Internal Urethrotomy:

What is Internal Urethrotomy?

Internal 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 urethra.

Who is an ideal candidate for Internal Urethrotomy?

If 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.

How 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 Urethrotomy procedure.

What does the Internal Urethrotomy procedure involve?

The 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 Urethrotomy?

You 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.

What is the outcome of Internal Urethrotomy?

The 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 less.

Benefits of Internal Urethrotomy

Internal 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.

Risks of Internal Urethrotomy

Recurrence of urethral stricture
Infection – Wound infection or urinary tract infection
Fistula formation
Perforation of urethra or urinary bladder.
Allergic reaction to anesthesia

Alternatives to Internal Urethrotomy

Urethral 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.

Urethral 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 permanently.

Urethroplasty - 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

Several 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 Urethrotomy.