What is Visual Internal Urothrotomy?
Visual Internal Urethrotomy (also called Direct Vision Internal Urethrotomy or DVIU) is a simple and minimally invasive procedure used to treat urethral strictures, which are narrowings in the tube that carries urine from your bladder out of your body. If you've ever wondered why it's hard or painful to pass urine, a stricture could be the reason. VIU aims to provide relief and restore your natural flow, using a technique that doctors can perform with only a small incision inside the urethra.
VIU helps open up a narrowed urethra without making cuts outside your body. Instead, the doctor uses a thin, flexible tube called a cystoscope with a tiny camera and special surgical instruments. This allows them to find and treat the blockage from inside the urethra.
Types of Visual Internal Urethrotomy
There are mainly two ways doctors perform VIU, depending on your needs and the type of stricture:
- Cold Knife Visual Internal Urethrotomy: Here, a tiny blade is used through the cystoscope to cut the stricture. It's called the "cold knife" because it doesn't use heat, just a very sharp surgical instrument. This method is widely used and has a high success rate for short, simple strictures.
- Laser Visual Internal Urethrotomy: Some strictures respond better to a laser instead of a knife. The doctor uses a focused laser beam to slice through the blockage. Lasers can sometimes reduce bleeding and offer quicker recovery for certain patients.
30 to 60 Minutes
Procedure Duration
Local Anesthesia or Spinal
Anesthesia Used
Same-day discharge
Hospital Stay
Several Weeks
Recovery Timeline
When is VIU Recommended?
A minimally invasive treatment called Visual Internal Urethrotomy (VIU surgery is used to treat urethral strictures. During this surgical procedure, the restricted section of the urethra is visualised and cut using a cystoscope, a thin tube equipped with a camera.
- Short-Segment Urethral Stricture: If there's a tight spot in your urethra (usually less than 1-1.5 cm in length), your doctor may suggest VIU. Why? Shorter strictures are more likely to respond well to this gentle procedure.
- First-Time Stricture: Are you experiencing urethral narrowing for the first time? VIU often works best when strictures haven't come back multiple times. Trying it early can offer a good chance for relief.
- Soft or Easily Passable Stricture: Sometimes, strictures are not too hard or scarred. If a soft narrowing responds to gentle pressure, VIU is usually safe and effective.
- Symptoms Affecting Your Life: Are you finding it difficult to pass urine, dealing with a weak stream, or facing painful urination? VIU can help ease these symptoms and improve your everyday comfort.
- No Complex Scarring or Infection: If your stricture isn't linked to deep scarring, major injury, or ongoing infection, your doctor is more likely to consider VIU. Complex conditions may need different treatments.
Diagnosing Urethral Stricture Illness
Your healthcare practitioner may suspect a constriction in your urethra (the tube that allows urine to exit from your bladder) if you experience symptoms such as:
The next step will be to determine if you have urethral stricture illness. This can be detected through various methods, including:
- Basic physical assessment
- Ultrasound or urethral X-ray
- An inverted urethrogram
- Urethroscopy
- Cystoscopy
- Measuring post-void residuals (PVR)
How to Prepare for Visual Internal Urothrotomy?
Preparing for a Visual Internal Urethrotomy (VIU) isn't as complicated as it might sound. If your doctor has recommended this procedure, here's what you can expect, explained in clear, everyday language so you feel confident and ready for your hospital visit.
Before your procedure, your doctor will talk to you about your urinary symptoms, review your medical history, and explain why this treatment is right for you. Do you have questions or any worries about anesthesia or recovery? It's perfectly normal, and your healthcare team is there to help.
Key Preparation Steps for VIU
- Health Assessment: Your doctor will check how well your heart and lungs work. Blood tests and, sometimes, an ECG are needed. Why? So your doctor can make sure it's safe for you to have anesthesia.
- Discuss Your Medications: If you take medicines every day, bring a list. Make sure to tell your doctor about blood thinners, as these might need to be stopped before the surgery.
