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by Neff DM

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 (called urethral 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
si55550234 male urethra
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Urethral stricture, which is more common in men than in women, can result in:
  • In men, problems with the prostate (eg, infection, inflammation )
  • Infections of the bladder , ureters (carry urine from the kidneys to bladder), or kidneys
  • Inability to urinate or empty the bladder completely

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have a DVIU, your doctor will review a list of possible complications, which may include:
  • Abscess or damage to urethra
  • Recurrent stricture
  • Need for more procedures
  • Penis pain
  • Erectile dysfunction
  • Pain when urinating
  • General complications, like:
    • Bleeding
    • Reaction to anesthesia (eg, light-headedness, low blood pressure, wheezing)
    • Infection
    • Damage or scarring of tissue
    • Injury to surrounding structures
    • Heart attack or stroke
    • Blood clots
Factors that may increase the risk of complications include:
  • Bleeding disorders or taking medicines 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
  • Order imaging, blood, and urine tests
  • Talk about the anesthesia being used and its potential risks
You should also talk to your doctor about your medicines. You may be asked to stop taking some medicines up to ten days before the procedure, including:
  • Aspirin or other anti-inflammatory drugs
  • Blood thinners, like warfarin (Coumadin)
  • Clopidogrel (Plavix)
In the days leading up to the procedure:
  • Take a shower both the night before and the morning of your 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 medicines 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. It is given through an IV.

Description of the Procedure

After you are asleep, a special tube called a cystoscope (fiberoptic telescope) 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. You will be given pain medicine to ease pain or soreness after the surgery.

Average Hospital Stay

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

Post-procedure Care

At the Hospital
  • 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 medicine.
  • 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 medicines 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 (eg, 8-10 glasses per day).
  • Do not drive or have sex for one week.
  • 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.

Call Your Doctor

After you leave the hospital, contact 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
  • A lot of blood in urine (small amounts are normal)
In case of 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://www2.niddk.nih.gov/

CANADIAN RESOURCES

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

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

References

Husmann D. Endoscopic repair of the urethral injury: immediate endoscopic realignment, delayed urethroplasty with direct internal visual urethrotomy, and delayed urethroplasty with cut to light procedure. In: Wein AJ, ed. Campbell-Walsh Urology . 9th ed. Philadelphia, PA: Saunders Elsevier; 2007:chap 132.

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 . Accessed November 2, 2012.

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