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Management - DVIU/VIU

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Direct Visual Internal Urethrotomy (Visual Internal Urethrotomy) is considered primary form of treatment for the stricture urethra today. Many patients are diagnosed to have a stricture in the urethra when a urologist is performing endoscopy of the urinary tract.

Indications: Short Bulbar Stricture less than 1.5cms

Not indicated in 1) Penile Urethra 2) Long Bulbar Stricture 3) Membranous Urethra

Site of DVIU – if the narrow urethral opening is eccentric then the stricture should be incised towards the centre of the urethra.  A terumo guide wire is passed through the narrow stricture urethra into the bladder.

If the urethral opening is central, many Urologists incised the spongiofibrotic urethra towards 12 O’ Clock position. Ideally, we have to incise urethra towards 6 O’ Clock position and if required at 2 and 10 O’ Clock position mimicking Mercedes Benz sign. The bulbar urethra lies dorsally in the corpora spongiosa and is attached to the corpora cavernosa dorsally. There is a rare chance of incising corpora cavernosa during urethrotomy and may lead to severe bleeding and impotence. As the urethra is anchored to the corpora cavernosa dorsally there is hardly any space for the urethral lumen to expand.

If we incise the stricture at 6 O’ Clock or 4 and 8 O’ Clock, we encounter large amount of spongy tissue to incise and allow the urethral lumen to expand. 
Number of DVIU in passed 3 DVIU are recommended for the cure of stricture urethra. The current thinking is if one DVIU does not cure stricture the second will not so only DVIU is recommended.

Post urethroplasty recurrent urethral strictures are at times amenable to DVIU as the first choice.

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