Scrotal oedema: a misadventure of direct vision internal ure
The present case has been reported in the journal BMJ case reports.

A 30-year-old man presented with voiding lower urinary tract symptoms for 2 years due to bulbar urethral stricture. He had a history of appendectomy two and a half years ago during which he was catheterised. His retrograde urethrogram was suggestive of a short (<1 cm) bulbar urethral stricture.

After proper counselling, he was posted for direct vision internal urethrotomy (DVIU) under spinal anaesthesia. Immediately following the procedure, he developed scrotal oedema. Perineal compression was given along with scrotal support. The patient was observed for 2 days in the ward; there was no increase in the oedema.

He was subsequently discharged with an advice to keep a scrotal support and called on the 10th postoperative day. His oedema had completely resolved and his catheter was removed. He voided with a good flow rate of 27 mL/s and had a normal bell-shaped curve on uroflow with no residual urine. He was advised to do intermittent self-dilation two times per week. He is doing well 4 months after the procedure.

Learning points
• Direct vision internal urethrotomy (DVIU) is one of the most common procedures for bulbar urethral strictures and is best suited for strictures <1 cm in length with minimal spongiofibrosis.

• Complications usually occur when the procedure is more than usually traumatic, and the best way to prevent them is to place a guidewire and proceed with small stepwise cuts under vision at 12 o’clock with minimal use of the bulb irrigator.

• Scrotal oedema after DVIU is mostly managed conservatively with scrotal support and perineal compression.

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Dr. S●●●●●●●h T●●●i and 1 others like this
Dr. S●●●●●●●h T●●●i
Dr. S●●●●●●●h T●●●i Urology
The extravasation of urine may occur after a DVIU for stricture, especially after multiple' s important to know that on such cases - less is more. Overzealous incisions into corpora may cause such complications..also the long term fibrosis is also greater..
Sep 4, 2018Like