WHAT IS DVIU SURGERY?

DVIU
( Direct vision internal urethrotomy)

                  Urethral stricture
What is DVIU? 

Definition :
Introduced in 1971
Direct vision internal urethrotomy (DVIU) is a surgical procedure performed in operation theater ( sterile zone) in which surgeon repair narrow section of urethra. This condition referred as stricture. Urethra is a tube like structure which carries urine from bladder to the outside of the body.

This procedure  is very common male urethral strictures.

Causes of urethral strictures :

1.Traumatic (due to previous surgery         instrumentation)
2.Inflammatory due to infection 
3.Hypospadias
4.previous instrumentation surgery 
5.Idiopathic 

Symptoms & sign of urethral stricture:

- Pain during the urination. 
-Blood in urine and forceful urination. 
-Urinary retention (patient cannot pass     the urine.
-Urinary track infection. 
-Decreased force of urinary system. 
- Incomplete emptying of the bladder. 
-Needing to strain with urination. 
- Splyed urinary system. 

What happens if urethral stricture untreated :

1.Prostatitis (infection in prostate )

2.Stone development 

3.Epididymo-orchitis (inflammed scrotum )

4.Peri -urethral absecess (pus formation)

5.Fistula to perineum. 

6. Fournier gangrene. 

7.Thick walled bladder.

8.Acute urinary track infection. 

9.Hydronephrosis of the kidney. 

10.Acute renal failure. 




General clinical evolution and diagnosed by:

1.Medical history. 

2.Physical exam 

3. Urinary flow diagnose by uroflowmetry procedure. 

4.Bladder ultrasonography 

5. By endoscopic procedure cystoscopy 

6.Urethrography 



Duration of surgery : 30 minutes

Stay of the hospital : one day ( depends on patient condition and doctor advice).

What  should I before the surgery? 

Blood test

HIV and HBSag test

Chest x-ray for cardiac assessment  physical fitness bcoz patient will goes under the anesthesia before the surgery.

Stop eating and drinking at the time your doctor tells you before surgery.

Procedure of DVIU in the operation theatre:

Start intravenously fluid or antibiotic for prevent infection and  fluids allowed to run until administration of the prescribed dose is completed.(as per doctors advised )

DVIU procedure done under the general anesthesia ,  spinal anesthesia or short general anesthesia for pain relief during surgery and comfort to patient.

 In this patient will  received intravenous anxiolytic medication like This benzodiazepine, often, diazepam or midazolam is given.this anesthesia under goes in to the short general anesthesia.  The urological surgeon narcotic analgesic such as fentanyl citrate, depending on the level of discomfort anticipated by the surgeon. 

If strictures is long and procedure can take long time than than endotracheal intubation will given and hypnotic agent like propofol given. 
Than anesthesist continue watching monitor and watch vital signs including pulse, spo2(saturation ), E.C.G,  body temperature and blood until the  patient  will not shifted from operation theatre to recovery  

Painting and drapping :

Paint and cleanse the Surgical site and space of urethra with betadiene antibacterial solution it contains  Povidone-iodine, then patient draped by sterile drap.


A topical anesthetic, 2% xylocaine jelly this  viscous lidocaine like jelly  is introduced  into the urethra, and  hold the tip of the penile atleast for  five minutes, then removed and introduce the  cystoscope.

cystoscope & urethrotome combination will be inserted and assess the location of  stricture and a small blade towards the tip of the instrument will be present  using a trigger mechanism to cut the stricture at location. 
After the incision or cut withdrawn instruments appropriately sized its depend of patients age Foley catheter will be inserted through the repair and into the urinary bladder, and locked or fix into place by filling its balloon (positioned inside of the bladder near the urethral junction) with sterile water. 






Reason of foley's  cathetherizatoon

1.It provides drainage of the urine           produced in the kidneys

2.It secures the incised areas, holding them open for three to seven days to permit thorough healing of the urethra. The catheter is  attached with urinary bag (urobag).


For know more details & appointment contact us : 
+91 7692976910

DR. VIMAL KESWANI
MBBS, MS, DNB Urologist & andrologist, Mumbai
Consultant urosurgeon 
Former consultant at R.G. stone hospital, mumbai




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