Urethrotomy and urethral dilation
Urethrotomy and dilation open a narrowed, scarred section of the urethra from the inside, using a tiny knife or a balloon passed through a scope, with no skin incision. A newer drug-coated balloon (Optilume) also leaves behind a medicine that slows the scar from closing again.
Also called DVIU, direct vision internal urethrotomy, internal urethrotomy, optical urethrotomy, cold knife urethrotomy, urethral dilation, stretching the urethra, balloon dilation of the urethra
- Where
- Outpatient surgery center or hospital operating room; some dilations are done in the clinic
- Anesthesia
- General or spinal anesthesia; numbing gel for some office dilations
- Time in the room
- About 20 to 45 minutes
- Hospital stay
- Same day
- Going home with
- A catheter for a few days in most cases (often 1 to 5 days)
- Back to normal
- A few days
- Back to work
- About 2 to 5 days
Overview
A urethral stricture is a ring or short segment of scar inside the urethra, the tube that carries urine out of the body. The scar narrows the channel, so the stream gets weak, slow or split, and the bladder may not empty fully.
These treatments open the scar from inside, through the tip of the penis, with no cuts on the skin. In a direct vision internal urethrotomy (DVIU), the surgeon looks through a scope and cuts the scar with a tiny blade. In a dilation, the scar is stretched open with a balloon or with smooth rods of increasing size. A drug-coated balloon, known by the brand name Optilume, stretches the scar and leaves behind a medicine called paclitaxel that helps keep scar tissue from growing back.
The procedures are quick and the recovery is short. The honest downside is that the scar often comes back. For a short, first-time stricture in the bulbar urethra (behind the scrotum), a single procedure may be all you need. Each time the scar returns and is treated the same way, the chance of lasting success goes down. AUA guidelines recommend that men whose stricture comes back be offered urethroplasty, an open repair with much better long-term results, rather than repeated cutting or stretching.
The drug-coated balloon was approved by the FDA in 2021 for shorter strictures (up to about 3 cm, a little over an inch) in adult men. It was studied mainly in men whose stricture had come back after an earlier treatment, and it did better than plain cutting or stretching in a randomized trial. Results beyond a few years are still being collected.
The parts of your body involved
The urethra runs from the bladder through the prostate and past the sphincter muscle, then behind the scrotum (the bulbar urethra) and along the penis to the tip. Strictures that respond best to these procedures are short scars in the bulbar urethra. The urethra is wrapped in a spongy layer of tissue (the corpus spongiosum). When the lining is injured, scar can form in this tissue and squeeze the channel.
- Bladder
Stores urine. It has to push harder to empty past a stricture.
- Bulbar urethra
The section behind the scrotum. Short strictures here do best with these procedures.
- Penile urethra
The section inside the penis. Strictures here tend to come back after cutting and are often better treated with urethroplasty.
- Sphincter
The muscle that holds urine in. The surgeon keeps the cut well away from it.
- Corpus spongiosum
The spongy tissue around the urethra. Deeper scar in this layer is a reason strictures return.
Why it’s done
These procedures are a reasonable first treatment for a short stricture, and an option for men who are not candidates for, or do not want, open surgery.
- A first, short stricture
For a scar under about 2 cm (under an inch) in the bulbar urethra, AUA guidelines list dilation, urethrotomy and urethroplasty as reasonable first choices.
- Symptoms of blockage
A weak or spraying stream, straining, a long time to empty, or feeling that you never fully empty.
- Infections or being unable to pee
A stricture can cause repeated urinary infections or sudden inability to pass urine.
- A short stricture that came back
The drug-coated balloon is designed for this situation, as an option alongside urethroplasty.
- Open surgery is not right for you
For men with serious health problems, or who prefer a smaller procedure and accept the chance of needing more treatment.
Other options
- Urethroplasty
An open repair that cuts out the scar or patches it with a graft from the inside of the cheek. A longer recovery, but the best chance of a lasting cure, especially for strictures that have come back.
- Self-dilation
After a cut or stretch, some men pass a soft catheter themselves on a schedule to keep the scar open. It helps while you keep doing it.
- Suprapubic catheter
A tube through the lower belly into the bladder bypasses the urethra. An option for men who cannot have further procedures.
- Watching
If symptoms are mild, you empty well and you have no infections, regular check-ups are reasonable.
