from moving backwards. This third piece 35 is the part of the device 3 which, once it has been inserted inside the patient, is connected to a corresponding part of the device fixed with the urethra, as will be explained later. The third piece 35 is also used to connect the device 3 with the outer tube 1 before its insertion into the urethra, as shown in Figure 3A.

Once the surgeon has removed the patient's prosthetic gland, the first outer tube or tube 1 carrying the second inner tube or tube 2 is inserted into the urethra 4. The outer tube 1 in turn has the device 3 fixed in its distal end This assembly formed by the device 3, the outer tube 1 and the inner tube 2 is illustrated in Figure 3C. When the assembly reaches the bladder neck 5, the surgeon places this appropriately manually (the surgeon still has surgical access to the abdomen). The surgeon knows when the inner tube 2 has been pushed to its correct position for example by marking a signal on the part that remains outside the patient. When the inner tube 2 has reached its correct position, this means that, consequently, also the outer tube 1 has been positioned correctly. The markings on the inner tube 2 indicate to the surgeon the locations in which the tube 2 is to be coupled or placed in the different phases or stages of the introduction, the establishment and removal of this first device 3 and a second device 6, That has not been explained yet.

Once the device 3 has been properly placed, the surgeon activates the second inner tube or tube 2 until the bush 31 pushes, in turn, the rods 33 until they are inserted into the wall of the bladder 5. The activation is illustrated in Figures 3D and 3E and works as follows: when a pump located at the proximal end of the tube 2 is pressed, a fluid is injected along the tube 2 and, when this fluid reaches the distal end of the tube 2, a grooved part 25 of tube 2 is filled with this fluid to a certain Pressure. The ribbed portion 25 is preferably made of silicone. In a preferred embodiment, the pressure value is chosen from values within the range of 0.2 to 1 bar and, more preferably, 0.5 to 1 bar. In a preferred embodiment, the fluid is a serum. Alternatively, this may be air. In a preferred embodiment, the pump (not shown) is activated manually. The pump is a conventional pump that is designed, for example, to inject serum into a patient. The pressure causes an increase in the diameter or volume of this corrugated part 25.

Figure 2B shows a view of the inner tube 2. The rear (proximal part) of the inner tube 2 can be removed and comprises two different arms or ducts 26 27. A first inlet or duct 27 allows urine to flow out of the bladder. A second inlet or conduit 26 allows a fluid (in a preferred embodiment, serum) to enter the patient's abdomen cavity. Figure 2B also illustrates a conduit 28 that connects the second inlet 26 with the inflation area (the grooved part 25) (which is not illustrated in Figure 2B). In the second inlet or conduit 26 there is a non-return valve (not illustrated) configured to prevent the fluid from leaving the tube 2 instead of moving along the urethra into the patient's cavity. By pressing the non-return valve inwards, the pressure in the circuit is reduced to substantially 0 bar (from the applied pressure of 0.2 - 1 bar).

Figure 2C shows a view of the distal end of tube 2. On the right, the proximal end of the first tube 1 can be seen. This is the end of the tube 1 through which the tube 2 is introduced. The conduit 28 for transporting the fluid is also shown. It can be seen that the tube 2 is made of two parts, a solid part 29 and a transparent part 24, which are joined during the manufacture of the tube 2. The tube 2 is a conventional one and is outside the scope of the present invention.

The inner tube 2 is then pushed inwards (towards the bladder) through the outer tube 1 until a mark on it indicates that it has reached its correct position. Once it has been inflated with pressure, the grooved part (or "inflated" part) 25 adapts to the size and inner shape of the bush 31, which moves inwards. When the lower bushing 31 moves inwards, the rods 33, which until then are located at the beginning of the corresponding channels or tracks 36 in the inner part of the upper bushing 32, are forced to move along said channels or tracks 36. Because these channels 36 are curved, the rods 33 are forced to bend. The lower bushing 31 (comprising / holding the rods 33) is the only part of the device 3 that moves. The others parts 32 35 remain fixed with respect to each other and with the outer tube 1.

