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VIU (Visual Internal Urethrotomy)
Visual Internal Urethrotomy (VIU) is an endoscopic procedure that incises a urethral stricture under direct visual guidance — providing immediate improvement in urinary flow with no external incisions, making it the first-line minimally invasive treatment for appropriate urethral stricture presentations.
Overview
Visual Internal Urethrotomy (VIU) is the endoscopic counterpart to optical urethrotomy, using a rigid urethrotome with an integral telescope and light source to navigate to the stricture under direct vision and incise the fibrotic scar tissue under continuous visual control. The procedure is identical in principle and technique to DVIU, both using direct vision to guide the knife or laser to the stricture, but the terminology VIU is used interchangeably with DVIU in many centres. VIU achieves the best outcomes in short-segment bulbar urethral strictures in patients who have not previously undergone urethrotomy, with recurrence rates below 30% at 2 years for first-time treatments of suitable anatomy.
Types of Visual Internal Urethrotomy
VIU encompasses cold knife and laser variants, with some centres preferring specific technologies for their haemostatic or precision advantages.
- Cold Knife VIU (classic technique — incision at 12 o'clock position)
- Holmium Laser Urethrotomy (precise laser incision with simultaneous haemostasis)
- KTP Green Light Laser Urethrotomy (vaporisation of stricture tissue)
- VIU with Mitomycin C Application (anti-fibrotic agent applied to incision site to reduce re-scarring)
- VIU Followed by Self-Catheterisation (post-procedure intermittent self-catheterisation programme)
Risk Factors for Urethral Stricture
The risk factors for urethral stricture requiring VIU treatment are the same as those for all urethral stricture disease.
- Previous urethral catheterisation or endoscopic procedure
- Gonococcal or non-gonococcal urethritis
- Straddle or perineal trauma injury
- Lichen sclerosus causing obliterative stricture disease
- Hypospadias repair complication
- Previous radiotherapy to the pelvis or prostate
Urethral Stricture Symptoms
These symptoms indicate urethral stricture disease requiring uroflowmetry and urethrographic assessment before VIU.
- Progressively diminishing urinary stream
- Urinary hesitancy and straining to void
- Post-void dribbling and sense of incomplete emptying
- Recurrent urinary tract infections
- Urgency and frequency from incomplete bladder emptying
- Acute urinary retention requiring emergency catheterisation
- Reduced maximum flow rate below 10 mL/s on uroflowmetry
- Retrograde urethrogram demonstrating urethral narrowing
Key Benefits
Discover the advantages of choosing our viu (visual internal urethrotomy) services.
Immediate urinary flow improvement noticed from the day of catheter removal
No external incisions or wound management required after the procedure
Same-day discharge with return to normal activities within 24 to 48 hours
Well-tolerated procedure with minimal post-operative discomfort
Appropriate first-line endoscopic treatment for suitable short-segment urethral strictures
Clinical Features
The technology, techniques and clinical approach behind our viu (visual internal urethrotomy).
Retrograde urethrogram reviewed immediately before VIU to confirm stricture length and location
12 o'clock incision position consistently targets the fibrotic scar while protecting ventral spongiosum
Incision extended the full length of the narrowing confirmed by scope advancement through the treated segment
Catheter duration individualised based on stricture characteristics and any planned CISC programme
Day-case procedure — most patients discharged the same day after catheter placement
Preparation Instructions
After VIU, follow the same post-procedure care as optical urethrotomy — maintain the catheter for the full prescribed period and attend follow-up uroflowmetry at 3 and 6 months. For patients on a self-catheterisation programme, strict compliance with the frequency and technique taught by the urology nurse is essential for maintaining the opened urethral lumen. Contact your urology team promptly for deteriorating flow, recurrent infections, or difficulty passing the catheter during the self-catheterisation programme.
The Procedure
Step-by-step guide to what you can expect during your viu (visual internal urethrotomy) procedure.
Retrograde Urethrogram Review
Your urologist reviews the retrograde urethrogram to confirm the stricture location, length, and density — planning the scope entry approach and the precise length of incision required to divide the full extent of the fibrotic scar completely.
Lithotomy Position and Sterile Preparation
You are positioned in the lithotomy position with legs supported in stirrups. The urethral meatus and penile shaft are cleaned with antiseptic solution and draped sterily for the endoscopic procedure.
Direct Vision Urethroscopy to the Stricture
The VIU instrument — a rigid sheath with an integrated telescope — is passed through the urethra under direct vision to the anterior face of the stricture under adequate illumination and magnification.
Precise Knife Incision at 12 O'Clock
A retractable knife is extended from the instrument tip and a controlled incision is made through the stricture at the 12 o'clock position — extending the full length of the fibrotic segment until normal pliable urethral mucosa is encountered at both ends of the incision.
Full-Length Incision Confirmation
The scope is advanced through the incised area under direct vision to confirm the incision extends the complete length of the narrowing and that the urethral lumen has opened to an adequate calibre throughout the treated segment.
Catheter Placement and Instruction
A urethral catheter is inserted and a personalised decision is made on duration — typically 1 to 3 days for most strictures. Patients on an intermittent self-catheterisation programme have their catheter schedule specifically discussed and documented before discharge.
What to Expect
VIU is performed under general or spinal anaesthesia and takes 20 to 30 minutes. The urethrotome is navigated under direct vision to the stricture site, a precise incision is made through the scar at 12 o'clock, and a urethral catheter is left in place for 24 to 72 hours. Most patients are discharged the same day and notice immediate improvement in urinary stream after catheter removal.
Frequently Asked Questions
Common questions about viu (visual internal urethrotomy).
Related Services
Explore other services in our Urology department.
Nephrectomy Open
Optical Urethrotomy
Nephrectomy Laparoscopic
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