Name of the Procedure:

Cystourethroscopy with direct vision internal urethrotomy (DVIU)

Summary

Cystourethroscopy with DVIU is a medical procedure used to examine the interior of the bladder and urethra, while also treating urethral strictures by making precise incisions to widen the narrowed areas.

Purpose

This procedure addresses the issue of urethral strictures, which are narrowings of the urethra that can cause difficulty in urinating, urinary tract infections, and other urinary problems. The goal is to improve urine flow and reduce the symptoms associated with these strictures.

Indications

• Difficulty urinating or weak urine stream
• Frequent urinary tract infections
• Sensation of incomplete bladder emptying
• History of urethral trauma or infection that causes scarring

Preparation

• Patients may need to fast for 6-8 hours before the procedure.
• Inform the doctor of any medications being taken; some may need to be paused.
• Pre-procedure tests might include urine analysis, ultrasound, or imaging studies.
• Arrangements for transportation post-procedure, as anesthesia may be used.

Procedure Description

1. Anesthesia: Local or general anesthesia is administered to ensure patient comfort.
2. Cystourethroscopy: A thin, flexible tube with a camera (cystoscope) is inserted through the urethra to visually inspect the urethra and bladder.
3. Internal Urethrotomy: Upon identifying the stricture, a small incision is made using a specialized instrument passed through the cystoscope to widen the narrowed segment.
4. Completion: The instruments are removed, and the bladder is drained to ensure proper urine flow.

Duration

The procedure typically takes about 15-30 minutes, depending on the complexity of the stricture.

Setting

Performed in a hospital or outpatient surgical center, often in a dedicated urology suite.

Personnel

• Urologist (performing surgeon)
• Anesthesiologist or nurse anesthetist (if general anesthesia is used)
• Nursing staff

Risks and Complications

• Common: Bleeding, temporary discomfort or pain while urinating, urinary tract infection
• Rare: Urethral perforation, recurrence of the stricture, scar formation, and need for repeat procedures

Benefits

• Improved urine flow and relief from restrictive urinary symptoms
• Reduction in frequency and risk of urinary tract infections
• Benefits are typically noticed soon after recovery from the procedure

Recovery

• Post-procedure monitoring for a few hours
• Prescription of antibiotics to prevent infection
• Pain management with over-the-counter pain relievers
• Advise mild activity for a few days, avoiding heavy lifting
• Follow-up appointment for monitoring and assessment within a few weeks

Alternatives

• Urethral dilatation: Involves stretching the narrowed area but often has temporary results.
• Urethral stent placement: Provides support to keep the urethra open, usually reserved for recurrent cases.
• Open urethroplasty: A more extensive surgical procedure with longer recovery but potentially more permanent results.

Patient Experience

• Mild discomfort from the cystoscope insertion
• Pain at the incision site, manageable with medications
• Increased frequency or urge to urinate temporarily post-procedure
• Overall, most patients gain significant symptom relief with manageable discomfort during recovery.