Figures 3C and 3D show a detail of the distal end of the tube 2, in which the grooved part 25 can be seen. In Figure 3C no pressure has been inserted (by means of a fluid that travels along the conduit 28) to the grooved part 25. The lower bushing 31 is still in contact with the third part 35. When the pressure reaches a certain value, the grooved part 25 expands and engages with a corresponding part of the bushing 31. Figure 3D shows the inflated or expanded ribbed portion 25. The mobile lower bushing 31 then moves (away from the third piece 35), as a consequence of which the rods 33 are forced to move along the channel or track 36 of the upper bushing 32. As already explained, The bushing 32 comprises a plurality of curved channels or tracks 36 (one per rod) that define the path that each rod has to follow through the inner wall of the bladder. When the inner tube 2 (its grooved part 25) pushes the bushing 31, the rods slide along the respective channels. In this way, the rods, which are originally straight (Figure 4A), become curved or partially curved (Figure 4B) because they follow the path imposed by the channels or tracks 36. In other words, the inner tube 2 activates the coupling means (rods) that are partially inserted into the wall of the bladder 5. Figure 3E shows how the rods 33 continue to slide along the channels 36, until they reach their maximum possible curvature, which is represented in figure 3F. In Fig. 3F the grooved part 25 is fully engaged with a corresponding cavity in the bushing 31 and the inner tube 2 has reached its farthest position with respect to the upper bushing 32. At this time, the rods 33 have totally slid to along its corresponding channels (figure 4C). The distal ends of the rods engage with the inner wall of the bladder (which is also illustrated in Figures 3D-3F). The surgeon manually moves the device 3 in such a way that this engagement takes place.

In this way the rods 33 are introduced into the inner wall of the bladder. In a preferred embodiment, all of the rods 33 are pushed simultaneously. Figure 1 B shows how the rods 33 engage with the inner wall of the bladder 5 without perforating the bladder 5. Therefore, infections and tears of the bladder are avoided. The inner tube 2 and the outer tube 1 are still connected to the device 3. The hole in which the prosthetic gland (between the bladder and the urethra) used to be can also be seen. Figure 5A shows a view of the outer surface of the device 3 in which the rods 33 have been made to slide completely along the channels. The 1 2 pipes and the wall of The bladder is not illustrated. It can be seen how the shape of the device 3 is designed to fit the shape of the outer tube 1 (see for example Figure 2A). In particular, the device 3 has two parts 37 38 of different diameter and projections 39 on the part having a smaller diameter 37. This allows the coupling with the outer tube 1.

Next, the surgeon removes the first outer tube or tube 1 from the device 3 (the droppers 31 32, the rods 33 and the third part 35) that has been located in the bladder neck 5. The surgeon removes the outer tube 1 of the patient along his urethra. This is done as follows: First, the outer tube 1 is rotated manually counterclockwise with respect to the inner tube 2, which remains fixed. Next, the manipulator (for example, the surgeon) pulls the outer tube 1 until it leaves the urethra. The distal end of the second inner tube or tube 2 remains, together with the device 3, fixed with / coupled to the bladder 5, while the proximal end of the second tube 2 remains outside the patient. Therefore, the patient can urinate through the second tube 2 (in particular through the duct 27 in Figure 2B), thus preventing the leakage of urine into the abdominal cavity.

Next, a second device 6 is inserted into the patient's body, as shown in Figure 1 C. The second device 6 is coupled with the distal end of the first tube 1, in a manner similar to how the first device 3 was coupled previously with the outer tube 1, that is, by means of a conventional bayonet type coupling (bayonet coupling). Preferably, the inner tube 2 remains inserted in the urethra and its distal end is connected to the bladder. In order to introduce the first tube 1 and the second device 6 through the urethra, the back (proximal part) of the inner tube 2, formed by the arms 26 27, is disassembled. This second device 6 is similar to the device 3 that has been fixed with the bladder 5. The second device 6 is arranged in, or fixed to, the first outer tube or tube 1 in a similar manner (by means of a type coupling bayonet) to how the device 3 had previously been fixed with the first tube 1. However, the coupling between the tube 1 and the device 6 is made by means of the second bushing 62 (instead of the third piece 35, as in the first device 1).

Figures 6A to 61 show a possible embodiment of the device 6. Preferably, the second device 6 comprises two corresponding bushing 61 62: a first bushing 61 and a second bushing 62. This also comprises or carries a plurality of rods 63. The explanation that it has been given for the device 3 (the rods 33 and the droppers 31 32) configured to fix with the bladder can be applied, mutatis mutandis, to this second device 6 configured to be fixed with the urethra. The second device 6 also comprises a third piece 65, which is a lock or stop to prevent the first bushing 61 from moving beyond a maximum. This third piece 65 is the part of the device 6 which, once it has been inserted and hooked with the patient's urethra, is connected to a corresponding part 35 of the device 3 fixed with the bladder.

