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Informational purposes only, not medical or legal advice. Please consult your doctor or surgeon.
Direct vision internal urethrotomy (DVIU) is a procedure to temporarily open a narrowed urethra—the tube that carries urine from your bladder out of your body. When scar tissue forms inside this tube (a urethral stricture), the passage gets tight, so urine has to force its way through a small gap. This can cause a weak stream, straining, taking a long time to urinate, or feeling like you never fully empty.
In a DVIU, the urologist uses a thin camera (a scope) that goes in through the penis into the urethra. Under direct vision on a screen, they find the tight, scarred segment. A tiny blade or laser on the scope is then used to carefully cut through the scar from the inside, opening the channel so urine can flow more freely again.
DVIU does not remove all the scar; it simply slices it to widen the space. It is usually considered a less invasive option compared to full urethroplasty, mainly used for shorter strictures or as a first step before talking about bigger reconstruction.
Timings can vary a bit by clinic and by how complex your stricture is, but here’s the general idea.
1. Check‑in and planning: You arrive, change into a gown, and meet the nurse, anaesthesia team, and urologist. They review your history, flow tests, and any imaging, then confirm where your stricture is and that DVIU is the plan.
2. Anaesthesia: Most people get general anaesthesia, so you’re fully asleep and don’t feel anything. Some centres may use a lighter anaesthetic with sedation, depending on your situation.
3. Position and prep: You lie on a padded table. The genital area is cleaned with antiseptic and covered with sterile drapes. Local freezing gel or fluid may be used inside the urethra.
4. Scope into the urethra: The surgeon gently passes a thin camera (cystoscope) into the urethra through the tip of the penis. They watch a screen to guide the scope down the pee tube until they see the narrow, scarred segment.
5. Cutting the stricture: Using a tiny blade or laser attached to the scope, they cut through the scar tissue from the inside under direct vision. The goal is to open up the tight ring so the channel is wider and urine can pass more easily.
6. Checking and catheter: They re‑check that the scope and fluid pass more freely through the area. In many cases, a urinary catheter is left in for a short time to keep the channel open while the lining starts to heal.
7. Wake‑up and early instructions: You wake up in recovery while nurses monitor you. Once you’re stable, you get simple instructions about the catheter (if you have one), pain meds, drinking fluids, and when to call for help. Then you go home the same day with a ride.
Everyone’s different, so your urologist’s plan always comes first. DVIU is smaller than a full urethroplasty, but it’s still real surgery on your urinary tract, so expect some discomfort for a bit.
What it feels like:
Main goals:
You’ll usually be told to:
Things often start to settle:
You can usually do:
Still avoid: hard workouts, heavy lifting, and sexual activity until your urologist clears you.
Recovery from DVIU is mostly about giving the urethra time to calm down, keeping urine flowing, and showing up for follow‑ups so your urologist can see how well it worked.
Costs for DVIU can vary a lot, so always ask each clinic for a written, itemized quote. Here’s a general overview.
DVIU is usually cheaper than full urethroplasty, but it’s still a specialist procedure in an OR.
In the U.S., prices are usually higher once hospital and anaesthesia fees are added. Total charges can range roughly between CA$4,500–CA$9,000.
Choosing your surgeon is one of the benefits of going the private route. Here's how to choose wisely.
Experience and volume
Credentials and training
Indications and plan
Outcomes and safety
Ask for recent information like:
They should be comfortable discussing numbers and trade‑offs, not just saying “it’ll be fine.”
Pre‑op and after‑care
Look for a clear, written plan that itemizes:
Facility quality
Pricing transparency (for private care)
A strong DVIU program is open about results, clear about the plan, easy to reach with questions, and totally transparent about what you’re paying for.
Figuring out if DVIU is right for you starts with what your urethra actually looks like on tests, not just how annoying your stream feels. Your urologist will help you decide based on your symptoms, imaging, and goals.
To get quicker relief from blockage symptoms with a less invasive procedure, as a first step before talking about full urethroplasty, or when surgery needs to be shorter/ simpler because of other health issues.
In short: DVIU is usually for shorter, suitable strictures when you and your urologist want a quicker, less invasive option, knowing it may not be a permanent fix.
No, you do not need a referral for a private DVIU in Canada. You can book a consultation directly with a urologist, and they will review your options and diagnostics.
Your urologist’s instructions always come first—if their plan is different from this, follow them. DVIU is usually a short, same‑day procedure, but a bit of prep makes it smoother.
Being organized about your health, home setup, and ride/home help makes the DVIU experience less stressful and gives you more headspace to focus on healing and follow‑up.
Your personal risk with DVIU depends on your health, where the stricture is, how long and dense it is, what tools are used (blade vs laser), and how closely you follow after‑care. Your urologist will help you understand the risks for your personal situation.
These are uncomfortable but expected for many people:
These happen less often, but you should know about them:
Because DVIU cuts the scar from the inside rather than removing it:
These are rare, but more serious:
You can’t make risk zero, but you can tilt things your way:
Red flags: fever or chills, pee that turns very dark red with clots, suddenly not being able to pee, severe pain that isn’t helped by meds, or chest/calf pain or shortness of breath. If these show up, contact your team or go to urgent care/ER.
DVIU is a well‑known, less invasive option for certain strictures. In experienced hands, most side effects are mild and short‑lived, but it’s important to understand the chance that the narrowing can return.
Whether delaying DVIU is risky for you depends on how bad your symptoms are, what your tests show (length and location of the stricture), your goals (comfort, avoiding catheters, long‑term plan), and how well simpler things are working. Go over details with your urologist.
(when symptoms or tests are significant)
Progressive symptoms and limits
If the urethral narrowing stays or worsens, you may notice:
Some people eventually hit urinary retention (can’t pee at all) and need emergency catheters.
Bladder and kidney strain
When urine can’t flow out properly:
Harder problem to treat later
An untreated stricture over months or years can:
Quality‑of‑life drag
Living with a significant stricture can mean:
Over time, that can wear down your mood, energy, and confidence.
Delaying DVIU (or any procedure) may be okay if:
You and your urologist should talk seriously about DVIU or another procedure if:
DVIU isn’t the answer for every stricture, and it’s not always permanent. But if a proven narrowing is repeatedly causing blockage, infections, or emergencies, dealing with it sooner—whether by DVIU or a more definite surgery—can protect your bladder and kidneys and make everyday life a lot easier.
If you still have questions, then feel free to contact us directly.
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BROWSE SURGEONS
An FRCSC-certified urologist, with 25 years of experience, and 10,000+ procedures completed. Experienced with prostate disease, urinary incontinence, erectile dysfunction, bladder & testicular conditions.