- Fasting: Usually, you will be asked not to eat or drink for at least six hours before the procedure. This helps prevent any problems with anesthesia. Wondering if water is okay? Your doctor will tell you exactly when to stop, so just ask if unsure.
- Hospital Admission: You'll check into the hospital on the day of surgery or sometimes the night before. Bring your ID, insurance paperwork, and any medical documents.
- Personal Hygiene: It's a good idea to shower the night before the procedure. Clean skin helps reduce the risk of infection. Feeling nervous about shaving areas for surgery? Nurses will guide you, and most of the time, it's not needed for VIU.
- Bowel Preparation (If Advised): Sometimes, for better visibility, a mild laxative might be given. If so, your nurse will explain how to use it.
- Arranging for Help After Surgery: The whole procedure is usually quick, but you might be a bit drowsy after. Ask a friend or family member to be available to take you home.
Step-by-Step Procedure of Visual Internal Urethrotomy
Most urethrotomies are typically performed under spinal or general anesthesia, although local anesthesia may be opted for in specific cases. Pre-operative antibiotics are routinely administered to mitigate the risk of infection. Upon arrival, you will change into a nursing gown and assume the dorsal lithotomy position on a cystoscopy table. Using either a urethrotome or cystoscope equipped with a surgical knife, the skilled surgeon will carefully navigate your urethra to open the strictured area.
- Preparation and Anesthesia: Before the procedure, you will be prepared by the medical team, usually asked to fast for some hours. You will receive anesthesia to keep you comfortable. This may be local anesthesia with sedation or general anesthesia depending on your health and the doctor's advice.
- Positioning: You will lie on your back with legs positioned to allow easy access to the urethra.
- Insertion of Cystoscope: The urologist inserts a thin, rigid or flexible tube called a cystoscope into your urethra. This tube has a light and a camera, allowing the doctor to see inside the urethra.
- Locating the Stricture: Using the camera, the urologist carefully locates the narrowed section inside your urethra.
- Incision of the Stricture: Through the cystoscope, a special cutting instrument (like a cold knife or laser) is passed. The doctor makes a precise cut along the narrowed part (usually at the 12 o'clock position) to open up the stricture.
- Medication Injection (Optional): Sometimes, the doctor injects medication into the scar tissue to help reduce the chance of the narrowing returning.
- Catheter Placement: A urinary catheter (a soft tube) is inserted to keep the urethra open and allow urine to pass while the area heals. This catheter usually stays in place for 2 to 7 days.
- Recovery: After the procedure, you will wake up in a recovery room. Some blood in the urine and mild discomfort are normal but usually temporary. You will receive instructions on how to care for the catheter and yourself at home.
Who Performs VIU?
This procedure is done by a urologist, a doctor specialized in urinary tract and male reproductive system conditions. The urologist has special training and uses advanced instruments to perform VIU safely and effectively.
Recovery Process After Visual Internal Urethrotomy (VIU)
The recovery process after Visual Internal Urethrotomy (VIU) and relevant lifestyle changes can be explained in a clear, conversational tone with simple language and empathetic tips that connect well with patients visiting a hospital website. Here is a structured explanation:
Immediate Aftercare
- Right after the procedure, you may feel some mild discomfort or a burning feeling when you pee. This is normal and should ease in a few days.
- You might also see some blood in your urine for a few days. Don't worry; it's a temporary part of healing.
- Your doctor may give you pain medicine and sometimes antibiotics to prevent infection.
Rest and Hydration
- Rest is important. Take it easy for a few days to help your body heal well.
- Drink plenty of water. Staying hydrated flushes out your bladder and urethra, which helps clean out any leftover debris and reduces infection risk.
- Try to avoid heavy lifting, strenuous exercise, or activities that strain your abdomen for at least the first week.
Catheter Care
- Sometimes a catheter (a small tube) is placed during the procedure to help urine flow.
- Keep the catheter and drainage bag clean, and follow your doctor's instructions on how to care for it.
- Don't pull or tug on the catheter, it can hurt and cause bleeding.
- Your healthcare provider will remove it at the right time.
Follow-Up Visits
- You need to see your urologist for follow-up check-ups.
