Prof. Dr. Emel Akoğlu
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- 57+years exp.
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Kidney & Bladder
Internal urethrotomy (dviu)
What internal urethrotomy (DVIU) is, how the surgeon cuts a urethral stricture under direct vision, what the evidence says about recurrence, who is better suited to urethroplasty, approximate costs in Turkey against the UK, US and Germany, catheter and recovery timelines, risks and the questions to ask a urology clinic.
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Prof. Dr. Zerrin Biçik Bahçebaşı
UrologyVerified
- 37+years exp.
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Internal urethrotomy (DVIU) in Turkey: what it is and how it works
Internal urethrotomy (DVIU), short for direct vision internal urethrotomy, is a keyhole operation for a urethral stricture, a scar that narrows the tube carrying urine out of the bladder. A thin telescope (urethroscope) is passed along the urethra, the surgeon sees the scar on a screen and cuts through it with a small blade or a laser fibre. The cut lets the scar open up so urine can pass freely again. No skin incision is made.
A stricture shows itself as a slow, thin or split stream, straining, a feeling of incomplete emptying, repeated urinary infections or, in the worst case, being unable to pass urine. This guide explains what internal urethrotomy (DVIU) does, how often strictures return, who should consider a different operation, what it costs in Turkey compared with the UK, US and Germany, and what recovery looks like. Urology departments in Turkey also offer related procedures; see our overview of urology treatments in Turkey.
What causes a urethral stricture, and when is DVIU used?
Strictures form when the lining of the urethra is injured and heals with scar tissue. Common causes are a previous catheter or instrument, infection, a fall onto the perineum, radiotherapy, an earlier prostate operation (see our guide to laser prostate surgery) and inflammatory skin disease of the penis, which can narrow the opening at the tip and is sometimes dealt with together with circumcision. Often no cause is found.
DVIU is mainly used for short strictures, usually under about 2 cm, that have not been treated before and sit in the bulbar urethra (the section behind the scrotum). For these it is quick, done through the natural passage and can be repeated. Long, dense or repeatedly recurring strictures behave differently, which is why the next sections matter.
How is the DVIU operation done, step by step?
Before surgery the urologist confirms the stricture with a flow-rate test, a urethrogram (an X-ray with contrast dye) and often a look inside with a flexible cystoscopy. A urine culture is checked and any infection is treated first.
- Anaesthesia: spinal or general anaesthesia is usual; some short strictures are treated under local anaesthetic gel with sedation.
- Visualisation: the urethroscope is advanced until the narrowed segment is seen as a pale ring or slit.
- The cut: a cold-knife blade (often called the Sachse method) or a holmium or diode laser fibre divides the scar, normally at the 12 o'clock position, until healthy tissue appears and the scope passes through into the bladder.
- Catheter: a silicone catheter is left in so that the cut heals open while urine drains. It usually stays between two and five days, longer in some cases.
The operation takes 15 to 40 minutes. Many patients go home the same day or after one night, but when travelling abroad most people stay until the catheter is out and urine flows well.
Does internal urethrotomy (DVIU) actually work, and how often does the stricture return?
DVIU relieves symptoms in most people at first, but the scar frequently returns because the cut is not removed, it only heals open. Published studies and urology guidelines such as those from the European Association of Urology report that a first DVIU cures roughly half to six in ten short, first-time strictures, with better results for short bulbar strictures and worse results for long, penile or previously treated strictures. A second or third repeat gives progressively less benefit. Because of this, guidelines advise that after one failed DVIU or dilatation, a different approach, usually urethroplasty, should be discussed rather than repeating the same operation many times.
That honesty matters when you compare quotes. A trustworthy clinic will explain the chance of recurrence for your stricture length and location, and will not describe DVIU as a one-time permanent cure.
DVIU, dilatation or urethroplasty: which suits which stricture?
These are the three main options for a urethral stricture. The table lists what each is best suited to and where it falls short.
| Option | Best suited to | Typical limits |
|---|---|---|
| DVIU (internal urethrotomy) | First short bulbar stricture, under about 2 cm | High recurrence; repeats give less benefit |
| Urethral dilatation | Mild strictures, or maintenance between treatments | Temporary; some patients need repeat visits or self-dilatation |
| Urethroplasty (open reconstruction) | Long, dense or recurrent strictures | Larger operation, longer catheter time and recovery |
Urethroplasty removes the scar and rebuilds the urethra, often with a patch of cheek or penile skin, and has the highest long-term success, but it needs a surgeon who does the operation regularly. For a first short stricture, many urologists begin with DVIU and move on only if it returns. This is a decision for you and the surgeon after imaging.
What does internal urethrotomy (DVIU) cost in Turkey compared with the UK, US and Germany?
The ranges below are approximate for the whole procedure, not hospital quotes. Each hospital confirms its own price in a written quote.
| Country | Approximate cost range |
|---|---|
| Turkey | €1,200 – €3,500 |
| United Kingdom | €2,500 – €6,500 |
| United States | €5,000 – €15,000 |
| Germany | €3,000 – €7,000 |
What changes the price: cold knife or laser, the type of anaesthesia, how many nights you stay, the pre-operative imaging and the catheter and follow-up visits. A package usually includes the consultation, tests, surgery, anaesthetist, hospital stay, medication and airport transfers; ask for it in writing, and ask whether a second visit is included if a catheter problem arises.