Returning to Figure 6A, a view of the device 6 is shown, which represents the device 6 after its coupling with the outer tube 1 and during its introduction into the urethra of the patient 4. The second tube 2 has previously been released from the first device 3 (the device that has been hooked with the bladder). This is done by removing the pressure applied to the grooved part 25. This is achieved by pressing the non-return valve, which causes a reduction in the pressure applied to the grooved part 25. In fact, the pressure, which had a value between 0.2 and 1 bar, is substantially reduced to 0 bars. The inner tube 2 is then removed (pulled out of the urethra) until it reaches a position that coincides with the position of the first socket 61 of the second device 6 inserted into the urethra fixed with the outer tube 1. The first bushing 61 is coupled with the second bushing 62. The rods 63 are completely straight (which is their natural position) and their free ends are located at the beginning of corresponding channels or tracks 66 in the inner part of the second bushing 62 Unlike the first device 3, the coupling between the device 6 and the outer tube 1 is not achieved by means of the third piece 65. On the contrary, this coupling with the outer tube 1 is made by the second bushing 62 , as seen clearly in Figure 6A. This third piece 65 is coupled with the other end of the second sleeve 62, guiding this towards the device 3 fixed with the bladder 5. The surgeon knows when the assembly formed by the outer tube 1, the inner tube 2 and the device 6 has been pushed to its correct position inside the urethra 4 (the upper part of the urethra 4, that is, the part of the urethra that was connected to the prosthetic gland before it had been removed) for example by the mark of a signal on the part that remains outside the patient. When the inner tube 2 has reached its correct position, this means that, consequently, also the outer tube 1 has been positioned correctly.

Once the device 6 has been properly placed, the surgeon activates the second inner tube or tube 2 until the bushing 61, in turn, pushes the rods 63 until they are inserted into the wall of the urethra 4. The activation is illustrated in Figures 6A to 6D and works in a manner similar to that of the activation of the rods 33 in the fixed device 3 with the bladder 5. When a pump located at the proximal end of the tube 2 is pressed, a fluid is injected along the tube 2 (along the conduit 28) and, when this fluid reaches the distal end of the tube 2, the grooved part 25 of the tube 2 is filled with this fluid at a certain pressure. As before, in a preferred embodiment the pressure varies between 0.2 and 1 bar and, more preferably, between 0.5 and 1 bar. In a preferred embodiment, the fluid is a serum. Alternatively, this may be air. In a preferred embodiment, the pump (not shown) is activated manually. The pump is a conventional pump that is designed, for example, to inject serum into a patient. The pressure causes an increase in the diameter or volume of this grooved part 25, which adapts to the size and inner shape of the sleeve 61. When the first bushing 61 moves inwards, the rods 63, which until then are placed at the beginning of the corresponding channels or tracks 66 in the inner part of the second bushing 62, are forced to move along said channels or tracks 66. Because these channels 66 are curved, the rods 63 are forced to bend. The first bushing 61 (which holds the rods 63) is the only part of the device 6 that moves. The other parts 62 65 remain fixed with respect to each other and with the outer tube 1.

Figure 6A shows the rods 63, which are still straight (their natural position). The grooved part 25 has already expanded. The first mobile bushing 61 then moves proximally, as a consequence of which the rods 63 are forced to move along the channel or track 66 of the second bushing 62. As already explained, the bushing 62 comprises a plurality of channels or curved tracks 66 (one per rod) that define the path that each rod has to follow through the inner wall of the urethra. When the inner tube 2 (its grooved part 25) pushes the bushing 61, the rods slide along the respective channels 36. In this way, the rods, which are originally straight (figure 6A), become curved or partially curved (figure 6B) because they follow the path imposed by the channels or tracks 36. It is emphasized that, due to the physical configuration of the second device 6, on this occasion the first bushing 61 carrying the rods 66 recedes, that is, it moves backwards or towards the outside of the urethra (only for a short distance, because the grooved part 25 engages with a corresponding part in the second bushing 62 and the rods 66 penetrate the inner wall of the urethra). Figure 6C shows how the rods 63 continue to slide along the channels 66, until they reach their maximum possible curvature, which is shown in Figure 6D. In Fig. 6D the grooved part 25 is fully engaged with a corresponding cavity in the bushing 61 and the inner tube 2 has reached its farthest position with respect to the third piece 35. At this time, the rods 63 have totally slipped to along its channels corresponding (figure 6D). The distal ends of the rods engage with the inner wall of the urethra. In this way the rods 63 are introduced into the inner wall of the urethra. In a preferred embodiment, all of the rods 63 are pushed simultaneously. Figure 6D shows how the rods 63 engage with the inner wall of the urethra 4 without perforating the urethra 4. Therefore, infections and tears of the urethra are avoided.

The system of the invention is now ready to join the bladder and urethra together by coupling, respectively, of device 3 with device 6. Figure 6E shows the current situation: a first device 3 fixed with the bladder, a second device 6 fixed with the urethra and an inner tube 2 having its grooved part 25 inserted into a groove or opening of the second bushing 32 of the device 3 fixed with the bladder. The opposite end of the inner tube 2 is held in the surgeon's hand. The end of the outer tube 1 that is inserted into the urethra and fixed with the device 6 can also be seen. Its opposite end is also held in the surgeon's hand.

