DVIU Vs Urethroplasty: by Sanjay Kulkarni and Pankaj Joshi
Jing Shen published an article in BMC Urology about cost effective comparison between DVIU and Urethroplasty. The conclusion was DVIU is more cost effective.
Every patient in the world, irrespective of type of Health Care or Finances, deserves the correct treatment. Finances should not govern the patient care. Recurrent admissions, multiple surgical procedures burden the healthcare. If there is a single surgical procedure which can offer long term success, it should be performed. This holds true for DVIU versus Urethroplasty.
Role of DVIU:
DVIU is to be avoided in the penile and membranous urethra.
The ideal indication of performing DVIU today is for short segment (<1 cm) non traumatic bulbar urethral stricture.
Performing repeated DVIU makes the stricture longer and dense. Santucci et al studied the long-term success of DVIU. Success rates were no higher than 9% in this series for first or subsequent urethrotomy during the observation period. Most of the patients in this series will be expected to experience failure with longer follow-up and the expected long-term success rate from any (1 through 5) urethrotomy approach is 0%. Urethrotomy should be considered a temporizing measure until definitive curative reconstruction can be planned (1).
Ideal Instrument: DVIU for anterior urethra should be performed by cold knife. Lasers should be used for DVIU for anastomotic strictures after failed pelvic fracture urethral surgery.
Site of DVIU: The concept of DVIU is to create a gap between the epithelium and hope for primary healing. In bulbar urethra, sponge is most wide at 6 0 Clock position. At 12 O clock position, there are the corpora. DVIU at 12 o Clock position can injure the corpora, lead to bleeding and rarely ED. At 6 o clock there is wide sponge. This allows the urethral margins to expand and allow healing. Turner Warwick, Father of Urethroplasty recommended performing DVIU between 4-8 oâ€™clock.