What is Direct Vision Internal Urethrotomy?
Direct Vision internal urethrotomy (DVIU) is a surgical procedure to open up a urethral stricture (scarred, narrowed area of the urethra).
What are the potential benefits of DVIU?
DVIU can help you urinate with a stronger stream, help you empty the bladder better, and help you urinate less often.
What are the risks or complications of DVIU?
The risks or complications of DVIU may include but are not limited to bleeding, infection, painful urination, erectile dysfunction, "false passage" (going outside of the urethra), fistula (abnormal connections with other structures), and curvature of the penis.
What is the likelihood of success?
The likelihood of short term success is high, but likelihood of long term success is low.
The stricture has a tendency to come back.
What are the problems related to recuperation?
You have to wear a Foley catheter after procedure.
What are the possible results of non-treatment?
Slow urine stream, frequent and urgent urination, urinary retention, UTI
What are significant alternatives?
Open urethroplasty (open surgery) is an alternative that usually has a higher long term success rate. Urethral dilation is another alternative but usually has a lower success rate.
What kind of anesthesia is required?
General or spinal anesthesia
What are the risks and benefits of the chosen anesthesia or sedation?
You can discuss with your doctor and the anesthesiologist (the doctor that gives you anesthesia).
What kind of anesthesia is required?
You will have some bleeding at the tip of the penis and have some blood in the urine bag on and off for several weeks. However, the risk of severe bleeding and the need for blood transfusion is low.
Your doctor may do:
A physical exam and ask about your medical history.
Blood, urine, and other tests.
You should talk to your doctor about your allergies, medications including over the counter medications, and any other possible conditions (e.g. pregnancy).
Ask your doctor if you need to stop any of your medications (especially blood thinners) and for how long before the procedure.
Also ask how you should take your regular medications in the morning of the procedure.
Arrange for someone to drive you to and from the surgery center/hospital.
Do not drink or eat anything starting 8 hours prior to your procedure.
During the procedure:
After adequate anesthesia is given so that you do not have any pain, the doctor places a DVIU scope into your urethra. A "cold knife" (a small sharp instrument) or laser is used to cut the urethra to widen the opening inside the urethra. A Foley catheter (a tube to drain your bladder) is placed.
How long will the procedure take?
The procedure will take about 30 minutes.
What is the average hospital stay?
DVIU is an outpatient procedure, so there is no hospital stay. You will go home the same day.
After procedure care:
At the surgery center or hospital:
You will be monitored in a recovery room, given pain medication, and some food to eat.
The Foley catheter can be connected to a bag or attached to your leg. The nurse will show you how to empty it at home.
At home:
Your doctor may want to keep the Foley catheter in from a few days up to 1-2 weeks.
The Foley catheter will be removed in your doctor's office.
Your doctor may show you how to insert a catheter into your urethra a few times a week to keep the stricture area from closing down again.
Ask your doctor when you can have sexual activity.
Call your doctor if:
You are experiencing increasing severe pain
Your catheter is not draining
You cannot void after Foley catheter removal
You have a fever (101°F) or chills
You have heavy bleeding (like ketchup; it is okay to see some blood in your urine)