Once the second device 6 engages with the urethra 4 (Figure 6E), the surgeon pushes the first outer tube or tube 1, which still carries the device 6, towards the bladder 5 and simultaneously, with his other hand, Bring the bladder closer to the urethra (until they touch each other) and connect both devices 3 6 (for example, with your left hand hold the outer tube 1 and with your right hand hold the inner tube 2). This is also illustrated in Figure 1 D. The two devices are joined together by a click system 7, as referenced thereto in Figure 1 D. In a preferred embodiment, the third part 65 (which has a female type connection) of the second device 6, is coupled with the third part 35 (which has a male type connection or plug) of the first device 3. As shown in Figure 6F, a slot or opening 67 in the third part 65 (the female connector) prevents the third coupled part 35 (the male plug) from separating from the female coupled part 65. The click system 7 can only be unfastened once the assembly formed by both devices 3 6 has been removed of the urethra. This permanent connection between the device 3 and the device 6 is achieved by coupling the third piece 35 of the device 3 with the third piece 65 of the device 6. In a preferred embodiment, the third piece 35 of the device 3 comprises a male connector ( plug type connector), while the third part 65 of the device 6 comprises a female connector (female type connector). The male connector of the device 3 comprises a flexible clamp. Both the inner tube 2 and the outer tube 1 are still inside the urethra. The inner tube 2 allows the patient to urinate. Figure 6G shows the assembly formed by the connected devices 3 6, the first tube 1 and the second tube 2. Preferably, the assembly is kept inside the patient for several hours, in order to ensure that the urethra and bladder are united permanently. When it is said "inside the patient", it should be understood that only the upper or distal part of the first tube 1 and the upper or distal part of the second tube 2 remain inside the patient, because the proximal portions of these tubes are in any case outside the patient. In a most preferred embodiment, the assembly remains inside the patient for at least 48 hours. Once the assembly has been kept inside the patient for the time prescribed by the surgeon, the surgeon removes the first outer tube or tube 1 from the assembly formed by the device 3 (the droppers and the rods) and the device 6 ( the droppers and the rods), which has been located on the bladder neck 5. This is done as follows: First, the outer tube 1 is rotated manually counterclockwise with with respect to the inner tube 2, which remains fixed. This turn is called bayonet type, bayonet connection or bayonet coupling.

Next, the manipulator (for example, the surgeon) can pull the outer tube 1 until it leaves the urethra. Next, the surgeon or manipulator removes the inner tube 2 from the patient. In fact, the extraction of both tubes 1 2 can be done simultaneously or almost simultaneously. This is done as follows: The pressure is released (removed) from the inner tube or second tube 2, in such a way that the corrugated part of the second tube 2 is deflated. This is preferably done by means of the non-return valve. By pressing the check valve, a reduction of the pressure applied to the grooved part 25 is achieved. In fact, the pressure, which had a value between 0.2 and 1 bar, is substantially reduced to 0 bar. The second tube 2 can then be disengaged from the cap of the device 6. Now that the inner tube 2 has been released from the assembly, the inner tube 2 and the outer tube 1 can be removed simultaneously from the patient's urethra. Alternatively, the outer tube 1 has already been removed from the urethra immediately before.

Preferably, the connected devices 3 6 remain inside the patient a little longer, for example, a few more days, in order to guarantee absolute healing. In a preferred embodiment, the assembly formed by the devices 3 6 remains inside the patient for at least 4 additional days. Figure 6H shows the assembly formed by the connected devices 3 6 once the tubes 1 2 have been removed from the urethra. The patient can urinate without the need for additional tubes or equipment.

Once the set consisting of the connected devices 3 6 (without the tubes 1 2) has been kept inside the patient during the time prescribed by the surgeon, the set must be permanently removed from the patient's bladder - urethra.

In a possible implementation, this is done as follows: The expert (for example, the surgeon) introduces the two tubes simultaneously (the first outer tube or tube 1 and the second tube or inner tube 2) through the urethra until They reach the whole. Preferably the tubes are assembled concentrically from the beginning and are introduced through the urethra already mounted. In Fig. 6H, reference 620 refers to the area in the second bushing 62 with which the outer tube 1 is connected (preferably by means of a bayonet type coupling). The second inner tube or tube 2, which is inside the first tube 1, must reach the first bushing 61 (which holds the rods 63). In other words, the second tube 2 is inserted until its grooved part 25 reaches its corresponding slot or opening 39 in the first device 3 of the assembly. This is generally illustrated in Figure 1 E and in detail in Figure 61.

