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Optical Internal Urethrotomy (OIU)/ Direct Visual internal Urethrotomy (DVIU)
A. This procedure involves telescopic inspection of the urethra and bladder with incision of a stricture (narrowing caused by scar tissue) using a knife.
A. The alternatives include:
Q 3. What should I expect before the procedure?
A. If you are taking blood thinning medication on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits. Aspirin does not usually need to be stopped but will be the decision of your surgeon.
You will usually be admitted on the same day as your surgery, or a day before. You will normally undergo pre assessment on the day of your clinic. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and nurse.
You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.
Please be sure to inform your urologist in advance of your surgery if you have any of the following:
A. Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you.
You will usually be given injectable antibiotics before the procedure, after checking for any allergies.
The operation is performed using a telescope passed into the penis through the water pipe (urethra). Any narrowing due to stricture can then be cut using a special internal knife. All the cutting takes place internally and there are no incisions or stitches. Most patients require insertion of a catheter into the bladder for 3-5 days after the procedure.
A. There is often some bleeding around the catheter, as the incision has been made in the waterpipe that surrounds the catheter. This usually lasts for a short period, unless there has been a need for multiple or deep cuts. A pad will often be secured around the end of the penis to collect any blood which seeps out around the catheter; this pad is removed on the day after surgery.
A. The catheter is usually removed after 3-5 days. Once the catheter is removed, you should be able to pass urine with an improved flow but, in the early stages, this can often be painful and bloodstained. Provided you drink plenty of fluid, this will gradually settle over a few days.
After the operation, you may be instructed in the technique of self-catheterisation, using a “slippery” catheter, to keep your urethral stricture open.
A. The average hospital stay is usually 36 to 48 hours.
A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.
Common (greater than one in 10)
Occasional (between one in 10 and one in 50)
Rare (less than one in 50)
A. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation.
When you get home, you should drink twice as much fluid as you would normally for the next 24 to 48 hours to flush your system through. You may find that, when you first pass urine, it stings or burns slightly and it may be lightly bloodstained. If you continue to drink plenty of fluid, this discomfort and bleeding will resolve rapidly.
If self-catheterisation is to be used, you will be given written instructions as to how often to insert the catheter.
If you develop a fever, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your urologist immediately.
If you experience any problems with self-catheterisation, contact the urologist immediately.
You will normally receive an appointment for outpatient follow up at 5 days, followed by six to 12 weeks after the procedure.
Following a first-time operation, 40% of men will not require any further treatment. However, if the stricture does recur, you may need a further procedure carried out. In the longer term, you may need to continue self-catheterisation for several months.