title: Transvesical Suprapubic Externalization of Ureteral Stents - Introduction of a Surgical Innovation at the Development Stage.
abstract: OBJECTIVE
  In this study, we describe our first experiences with the new method of transvesical suprapubic externalization of ureteral stents. This method is assessed in patients with incurable ureteral obstruction and concomitant bladder dysfunction, and is classified according to the Idea, Development, Exploration, Assessment, Long-Term Study (IDEAL) recommendations.
  
  
  METHODS
  From 2009 to 2015, transvesical suprapubic externalization of ureteral stents was applied in 14 (8 males, 6 females) patients with incurable ureteral obstruction of malignant (n = 9, 64%) or benign (n = 5; 36%) etiology. All the patients had concomitant bladder pathologies that impaired quality of life (QoL). Classification according to IDEAL followed the respective recommendations.
  
  
  RESULTS
  Only minor complications, except 1 major complication not directly related to the procedure, were observed. QoL improvement was reported in all patients. The duration for this surgery was 45 (17-86) min; however, it varied between genders (female 37 min, male 51 min). The mean follow-up period was 26.6 months ranging from 12 to 73 months. Transvesical suprapubic externalization of ureteral stents resulted in a stable renal function and the elimination of urinary leakage via a compromised bladder in all patients.
  
  
  CONCLUSIONS
  Transvesical externalization of ureteral stents is a feasible method for urinary diversion, which seems to improve patients' QoL in appropriate indications. The method can be classified as IDEAL stage 2a.
authors.affiliation: Department of Urology, Lukas Hospital, Neuss, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Gerullis
authors.forename: Klaus
authors.initials: K
authors.lastname: Schwartmann
authors.forename: Thorsten H
authors.initials: TH
authors.lastname: Ecke
authors.forename: Evangelos
authors.initials: E
authors.lastname: Georgas
authors.forename: Philip
authors.initials: P
authors.lastname: Herberg
authors.forename: Alexander
authors.initials: A
authors.lastname: Winter
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Wawroschek
authors.forename: Dimitri
authors.initials: D
authors.lastname: Barski
authors.forename: Thomas
authors.initials: T
authors.lastname: Otto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001743:Urinary Bladder / Q000503:physiopathology*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*
keywords: IDEAL; Idea, Development, Exploration, Assessment, Long-Term Study; Surgical innovation; Ureteral stent; Urinary diversion