The surgeon knows when the first and second tubes 1 2 have reached their destination when they observe a mark on the inner tube 2. This means that the grooved part 25 of the inner tube 2 has reached its corresponding part in the first socket 61 (the inflation zone of the bushing 61) of the second device 6. Next, pressure is applied by injecting a fluid through the second inlet 26 of the outer tube 2 (see Figure 2B). Preferably, pressure is applied by injecting serum at a pressure that varies within the range of 0.2 to 1 bar and, more preferably, 0.5 to 1 bar. In Figures 2B and 2C, reference 23 refers to the area of the inner tube 2 for connection with the first bushing 61 of the second device 6. The fluid travels along the conduit 28 connecting the second inlet 26 and the part fluted 25. When the fluid inflates the grooved part 25, the inner tube 2 adapts to the inner diameter of the first bushing 61. Figure 6J shows how the rods 63 leave the channels and become straight (from their previous curved situation, for example in Figure 6H). This is achieved by pushing the inner tube 2 (for example with the right hand of the manipulator) while holding the outer tube 1 with the other hand without substantially varying the position of this outer tube 1.

Next, the surgeon or manipulator removes the pressure by acting on the non-return valve located in the second inlet or conduit 26 of the inner tube 2 (see Figure 2B). Next, the manipulator pushes the inner tube 2, for example, with its right hand - until it reaches the furthest bushing (the first bushing 31 of the first device 3). At the same time, it continues to hold the outer tube 1 with the other hand. This It is illustrated in Figure 6K. The manipulator stops pushing when the grooved part 25 of the inner tube 2 has reached its corresponding part in the first bushing 31 (the inflation zone of the bushing 31) of the first device 3. Preferably, this position is indicated by a mark that the manipulator You can identify. This is shown in Figure 6L.

This then applies pressure by injecting a fluid through the second inlet 26 of the outer tube 2 (see Figure 2B). As before, preferably the pressure is applied by injecting serum at a pressure that varies within the range of 0.2 to 1 bar and, more preferably, 0.5 to 1 bar. Next, the manipulator pulls the inner tube 2 proximally, in such a way that the first bushing 31 of the first device 3 moves backwards. This causes the rods 33, which until then were curved, to slide along the channels and become straight (their original natural position). This is shown in Figure 6M. The outer tube 1 is held and fixed substantially with the other hand.

Finally, the surgeon (manipulator) carefully extracts (pulls out) the assembly, as illustrated in Figures 6N and 60.

The urethra and bladder remain completely free and connected concentrically, thus allowing the usual flow of urine from the bladder to the urethra. It is emphasized that, when the assembly is extracted through the urethra, each rod (both the rods 33 hooked with the bladder and the rods 63 hooked with the urethra) undoes its path along the respective channel or path in the corresponding socket and it becomes straight again (substantially adopting its original form). In other words, each rod 33 63 is forced to move along the channel or path of the movable part of the bushing in the opposite direction (leaving the bladder or urethra).

Thanks to the use of straight rods, the disadvantages of prior art devices are avoided. In particular, perforation and damage of the urethra, bladder and other organs or vessels of the patient is avoided.

An alternative form of extraction of the assembly formed by the connected devices 3 6 is described below, which with respect to the previous extraction form, has the advantage that the surgeon has the opportunity to see the inside of the device to perform the extraction thereof. . This ensures even more reliable extraction. Extraction can be performed with an endoscope, preferably an endoscope specially designed for it. Optionally, the endoscope can have one or several video cameras connected to one or more monitors, in which case a video endoscopy can be performed, so that when the endoscope is introduced through the urethra to the device (set consisting of devices 3 6), the Surgeon sees inside the device. This is done as follows:

The expert (for example, the surgeon) introduces the first outer tube or tube 1 through the urethra until it reaches the assembly. In Fig. 6H, reference 620 refers to the area in the second bushing 62 with which the outer tube 1 is connected (preferably by means of a bayonet type coupling). Next, the endoscope is introduced, preferably a rigid endoscope - until the tip of the same scope, adapting, to the inner diameter of the first socket 61. Figures 7A and 7B show the use of a rigid endoscope 70 to operate the rod holder system. In Fig. 7A the bushing 61 is not expanded, while in Fig. 7B the bushing 61 is expanded. The figures also show a set of optical fibers 71 and a lens 72. In a possible embodiment, the lens 72 has a visual field of about 65 ^e . As can be seen, tube 2 is not inserted (not used).

Figure 7C shows the rear part of the endoscope 70. A vision zone 73 with adjustment system for image sharpness, an input 74 for the light guide beam and an actuation system 75 (actuation of a clamp) is schematized. .