Who is a good candidate for DVIU, and who should consider something else?
DVIU is reasonable if you have a short, first-time stricture proven on imaging, a urine culture that is clear and no other reason to prefer reconstruction. You are better advised to discuss urethroplasty first if the stricture is long or in the penile urethra, has returned after one or more treatments, followed radiotherapy, or involves a complex scar. Strictures caused by prostate enlargement or bladder-neck narrowing need a different operation. If you take blood thinners or have an untreated urine infection, the surgery may need to wait.
What is the catheter like, and how long is recovery?
Expect mild burning when passing urine, a few days of blood-stained urine and a feeling of urgency, usually settling within one to two weeks. The catheter comes out after two to five days. Most men travelling for DVIU plan five to seven nights in Turkey so the stream can be checked after catheter removal and so any early bleeding or retention is dealt with by the team that operated. Desk work is usually possible after about one week; avoid heavy lifting, cycling and sex for around two weeks, or as advised.
Some surgeons teach intermittent self-catheterisation or self-dilatation for a few weeks to keep the channel open, which can lower the chance of recurrence. If you may need it, ask to be taught before you fly home. Our page on how the process works explains how follow-up with your home doctor is arranged.
What results can I realistically expect?
Success is judged by the flow rate and symptoms rather than by a visual change. Many men notice a stronger, straighter stream within days of catheter removal. A flow test a few weeks later puts a number on it. Recurrence, when it happens, usually appears within three to twelve months as the stream slows again. Do not wait for complete retention before telling a doctor; a falling stream after DVIU is a reason to get the flow measured. Ask the clinic how it follows patients abroad and who will see you if the stricture returns.
What are the risks of internal urethrotomy (DVIU)?
Common effects are blood in the urine, burning, catheter discomfort and urinary infection. Less often there is bleeding that needs a longer catheter, temporary difficulty passing urine after the catheter is removed, a false passage made by the instrument, and erectile changes or penile curvature after cutting in the penile urethra. Rarely there is incontinence or sepsis. The NHS and the European Association of Urology both state that strictures commonly recur after DVIU. Antibiotic cover and a clean urine culture before surgery reduce infection risk. Sexual function is usually unchanged, but ask the surgeon whether your stricture location raises any concern.
How do I choose a urologist and hospital, and what are the red flags?
Look for a urologist in a licensed hospital who treats strictures regularly, offers or can refer for urethroplasty if DVIU is not suitable, performs the procedure with an anaesthetist and can explain your imaging. Red flags include a promise that DVIU is permanent, no urethrogram or cystoscopy before booking, no mention of recurrence, a quote with no breakdown and pressure to pay a deposit. Send your report and imaging through the free quote page and the hospital replies with a written plan and price.
Questions to ask the clinic:
- How long and where is my stricture, and is it a first treatment?
- Will you use a cold knife or a laser, and why?
- What is the chance of recurrence for a stricture like mine?
- How many nights should I stay, and when is the catheter removed?
- Should I learn self-dilatation, and what supplies do I need?
- If it returns, can you offer urethroplasty, and what would that cost?
Hospitals with Urology in Turkey
Frequently asked questions
DVIU, or direct vision internal urethrotomy, is a keyhole operation in which a surgeon cuts a urethral stricture from inside the urethra with a small blade or laser, guided by a telescope. It widens the narrowed tube so that urine can pass normally.
It relieves symptoms in many people, especially with short first-time strictures, but the scar often returns. Guidelines report that roughly half to six in ten first treatments succeed, and repeat DVIU is less effective each time.
Approximate ranges are €1,200 to €3,500 in Turkey, compared with about €2,500 to €6,500 in the UK. The price depends on knife or laser, the anaesthesia, nights in hospital and follow-up, and is confirmed in a written quote.
Usually two to five days, sometimes longer, so that the cut heals open while urine drains. Most people travelling abroad stay until the catheter has been removed and they are passing urine well.
You are under spinal or general anaesthetic, or sedated, during the operation. Afterwards expect burning when passing urine, catheter discomfort and some blood in the urine, which usually settle within one to two weeks.
It can. Recurrence is common and usually shows within three to twelve months as a slowing stream. Self-dilatation advised by your surgeon may lower the risk, and urethroplasty is the usual next step if it returns.
DVIU is a simpler first option for a short first-time stricture. Urethroplasty rebuilds the urethra and has the best long-term success for long or recurring strictures. Your surgeon should explain the choice using your imaging.
Most men return to desk work after about a week, and avoid heavy lifting and sex for around two weeks. Burning and blood-stained urine usually fade within a couple of weeks.
It is a common and generally safe procedure when performed in a licensed hospital, but risks include infection, bleeding, a false passage and recurrence. A urine culture before surgery and a clear aftercare plan reduce problems.
Plan five to seven nights so that the catheter can be removed, the stream checked and any early bleeding or retention managed by the team that operated before you fly home.
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