Open on phone

Direct Vision Internal Urethrotomy (DVIU)

Dr. Stephen Lukasewycz

What is this procedure?Tap to read

A urethral stricture is a band of scar that narrows the urethra, making it hard to pass urine.

DVIU: a scope with a small cold knife (urethrotome) goes into the urethra. Looking through the scope, the surgeon cuts the scar to open the narrow segment. No skin cuts are needed.

Afterward: a catheter is often left in for a short time while the urethra heals.

Key points

Cold knife: open the optical urethrotome and the Storz cold knife (27068K). Sensor wire on the field.
Saline, no pressure bag. Switch to water only if cautery is used.
B&O suppository after the prep.
C-arm with foot pedal for retrograde urethrogram (RUG). Call the X-ray tech before the patient is in the room so the C-arm is ready when the case starts.
Have the 18 Fr Council-tip catheter, 10 mL balloon available for the end of the case. It goes in over the Sensor wire, so keep the wire on the field until the catheter is in.

Supplies

Open

Cysto set and optical urethrotome
Storz camera, GloShield, cysto pack
Cold knife, Storz 27068K
Sensor wire
Lubricating jelly on a towel
Saline 3000 mL bag
C-arm drape
Contrast: Omnipaque 300 mgI/mL, 30 mL, diluted 50/50, with a 30 mL syringe for the RUG
Leg bag
Surgical jumpsuit (plastic overalls)

Available in room, open only if asked

18 Fr Council-tip catheter, 10 mL balloon
Van Buren sounds, full set
Open-end ureteral catheter, 6 Fr
TUR resectoscope set
Sterile water (if switching for cautery)

Gloves

7.5 white. Single glove; no blue.
Surgical jumpsuit (plastic overalls).

Anesthesia

General anesthesia.
B&O suppository after the prep.
Perioperative antibiotics: cefazolin (Ancef) 2 g IV, unless contraindicated.

Positioning

C-arm compatible bed.
Dorsal lithotomy in Yellofin stirrups (Allen stirrups at Same Day Surgery).
Left arm tucked.
SCDs on.

Prep and drape

Povidone-iodine (Betadine) scrub and paint: pubis, perineum, upper third of thighs, and genitals.
After the prep, dry the perineum and place the lithotomy drape.
Do not place towels under the drape. Towels let the drape slip and fall, which contaminates the field.
Please continue draping after the prep; no need to wait for the surgeon.

Irrigation

Saline, 3000 mL bag. No pressure bag.
If cautery is used, switch to water.
Water in a metal basin on the field (also used to fill the catheter balloon).

Why saline, and water only with cautery?Tap to read

No electricity, so saline is fine: the cold knife cuts without current, so saline is used. Saline is also safer if some is absorbed.

If cautery comes out: monopolar current spreads out in saline and will not work, so the irrigation is switched to water.

No pressure: pressure pushes fluid into the freshly cut urethra and surrounding tissue. Gravity flow is enough to see.

Cautery and laser

Usually none: cold knife.
Cautery may be used if needed.
Laser: only if requested.

After the case

Patient goes home with the catheter: connect a leg bag to start.
Send a 4 L night bag home with the patient.

← All briefings