Direct Vision Internal Urethrotomy Overview

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.

Prior to Procedure

Your doctor may do the following:

• Physical exam

• Imaging, blood, and urine tests

• Talk about the anesthesia being used and the 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, like:

• 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 about 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 (needle) in your hand or arm.

Description of the Procedure

Once 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.

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 yourself 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 rather than a bath until the catheter is removed.

RESOURCES:

American Urological Association
http://www.auanet.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/index-eng.php

References:

BMI Healthcare UK. Urethrotomy. BMI Healthcare UK website. Available at: http://www.bmihealthcare.co.uk/treatment/treatmentsdetail?pname=Urethrotomy&ptreatment_id=334 . Accessed August 10, 2010.

Flint Urology. Direct vision internal urethrotomy. Flint Urology website. Available at: http://www.flinturology.com/dvi_urethrotomy.shtml . Accessed August 19, 2010.

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.

Mayo Clinic. Urethral stricture. Mayo Clinic website. Available at: http://www.mayoclinic.org/urethral-stricture/ . Accessed August 19, 2010.

Urology Services Michigan. DVIU. Urology Services Michigan website. Available at: http://www.flinturology.com/dvi_urethrotomy.shtml . Accessed August 11, 2010.

UW Health. Direct vision internal urethrotomy home care after surgery. UW Health website. Available at: http://www.uwhealth.org/healthfacts/BEXTRANETHEALTHINFORMATION-FlexMember-ShowPublicHFFY1105110082515.html. Updated April 26, 2010. Accessed August 10, 2010.