As in relation to figures 6H, 6J and 6K, the rods 63 leave the channels and become straight (from their previous curved situation). Next, the surgeon pushes the endoscope distally - for example, with his right hand - until it reaches the furthest socket (the first socket 31 of the first device 3). At the same time, the person continues to hold the outer tube 1 with the other hand. The manipulator stops pushing when the grooved part 25 of the inner tube 2 has reached its corresponding part in the first socket 31 of the first device 3. Next, the manipulator pulls the endoscope proximally, in such a way that the first socket 31 of the first device 3 moves backwards. This causes the rods 33, which until then were curved, to slide along the channels and become straight (their original natural position). The outer tube 1 is held and fixed substantially with the other hand.

Finally, the surgeon (manipulator) carefully extracts (pulls out) the assembly, firstly removing the endoscope and then tube 1 with the device. The endoscope just described can also be used, and in fact it is recommended, in the following processes: During the operation, to ensure the correct placement of the device, and in the post-intervention reviews, to observe the process of evolution of the junction of the urethra with the bladder in the patient.

Finally, the following describes, in relation to Figures 8A to 8E, an alternative system for insertion, removal and activation of the device 3 6 to connect a urethra with a bladder. It is a concentric double tube system. Before its insertion into the urethra, the device 3, intended to be inserted until it engages in the bladder, is coupled to a tube 82A. Similarly, the device 6, intended to be inserted through the urethra until it is coupled to the end of the urethra, is coupled before insertion into a tube 82B. In Figure 8A both tubes 82A 82B are identified once introduced by the urethra. The devices 3 6 (connected to the respective tubes 82A 82B) can be introduced to their correct position by pushing or pulling them. In a possible embodiment, the outer tube 1 described above can be used for insertion. Alternatively, the devices 3 6 (together with their respective tubes 82A 82B) can be inserted in another way.

The main difference between this embodiment and the previous one is in the form of activation and deactivation of the rods (connection between each device 3 6 and bladder or urethra, respectively). In the case of the device 3, once the device 3 attached to its corresponding tube 82A has reached its correct location (ie, close to the bladder), the rod holder system (rods 33) is activated. This system is activated by introducing a fluid, preferably serum, through a non-return valve at a pressure that preferably varies between 0.2 and 1 bar. The fluid arrives through a conduit of the tube 82A to a hole that communicates with the rod holder system (with the channels, guides or paths 36), so that the fluid advances forward (in a movement similar to a hydraulic cylinder) . Thus, the rods 33 are curved following the guide or path 36, that is, penetrating the bladder, without piercing it. In the case of the device 6, once the device 6 attached to its corresponding tube 82B has reached its correct location (i.e., at the distal end of the urethra), the rod holder system (rods 63) of in the same way as that of device 3. Finally, both devices 3 6 are joined in a similar way as explained in the previous embodiment (figures 1 D, 6F or 6G), thus joining the urethra and the bladder. The rod activation system is explained in detail below.

Next, the operation of the rods is explained by the double tube system this realization As an example, it is explained in relation to the rods that are attached to the urethra, but the principle of operation is the same as that of the rods that are attached to the bladder. Figure 8B shows a diagram of the actuation of the rods that connect the device 6 to the urethra. Figure 8B shows the tube 82B that has been connected to the device 6 outside (before insertion). The pieces or bushing 61 62, the rods 63 attached to the bushing 6 and the third piece 65 are also observed. In the piece 62 the channels or guides 66 are observed. Unlike the tube 2 of the first embodiment, the tube 82B does not have a grooved part that expands or inflates as a result of the pressure exerted by the fluid. In this embodiment, the tube 82B has two orifices or conduits to the channels or guides 66: an orifice 801 to the rear of each channel or guide (the part through which each rod begins to access) and an orifice 802 input to a part of the front half of each channel or guide (the part that approximately begins to bend each rod once it has traveled at least half of the corresponding channel or guide). The first hole 801 serves to drive the rod system forward, hooking it to the urethra (or bladder, if applicable), while the second hole 802 serves to push the rod system backward, retracting them, freeing them from the urethra ( or bladder where appropriate). The principle of operation is that of a double acting hydraulic cylinder or piston. The fluid that accesses the first or second holes is propelled by the surgeon (or user) by operating two non-return valves.

