DVIU Procedure for Urethral Stricture in a 67 Y.O. Male with Urinary Retention

PACE Hospital’s expert Urology team successfully performed a Direct Vision Internal Urethrotomy (DVIU) on a 67-year-old male patient diagnosed with a urethral stricture. The procedure was performed with the aim of cutting and widening the narrowed section of the urethra to relieve urinary obstruction, improve urinary flow, prevent complications such as urinary retention or infections, and enhance the patient’s overall quality of life.

Chief Complaints

A 67-year-old male patient with a body mass index (BMI) of 21 presented to the Urology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of poor urine flow and urinary retention.

The patient had no history of hypertension, diabetes, or cardiac disease. He had not undergone any prior urological or major surgeries and had no known chronic kidney disease or recurrent urinary tract infections. No drug allergies were reported.

The patient was conscious, coherent, oriented, and hemodynamically stable. Abdominal examination revealed mild suprapubic fullness, suggestive of urinary retention. Genitourinary examination showed no external lesions or deformities. On palpation, the bladder was distended. Digital rectal examination revealed a normal-sized, non-tender prostate. No peripheral edema or other systemic abnormalities were noted.

Upon admission to PACE Hospitals, the patient was thoroughly evaluated by the Urology team, including a detailed review of his medical history and a comprehensive clinical examination. Presented with poor urine flow and urinary retention, there was clinical suspicion of a urethral pathology such as a urethral stricture or obstructive lesion.

The patient underwent diagnostic investigations, including uroflowmetry and ultrasonography of the urinary tract, which confirmed the presence of a dense panurethral urethral stricture. Laboratory investigations, including complete blood picture, renal function tests, blood sugar, coagulation profile, serum electrolytes, and viral screening for HIV, Hepatitis B, and C, were all within normal limits. 2D Echocardiography demonstrated normal cardiac chambers, valves, and function. Cardiovascular, abdominal, and neurological examinations were normal. Respiratory system examination was stable, with no acute wheezing or crepitations noted.

Based on the confirmed findings, the patient was advised to undergo Urethral stricture Treatment in Hyderabad, India, under the expert care of the Urology Department.

After a detailed consultation with Dr. Abhik Debnath, Consultant Laparoscopic Urologist, a comprehensive evaluation was conducted focusing on the patient’s presentation of poor urine flow and urinary retention and the diagnostic findings. Clinical and diagnostic findings, including uroflowmetry and ultrasonography of the urinary tract, confirmed the presence of a dense panurethral urethral stricture with no evidence of associated infection, calculi, or other obstructive lesions.

It was determined that Direct Vision Internal Urethrotomy (DVIU) was identified as the most appropriate intervention to relieve the patient’s obstructive urinary symptoms, restore urinary flow, and prevent complications such as recurrent urinary retention, infections, or further urethral damage.

The patient and his family members were informed about the diagnosis of panurethral urethral stricture, the planned surgical management, the associated risks, and the expected benefits aimed at relieving symptoms and preventing future complications.

Following the decision, the patient was scheduled for a Direct Vision Internal Urethrotomy (DVIU) Procedure in Hyderabad at PACE Hospitals, under the expert care of the urology department.

The procedure involved the following steps:

• Preoperative Preparation: The patient was positioned supine, and spinal anesthesia was administered. Standard aseptic precautions were followed, and the perineal and urethral areas were cleaned and draped.

• Cystoscopic Evaluation: A cystoscope was inserted into the urethra to visualise the stricture. The panurethral dense stricture with near obliteration of the urethral lumen was identified.

• Incision of the Stricture: The stricture was incised longitudinally at the 12 o’clock position under direct vision using a cold knife, carefully avoiding injury to surrounding tissue.

• Gradual Dilatation: The urethral lumen was gradually dilated up to 21 Fr to restore patency.

• Foley Catheter Placement: An 18 Fr Foley catheter was inserted to maintain the urethral lumen and ensure continuous drainage during the initial healing phase.
  

After surgery, the patient was closely monitored and remained stable throughout his hospital stay. His intraoperative and postoperative course was uneventful, with no complications observed. He received medications for pain relief and infection prevention as needed. The Foley catheter was maintained for urine drainage. The patient was discharged in stable condition.

The patient was prescribed medications for infection prevention, pain relief, acid-related gastrointestinal protection, bladder symptom management, and antioxidant support. The course and duration of each therapy were tailored to support recovery following the urethral procedure.

The patient was advised to avoid strenuous activities, including heavy lifting and forward bending. Mild urethral bleeding may occur, which is expected and not a cause for concern, and gentle perineal compression can be applied if needed. The patient was allowed a normal diet.

The patient was instructed to contact the emergency ward at PACE Hospitals in the event of an emergency or if symptoms such as fever, poor urine flow, catheter blockage, or vomiting.

The patient was advised to return for a follow-up visit with the Urologist in Hyderabad at PACE Hospitals after 7 days for catheter removal.

This case highlights the management of a urethral stricture causing poor urine flow and retention, treated successfully with DVIU under spinal anesthesia. The procedure restored urethral patency, and the intraoperative and postoperative course was uneventful. The patient was discharged in stable condition with a Foley catheter in situ and appropriate medications, with follow-up planned for catheter removal.