Direct Vision Internal Urethrotomy

Definition

Direct vision internal urethrotomy (DVIU) is surgery to repair a narrowed section of the urethra. This is referred to as a stricture. The urethra is the tube that carries urine from the bladder to the outside of the body.

Reasons for Procedure

Urethral stricture is due to scarring of the urethra. This scarring may be caused by infection or injury. DVIU cuts through the scar tissue and opens the urethra.

Urethral stricture can result in:

• Prostate problems in men
• Bladder and kidney infections
• Inability to urinate or empty the bladder completely.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

• Reaction to anesthesia
• Excessive bleeding
• Blood clots
• Infection
• Pain when urinating
• Damage to urethra
• Recurrent stricture
• Need for more procedures
• Penile pain
• Erectile dysfunction

Factors that may increase the risk of complications include:

• Bleeding disorders or taking medications that reduce blood clotting
• Obesity
• Smoking

Discuss these risks with your doctor before the procedure.

What to Expect

Prior to Procedure
Your doctor may do the following:

• Conduct a physical exam and ask about your medical history
• Order imaging, blood, and urine tests
• Talk about the anesthesia being used and its potential risks

Talk to your doctor about your medications. You may be asked to stop taking some medications up to 10 days before the procedure.
In the days leading up to the procedure:

• Take a shower before the procedure as directed.
• Arrange for a ride home from the hospital.
• Do not take anything by mouth starting 8 hours before your procedure. Ask the doctor how you should take your regular medications on the morning of your procedure.

Anesthesia

General or spinal anesthesia will be used. It will block any pain and keep you asleep or sedated through the surgery.

Description of the Procedure

After you are under anesthesia, a special tube called a cystoscope will be placed in your urethra to locate the stricture. Next, a special tool will be placed through the cystoscope and used to cut away the scar tissue inside your urethra to make it wider. The scar tissue may be removed by cutting or using a laser or heat source. After the tissue is removed, the urethra and bladder area will be examined.

A catheter will be placed once the surgery is complete. A catheter is a plastic tube placed through the urethra into the bladder.

How Long Will It Take?

About 30 minutes

How Much Will It Hurt?

Anesthesia prevents pain during surgery.

Average Hospital Stay

You will be able to go home the next day morning in most cases.

Post-procedure Care

At the hospital,

During recovery immediately after surgery your vital signs will be monitored. Pain medication will be delivered as needed. The catheter will be checked to make sure urine is passing as expected.

You will be encouraged to move around and have some food before leaving.

At Home

A catheter will be left in place for 3 to 5 days once you leave the hospital. The catheter will help urine pass and keep the urethra open while it heals. You will need to visit the hospital after 3 to 5 days in morning for catheter removal.

After 5 days Self Clean intermittent catheterisation (SCIC) will be taught to you in OPD. This is to prevent recurrence of stricture urethra.