A diagram of the extraction of the assembly formed by the devices 3 6 by means of the concentric double tube system of this embodiment is shown in Figure 8C. As can be seen, the bladder and urethra are already joined and the rods have already been released from the curved canal that guided them at the time to engage the bladder or, where appropriate, urethra. A conduit 86 for the inlet of serum can be seen, as well as four holes 801 802 803 804. The first two 801 802 are those that actuate / release the rods 63 that are attached to the urethra, while the other 803 804 have the same function, but to hook the rods 33 to the bladder. Specifically, the hole 803 is the entrance to the rear of each channel or guide 36 (the part through which each rod 33 begins to access) and the hole 804 is the entrance to an area of the front half of each channel or guide 36 (the part through which each rod 33 approximately begins to bend once it has traveled at least half of the corresponding channel or guide 36). As in the case of Figure 8B, the first hole 803 serves to drive the rod system forward, hooking it to the bladder, while the second hole 802 serves to drive the rod system backwards, retracting them, freeing them from the bladder. Figure 8D shows a section of the outer part (proximal part) of the concentric double tube 82A 82B. Figure 8E shows in three dimensions the proximal part of the double concentric tube 82A 82B. The rear part (proximal part) can be disassembled and comprises a first inlet or conduit 87 allows fluid outflow (eg urine) from the bladder and four inlets or ducts 86 that allow the entry of a fluid (in a preferred embodiment, serum) into the patient's abdomen cavity and also house a non-return valve configured to prevent fluid from leaving the tube instead of moving along the urethra into the patient's cavity. Two of the ducts with their corresponding non-return valves serve to activate the urethral rod system and the other two serve to activate the bladder rod system, as explained above, that is, to allow access through holes 801 802 803 804. By pressing a non-return valve inwards, the pressure in the circuit is reduced to substantially 0 bar (from the applied pressure of 0.2 - 1 bar). The connection 88 is also schematically illustrated between the tubes that go to the urethral and bladder carrier systems.

The surgeon (specialist, in general) performs the check of the joint by irrigating the bladder through the tubes and observing the outflow of fluid through the tube to the outside and without leaking fluid inside the patient. The specialist determines the time that the whole device has to remain inside the patient. The device as a whole is removed as follows: first, the non-return valves are pressed to eliminate the pressure up to 0 bar in the ducts that communicate with the rod holder system (similar to a double acting hydraulic cylinder movement) to Remove the previous serum. Serum can also be introduced through another tube conduit at a pressure of 0.2 to 1 bar through the non-return valve to retract the rod system from the urethra and bladder to their initial positions (movement similar to a hydraulic cylinder of double effect), being the devices with the straight rods. The assembly can then be removed.

 Finally, the specialist carefully removes the two tubes that are attached to the assembly by traction.

This embodiment has the advantage that the removal of the device (assembly 3 6) is greatly facilitated, since it is not necessary to insert anything through the urethra (or endoscope, or tube 1), but simply pull the double concentric tube carefully. This embodiment has, however, the disadvantage that the patient must carry the double concentric tube as long as the device 3 6 is inserted, that is, as long as the specialist consider necessary for the stable union of the bladder with the urethra. In addition, the drain or fluid outlet duct (for example, urine) is of a smaller diameter than the device and system of the first embodiment. In this text, the expression "understand" and its derivations (such as "understanding / understanding", etc.) should not be understood in an exclusive sense, that is, it should not be construed that these expressions exclude the possibility that what is describes and defines may include additional elements, stages, etc. On the other hand, obviously the invention is not limited to the specific embodiment or embodiments described herein, but also encompasses any variation that may be considered by any person skilled in the art (for example, as regards the choice of materials, dimensions, components, configuration, etc.), within the general scope of the invention as defined in the claims.

