Direct visual internal urethrotomy (DVIU) is a minimally invasive treatment for urethral stricture and is usually done in lithotomy position. We presented a case of a 35-year-old man with complex deformities of both lower limbs from birth. The lower limbs were severely wasted with ankylosis of the hips, flexion of the knee joints and dorsiflexion at the ankle joints. He had a history of progressively worsening difficult in urination characterized by frequency, urgency, urgency incontinence, nocturia, poor urinary stream (improved by straining), intermittency and feeling of incomplete bladder emptying. He had occasional dysuria and total hematuria. He was not a known hypertensive or diabetic patient. No history of trauma, previous urethral instrumentation, and no history of purulent urethral discharge before the onset of problems. On presentation, his abdomen was full with slight suprapubic distention. The anal sphincter was spastic and the prostate was not enlarged. He had normal non-circumcised male external genitalia. There was no spinal deformity and the upper limbs were normal. White cell count was 14,000 cells/ mm3 with a differential neutrophil of 85.5% and urine culture showed moderate growth of coliforms. Abdominopelvic ultrasound showed a thickened bladder wall with mild hydronephrosis bilaterally and a retrograde urethrography and micturating cystourethrography showed 3 short segment bulbar urethral strictures. There was also a Christmas tree appearance of the bladder. A diagnosis of bladder outlet obstruction secondary to multiple short segment idiopathic bulbar urethral strictures on background neurogenic bladder was made. He had intravenous antibiotics for 48 hours and subsequently a DVIU under spinal anesthesia and in the supine position. Catheter was removed on the 7th day post procedure and he started clean intermittent catheterization (CIC) with 12 French catheters. Seven months post procedure, patient is still satisfied with the outcome of his treatment. We concluded that DVIU can be done safely in the supine position and CIC can help improve post procedure outcome and in managing comorbid neurogenic bladder.
D. Dubey, “The current role of direct vision internal urethrotomy and self-catheterization for anterior urethral strictures,” Indian J Urol, vol. 27, no. 3, pp. 392-396, Jul. 2011.
A. M. Harraz, A. El-Assmy, O. Mahmoud, A. A. Elbakry, M. Tharwat, H. Omar, H. Farg H, M. Laymon, and A. Mosbah, “Is there a way to predict failure after direct vision internal urethrotomy for single and short bulbar urethral strictures?,” Arab J Urol, vol. 13, no. 4, pp. 277-281, Dec. 2015.
D. Darlington, “A Novel Method of Local Anesthesia for Optical Internal Urethrotomy,” Cureus, vol. 11, no. 10, pp. e6043-e6043, Oct. 2019.
G. Barbagli, N. Fossati, F. Montorsi, S. Balò, C. Rimondi, A. Larcher, S. Sansalone, D. Butnaru, and M. Lazzeri, “Focus on internal urethrotomy as primary treatment for untreated bulbar urethral strictures: results from a multivariable analysis,” Eur Urol Focus, vol. 6, no. 1, pp. 164-169, Jan. 2020.
A. Jhanwar, A. K. Sokhal, K. Singh, S. Sankhwar, and D. K. Saini, “Assessment of quality of life in patients of urethral stricture on clean intermittent catheterization following direct vision internal urethrotomy,” Urol Ann, vol. 10, no. 4, pp. 395-399, Oct. 2018.
V. Kumar, S. Dharwadkar, C. Doshi, and A. Batta, “Role of intermittent self catheterization in prevention of recurrence of stricture urethra following visual internal urethrotomy: a prospective single centre study,” Int J Surg, vol. 6, no. 4, pp. 1093-1096, Mar. 2019.
L. Liao, “Evaluation and management of neurogenic bladder: what is new in China?,” Int J Mol Sci, vol. 16, no. 8, pp. 18580-18600, Aug. 2015.
K. Sureshkumar, P. K. Shukla, A. P. Gaharwar, M. Jeswani, and S. Sahu, “Role of visual internal urethrotomy in the management of short segment urethral stricture in male,” Int J Surg Sci, vol. 4, no.1 pp. 74-77, 2020.
A. G. Cavalcanti, and G. Fiedler, “Opinion: endoscopic urethrotomy,” Int Braz J Urol, vol. 41, no. 4, pp. 619-622. Aug. 2015.
J. Furr, and J. Gelman, “Endoscopic Management of Urethral Stricture Disease and Bladder Neck Contractures,” J Endourol, vol. 34, no. S1, pp. 7-12. May 2020.
M. G. Yenice, K. G. Seker, E. Sam, Y. Colakoglu, F. A. Atar, S. Sahin, A. Simsek, and V. Tugcu, “Comparison of cold-knife optical internal urethrotomy and holmium: YAG laser internal urethrotomy in bulbar urethral strictures,” Cent European J Urol, vol. 71, no. 1, pp. 114-120, 2018.
S. Yeşil, A. Atan, and F. Polat, “A method that facilitates urethral catheterization after internal urethrotomy,” Turk J Urol, vol. 45, no. S1, pp. S125-S127, Dec. 2019.
G. G. Ferguson, T. L. Bullock, R. E. Anderson, R. E. Blalock, and S. B. Brandes, “Minimally invasive methods for bulbar urethral strictures: a survey of members of the American Urological Association,” Urology, vol. 78, no. 3, pp. 701-706, Sept. 2011.
P. Albers, J. Fichtner, P. Bruhl, and S. C. Muller, “Long-term results of internal urethrotomy,” J Urol, vol. 156, no. 5, pp. 1611-1614, Nov. 1996.
A. Chandra, and S. K. Singh, “Internal Urethrotomy for Anterior Urethral Strictures, its Place in the Current Management of Stricture Disease and Role of CSIC in Prevention of Recurrence,” JAMDSR, vol. 7, no. 11, pp. 168-170, Nov. 2019.
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