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Direct Vision Internal Urethrotomy

(DVIU; Endoscopic Internal Urethrotomy)

Definition

Direct vision internal urethrotomy (DVIU) is a surgery to repair a narrowed section of the urethra. This is referred to as a stricture. The urethra is the tube through which urine passes 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.
Male Urethra
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Urethral stricture can result in:
  • Prostate problems in men
  • Infections of the bladder, ureters, which are tubes that carry urine from the kidneys to bladder, or kidneys
  • 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
  • Penis 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 ten days before the procedure, including:
  • Aspirin or other nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen
  • Blood thinners, such as warfarin
  • Anti-platelets, such as clopidogrel
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 eight 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 asleep, a special tube called a cystoscope will be placed in your urethra to locate the stricture. Next, the doctor will place the DVIU scope into your urethra. A special tool will be used to cut away the scar tissue inside your urethra to make it wider. The doctor may remove the scar tissue by cutting or using a laser or heat source. After the tissue is removed, the doctor will examine the urethra and bladder area.

How Long Will It Take?

About 30 minutes

How Much Will It Hurt?

Anesthesia prevents pain during surgery. Ask your doctor about medication to help with the pain.

Average Hospital Stay

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

Post-procedure Care

At the Care Center
  • You will be monitored while you recover from the anesthesia.
  • The nurses will help you eat and move around again.
  • You will be given pain medication.
  • A catheter will be placed temporarily after the procedure. A catheter is a tube placed through the urethra to the bladder to empty it.
At Home
When you return home, do the following to help ensure a smooth recovery:
  • Take medications as directed for pain. You may feel pain for up to two weeks.
  • Care for your catheter as directed. The catheter may need to remain in place from a few days to two weeks. Your doctor may ask you to insert a catheter a few times a week to keep the scar tissue from closing again.
  • Avoid lifting heavy objects for two weeks.
  • Drink plenty of fluids.
  • Do not drive or have sex until your doctor says it is okay.
  • Ask your doctor when you can return to work. You may be able to go back to work in a few days.
  • Take a shower instead of a bath until the catheter is removed.
  • Follow all your doctor's instructions.

Call Your Doctor

Call your doctor if any of the following occurs:
  • Increasing pressure or pain
  • Catheter does not drain properly
  • Difficulty passing urine after catheter is taken out
  • Changes in frequency or volume of urine
  • Signs of infection, including fever or chills
  • Excess blood in urine
If you think you have an emergency, call for medical help right away.

RESOURCES

American Urological Association http://www.urologyhealth.org

National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov

CANADIAN RESOURCES

Canadian Urological Association http://www.cua.org

Health Canada http://www.hc-sc.gc.ca

References

Cystoscopy with internal urethrotomy. Cleveland Urology Associates website. Available at: http://www.clevelandurology.net/internal%5Furethrotomy. Accessed May 21, 2013.

Direct vision internal urethrotomy. Flint Urology website. Available at: http://www.flinturology.com/dvi%5Furethrotomy.shtml. Accessed May 21, 2013.

Direct visual internal urethrotomy (DVIU) home care after surgery. University of Wisconsin Hospitals and Clinics website. Available at: http://www.uwhealth.org/healthfacts/B%5FEXTRANET%5FHEALTH%5FINFORMATION-FlexMember-Show%5FPublic%5FHFFY%5F1105110082515.html. Updated April 26, 2010. Accessed May 21, 2013.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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