Claims

one . A system for directly connecting a bladder (5) with a urethra (4), comprising: a first device (3) comprising a first plurality of rods (33); a second device (6) comprising a second plurality of rods (63); a first tube (1) configured to mount on one of its ends said first device (3) or said second device (6), said first tube (1) being configured to be introduced into the urethra (4) until the end having said first device (3) mounted on it reaches the bladder neck (5) or until the end having said second device (6) mounted on it reaches the distal end of the urethra (4); at least a second tube (2; 82A, 82B) of smaller diameter than the diameter of said first tube (1), said at least one second tube (2) being able to slide along said first tube (1); the system being characterized in that said first plurality of rods (33) and said second plurality of rods (63) are straight, the system also comprising activation means (26, 28, 25; 801 802 803 804) located therein minus a second tube (2; 82A, 82B), said activation means being configured to, in response to its manipulation when the system is being used, to inject a fluid along said at least a second tube (2; 82A, 82B), thereby applying a pressure that causes the displacement of a moving part (31, 61) of said first device (3) or second device (6), thereby forcing said first plurality of rods (33) or respective second plurality of rods (63) move along curving along corresponding channels (36, 66) of said device (3, 6), until the rods engage with the inner wall of the bladder (5) or the corresponding urethra (4), engaging respectively in this way the first device (3) with the bladder (5) or the second device (6) with the urethra (4), and wherein said first device (3) and said second device (6) are configured to, during the use of the system, and once these are hooked respectively with the bladder (5) and the urethra (4), fix one with the other, thus connecting the bladder (5) with the urethra (4). 2. The system of claim 1, wherein said first device (3) comprises a first bushing (31) and a second bushing (32), wherein said first bushing (31) carries said first plurality of rods (33) and wherein said second bushing (32) has said channels (36) along which the rods (33) are designed to move, said channels (36) being curved outward to allow the straight rods (33) to bend until that these are hooked with the inner wall of the bladder (5). 3. The system of any one of claims 1 or 2, wherein said second device (6) comprises a first bushing (61) and a second bushing (62), wherein said first bushing (61) carries said first plurality of rods (63) and where said second cap (62) has said channels (66) along which the rods (63) are designed to move, said channels (66) being curved outward to allow the straight rods (63) curl until they engage with the inner wall of the urethra (4). 4. The system of any preceding claim, wherein said first device (3) further comprises a third part (35) configured to connect the first device (3) with the outer tube (1) before insertion into the interior of the urethra and to connect the first device (3) with the second device (6) once both are inserted in the patient. 5. The system of any preceding claim, wherein said second device (6) further comprises a third part (65) configured to prevent the first socket (61) from moving beyond a maximum and to connect said second device ( 6) with the first device (3) once both are inserted in the patient. 6. The system of any preceding claim, comprising a single second tube (2) and wherein said activation means (26, 28, 25) located in said second tube (2) comprise a grooved part (25) and a conduit (28), said grooved part (25) being configured to, after receiving a certain pressure received from said conduit (28), press a corresponding part of said first device (3) or second device (6), as a consequence of which said plurality of rods (33, 63) moves along the corresponding channels (36, 66). 7. The system of any claim from 1 to 5, comprising two second concentric tubes (82A, 82B), wherein one of said tubes (82A) is connected to said first device (3) and the other tube (82B) is connected to said second device (6), wherein said activation means comprise a first and second holes (801, 802) located in the tube (82B) that is connected to the second device (6) and a third and fourth holes ( 803, 804) located in the tube (82A) that is connected to the first device (3), where said first and second holes (801, 802) are configured to actuate / release the rods (63) that are attached to the urethra a along a respective channel (66) and said third and fourth holes (803, 804 are configured to drive / release the rods (33) that engage the bladder along a respective channel (36), wherein said drive / rod release It occurs as a result of the pressure exerted by a fluid. The system of any preceding claim, further comprising an endoscope (70) configured to introduce said first and second devices (3, 6) through a urethra and / or to extract said devices through a urethra. 9. Use of the system of any of the preceding claims, in a surgical treatment. 10. The system according to claim 1 to 8, for use in a surgical method comprising attaching a bladder to a urethra. eleven . A method for directly connecting a bladder (5) with a urethra (4), characterized in that it comprises the steps of: fixing a first device (3) to one end of a first tube (1), wherein said first device (3) comprises a first plurality of straight rods (33); inserting a second tube (2) into said first tube (1); introducing said first tube (1) having said first device (3) fixed thereto and said second tube (2) in a urethra (4) until they reach the neck of a bladder (5); activating said second tube (2) until said first plurality of rods (33) engages with the bladder wall (5); separating said first tube (1) from the bladder (5) and removing it from the urethra (4); fixing a second device (6) to the end of said first tube (1), wherein said second device (6) comprises a second plurality of straight rods (63); inserting said first tube (1) into the urethra (4) until it reaches the distal end of the urethra (4); activating said second tube (2) until said second plurality of rods (63) engages with the wall of the urethra (4); connecting said first device (3) to said second device (6), thereby directly connecting the bladder (5) and the urethra (4); decoupling said first tube (1) from the second device (6) and removing said first tube (1) and said second tube (2) from the urethra (4), thereby leaving the assembly formed by said first device (3) coupled with said second device (6) inside the patient's abdominal cavity. 12. The method of claim 1, further comprising the steps of: after the assembly formed by the connected devices (3, 6) has been kept inside the patient for some time, introducing said first tube (1) through the urethra until it reaches the assembly; inserting said second tube (2) into the first tube (1) already inserted, until it reaches said assembly; coupling said second tube (2) with said assembly; coupling said first tube (1) with said assembly; pull said two tubes (1, 2) until said assembly leaves the urethra. 13. The method of claim 1, further comprising the steps of: after the assembly formed by the connected devices (3, 6) has been kept inside the patient for some time, introduced through the urethra the first tube and the second tube inside the first tube until they reach the assembly; couple the tubes with the assembly; pull the two tubes until the assembly leaves the urethra. 14. The method of claim 1, wherein an endoscope is used for insertion.