is Internal Urethrotomy?
Urethrotomy, also known as Direct Vision
Internal Urethrotomy (DVIU) is a surgical
procedure used to treat urethral strictures
(narrowing) due to scarring. Internal Urethrotomy
can be categorized as Reconstructive Urology
procedure where the normal anatomy and function
of the urethra is restored by dilatation
of the urethra. Internal Urethrotomy is
a minimally invasive endoscopic procedure
where a small cut is made in the narrowed
part to fix the abnormal narrowing of the
is an ideal candidate for Internal Urethrotomy?
you have a narrowing of your urethra due
to any of the causes i.e. repeated episodes
of urethritis, benign prostatic hyperplasia,
scarring from a previous surgery, injury
or trauma to the pelvic region or if there
is narrowing of your urethra due to a tumour
pressing on it, then you are an ideal candidate
for Internal Urethrotomy.
do I prepare for Internal Urethrotomy?
A thorough pre-operative assessment by your
urologist would comprise of physical examination,
urinalysis for the presence of blood and
white cells, urine culture for infection
and Cystoscopy to confirm the diagnosis
of urethral stricture. The standard urethral
imaging procedures like Retrograde Urethrogram
(RUG) and Voiding Cystourethrogram (VCUG)
will be performed. You will be hospitalized
at least one day before the surgery. Inform
your surgeon about your other health conditions
and medications (including all the prescription,
non-prescription medications, nutritional
supplements i.e. vitamins, minerals and
herbal products) that you are taking. Refrain
from taking aspirin or Ibuprofen at least
2 weeks before Internal Urethrotomy. Stop
smoking a few weeks before Internal Urethrotomy
to prevent healing problems during recovery
period. Do not eat or drink any thing for
at least 10 - 12 hours before the Internal
the Internal Urethrotomy procedure involve?
urinary bladder will be emptied using a
suprapubic catheter before the Internal
Urethrotomy to prevent urinary tract infection.
You will lie on your back on the operating
table with your legs wide apart. Internal
Urethrotomy is performed in a hospital setting
under general anesthesia. An endoscope with
a sharp cutting edge (knife) is inserted
into the urethra and an incision is made
to open the narrowed portion of the urethra.
A catheter is inserted to hold the urethra
open until the internal cut heals.
What is the
recovery period like following Internal
will be instructed to stay in bed for the
next 2 days, you will be given pain killers
and antibiotics for the next few days to
help you deal with the pain and risk of
infection. The indwelling catheter will
be retained for 3 - 5 days. Avoid performing
strenuous activities like lifting something
heavy, playing sports or having sexual intercourse
for at least 2 weeks after Internal Urethrotomy.
You will be able to perform all your routine
daily activities in about 2 weeks time.
You will be called in for follow up Cystoscopy
after 4 weeks of Internal Urethrotomy.
is the outcome of Internal Urethrotomy?
success rate reported for Internal Urethrotomy
to treat urethral stricture is 70 - 80%.
Internal Urethrotomy has optimal results
in case of small strictures i.e. 2 cm or
of Internal Urethrotomy
Urethrotomy relieves pain and discomfort
during voiding, relieves decreased flow
of urine i.e. restores the normal stream
of urine and need to urinate frequently.
Internal Urethrotomy can also reduce your
risk of getting orchitis, prostatitis or
recurrent urinary tract infection.
of Internal Urethrotomy
of urethral stricture
Infection - Wound infection or urinary
Perforation of urethra or urinary bladder.
Allergic reaction to anesthesia
to Internal Urethrotomy
dilatation - The goal of urethral
dilatation is to stretch the scar tissue
of the stricture without producing any
additional scarring. This method may be
effective in some very small strictures.
Stents - In this technique, a
short tube is placed inside the urethra
that holds the strictured portion of the
urethra open as it heals after surgery,
thus preventing the normal scar formation
of healing from causing the stricture
to recur. The lining of the urethra eventually
covers the stent, and it remains in place
- This surgical procedure entails open
urethral reconstruction. It can be performed
by 2 methods; primary repair which involves
complete excision of the narrowed part
of the urethra. The proximal and distal
patent parts are then rejoined. The second
method utilizes tissue transfer or free
graft technique. In this method, tissue
is grafted from bladder epithelium, or
buccal mucosa and is used to enlarge the
strictured segment of the urethra.
Decision to have Internal Urethrotomy
techniques are available for the treatment
of urethral stricture. You will be evaluated
pre-operatively by a urologist to determine
your suitability for Internal Urethrotomy
procedure. Discuss the procedure in detail
with your urologist to evaluate all the
benefits and risks associated with Internal
to "Urology Surgery"