- These visits help your doctor watch how well the urethra is healing and catch any problems early.
- Your doctor may do tests like urine flow tests or cystoscopy to make sure the stricture has not come back.
Managing Symptoms and Warning Signs
- Mild symptoms like burning or urgency to urinate are common early on.
- But if you notice worsening pain, fever, heavy bleeding, or pus-like discharge, contact your doctor immediately as these could be signs of infection or complications.
Lifestyle Changes After VIU
Healthy Fluid Intake
- Drinking enough water daily is key to keeping your urinary tract healthy and flushing out harmful bacteria or debris.
- Avoid drinks that can irritate your bladder like caffeine, alcohol, or very spicy and acidic beverages until your doctor says otherwise.
Personal Hygiene
- Keep the genital area clean to prevent infections.
- Follow your doctor's guidance on washing and care during the recovery period.
- Practice safe sex to reduce risks of infections that can worsen strictures.
Activity Modifications
- Avoid heavy lifting, straining, or strenuous workouts for a couple of weeks.
- Gradually return to normal activities as your comfort improves and after consulting your doctor.
Monitor for Recurrence
- Be aware that urethral strictures can come back.
- If you notice difficulty urinating, slowing of urine flow, or other urinary symptoms after recovery, seek medical advice promptly.
Psychological Well-being
- Recovery can sometimes cause anxiety or stress related to urinary symptoms.
- Stay positive, talk with your healthcare provider, and consider supportive counseling if needed.
By understanding the benefits, possible risks, and what to expect, you can be more confident when considering Visual Internal Urethrotomy for your urethral stricture treatment. Your healthcare team is here to guide you every step of the way to ensure the best outcome for your urinary health.
Benefits of Visual Internal Urethrotomy
- Less Invasive: VIU doesn't need external cuts or stitches, so recovery tends to be quicker and less painful compared to open surgery.
- Relieves Symptoms: It improves your urine flow, helps empty your bladder completely, reduces the urgency and frequency of urination, and eases discomfort.
- Short Hospital Stay: Many patients go home the same day or after a short hospital stay.
- Precise Treatment: The use of a camera allows the surgeon to target the exact narrowed area, which helps in effective treatment.
- Quicker Recovery: You can usually return to your daily activities faster than with more invasive surgeries.
- Cost-Effective: Generally, this procedure is less expensive than more complex surgeries.
Risks Associated with VIU
- Bleeding: Mild bleeding or blood in urine is common after the procedure but usually stops within a few days.
- Infection: There is a risk of urinary tract infection, which your doctor will monitor and treat if needed.
- Pain or Burning: You might feel some burning or discomfort during urination for a few days after the procedure.
- Recurrence of Stricture: The narrowed area can sometimes come back over time, which might require repeat treatment or a different type of surgery.
- Urinary Retention: Rarely, difficulty passing urine after the procedure may occur, needing further treatment.
- Other Less Common Risks: Penile swelling, formation of false passage (abnormal tract), erectile dysfunction, or rare complications like fistula (abnormal connections) may happen.
Common Side Effects After VIU
- Temporary discomfort when urinating
- Increased urgency or frequency of urination
- Mild blood in urine
- Feeling some pain or soreness around the urethra
- Having a urinary catheter for 1-3 days post-surgery to help urine flow easily
How Much Does DVIU Surgery Cost?
Wondering about the Visual Internal Urethrotomy (DVIU) cost? It generally ranges widely in India, from around Rs. 35,000 to Rs. 1,00,000 or more, depending on various factors. Here's what affects the price:
- Hospital Location and Quality: Big cities and top hospitals with advanced technology typically charge more.
- Type of Procedure: Optical or laser-assisted methods may cost differently.
- Doctor's Experience: Highly skilled urologists may have higher fees.
- Your Condition: Severity and complexity of your stricture affect how long and complicated the surgery will be.
- Additional Charges: These include anesthesia, operating room fees, post-surgery care, medications, and follow-up visits.
In cities like Hyderabad or Delhi, costs often range between Rs. 45,000 andRs. 1,00,000 depending on these factors.
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