OIU(Optical Internal Urethrotomy)

What is Optical Internal Urethrotomy (OIU/VIU/DVIU) ?

OIU or optical internal urethrotomy is an endoscopy procedure to manage and cure ureteral structures. In this procedure a cystoscope is introduced into the urethra and stricture is identified and cut using a cold knife.

What is Stricture Urethra?

Stricture of the urethra is a narrowing that occurs in the urinary passage leading to difficulty in passing urine. Due to the narrowing the patient is unable to pass urine entirely in one attempt and has to go to pass urine again and again. Even after passing urine the patient may feel that some amount of urine is remaining inside the bladder. Most patients take a long time to pass urine to satisfaction. Slowly and slowly with the passage of time the stream of urine becomes thin and the patient has to use the muscles of the abdomen to strain and pass urine out. In some neglected cases the passage of urine may stop completely leading to permanent damage to the kidneys.

How can stricture be diagnosed ?

Stricture of the urethra can be identified by a simple test called uroflowmetry which shows a plateau sort of a curve in such patients. Once the diagnosis has been made based on uroflowmetry, a study call retrograde urethrogram can be performed to delineate the exact size of the stricture and its length.

What are the treatment options for management of stricture ?

Structure of the urethra can be managed by open surgery which is called urethroplasty or a small endoscopy surgery called optical internal urethrotomy or OIU. Sometimes small strictures can also be managed by repeated dilatations.

How is OIU performed ?

Optical internal urethrotomy requires the placement of a cystoscope into the urethra to visualise the stricture. Once the site of narrowing has been delineated a knife which is fitted within the cystoscope is introduced and the narrow path is cut open. Usually this procedure can be performed under local anaesthesia and the patient tolerates the procedure well. After the procedure has been performed a catheter can be placed in the urethra for 5 days to allow healing of the stricture.

Procedure Timeline:

• 1: You will first be introduced to the private room and made to change into a patient gown.
• 2: Based on the type of anaesthesia that you choose for your surgery and intravenous line will be placed on your hand.
• 3: You will be explained about the risks and complications of the operation and the anaesthesia and subsequently shifted to the operating theatre.
• 4: In the operating room you will be made to lie on a table with your legs lifted on stirrups.
• 5: The appropriate anaesthesia will be administered.
• 6: Lubricating anaesthetic jelly will be introduced into the urinary pipe in a painless fashion which will numb the urinary pipe.
• 7: The penis and adjoining areas will be cleaned to prevent infection.
• 8: A cystoscope will then be introduced and the procedure performed as described earlier.

Duration of the Procedure

The duration of the procedure is usually 5 to 10 minutes. The stay in the hospital will be about 2 to 4 hours. After the procedure you will be shifted back to your room and observed for half an hour.

Post- operative course after OIU

• 1: After the procedure has been performed you will be observed for sometime and subsequently discharged home on a urinary catheter.
• 2: You will be prescribed medicines which will include pain killers, antibiotics and antacids.
• 3: You will be requested to report back to the hospital in the event of excessive bleeding, pain, swelling and fever.
• 4: A temporary dressing will be applied over the penis which can be removed once you reach home.
• 5: You can take bath the very next day and continue your daily routine activities including light work.
• 6: After 5 days you will be call back to the outpatient department and the catheter will be removed.
• 7: Subsequently you will be taught how to perform self-calibration of the urethra so that the opening in the urinary pipe can be maintained.

What are the Complications of OIU ?

Some common after optical internal urethrotomy include bleeding, infection and fever. Rare complications include swelling of the scrotum and penis, injury to the urethra and The adjoining structures with or without formation of a fistula and recurrence of the structure. Very rarely there may be injury to the bladder and bleeding that may require blood transfusion.