Getting ready
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Weeks before
The week before
The day before and the morning of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep
You get an antibiotic through an IV. Most men have general anesthesia or a spinal. A simple dilation can sometimes be done in the clinic with numbing gel instead.
After the operation
Right afterward
- Waking up
You wake up quickly. Burning at the tip of the penis and pink urine in the catheter bag are common.
- Catheter teaching
A nurse shows you how to use the leg bag and night bag.
- Without a catheter
After a simple dilation, some men go home without a catheter once they have passed urine.
- Pain medicine
Pain is usually mild. Acetaminophen is often enough, sometimes with a medicine for bladder spasms.
- Going home
Most men go home the same day.
At home
- Catheter care
Keep the catheter secured to your thigh so it does not tug. Clean where it enters the penis with soap and water daily.
- Blood in the urine
Pink urine or a few drops of blood at the tip, especially with erections, are common for several days.
- Burning
Burning with the first few pees after the catheter comes out is common and usually settles in 1 to 2 days.
- Fluids
Drink enough to keep your urine pale yellow, unless you have been told to limit fluids.
- Activity
Light activity from the next day. Avoid heavy lifting, hard exercise and cycling for about 1 to 2 weeks, or as your surgeon advises.
- Self-dilation
If your urologist asks you to self-dilate, a nurse teaches you how. Keep to the schedule, which usually starts often and slowly spaces out.
- Sex
Wait about 1 to 2 weeks, or until bleeding has stopped. After a drug-coated balloon, use condoms for as long as your team advises.
- Driving and work
You can usually drive the next day if you are not taking opioid pain medicine. Most men return to work in 2 to 5 days.
Recovery timeline
- Day 0Procedure
A short procedure, and home the same day.
- Days 1 to 5Catheter out
The catheter comes out in the clinic or at home, as your team arranges. The first pees may sting.
- Week 1Settling
Burning and bleeding settle, and the stream is usually strong.
- Weeks 4 to 8First check-up
A urine flow test and bladder scan show how well the channel is working.
- 3 to 12 monthsWatching closely
This is when a stricture is most likely to start narrowing again, so check-ups continue.
- 1 yearFurther check
Symptoms and a flow test are reviewed.
- Long termKnow your stream
If your stream slows again, see your urologist early and ask about urethroplasty.
What it feels like
Most men find the procedure itself easy and the catheter days the most annoying part. The emotional side often comes later: watching your stream and wondering whether the scar is coming back.
Before the procedure
Relief that there will be no incision, mixed with unease about a scope in the urethra.
What helpsYou are asleep or numb for the procedure itself. Ask what your chances of lasting success are, so your expectations fit your situation.
Waking up
Burning at the tip of the penis, and with a catheter, a feeling of needing to pee.
What helpsPain medicine and spasm medicine help, and the feeling usually eases within a day.
The catheter days
Bladder cramps, blood-tinged urine and the awkwardness of a bag.
What helpsKeep the tube secured, wear loose clothes, drink well, and take spasm medicine as directed.
Catheter out
The first pees sting and may spray. Then many men are surprised at how strong the stream is.
What helpsDrink normally and give it a day or two. The burning fades quickly.
Learning to self-dilate
Passing a catheter yourself sounds daunting, and the first tries feel awkward.
What helpsUse plenty of lubricant, breathe slowly and relax. A nurse will coach you. For most men it becomes quick and routine.
The months after
Some men find themselves noticing every slow stream and wondering if the scar is back.
What helpsKeep your follow-up visits and flow tests. If the stricture does return, there are good options, including urethroplasty.
How well it works
Success means a strong stream that lasts without another procedure. Results depend most on how long the scar is and how many times it has been treated before.
- A first, short stricture
Results vary widely between studies. Some men stay open for years after a single procedure, but many see the scar return, most often within the first year or two. Short scars in the bulbar urethra do best.
- Repeat treatments
If the scar comes back and is cut or stretched again, the chance of lasting success drops with each repeat. That is why guidelines recommend offering urethroplasty after a recurrence.
- The drug-coated balloon
In the main randomized trial, which enrolled men whose strictures had come back after earlier treatment, about 3 in 4 men treated with the drug-coated balloon had an open urethra on a camera check at 6 months, compared with about 1 in 4 after standard cutting or stretching. Longer follow-up suggests the benefit lasts for many men.
- How it is checked
Your symptoms, a urine flow test and a bladder scan after you pee. A cystoscopy if anything looks off.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Common for several days.
Usually settles in 1 to 2 days after the catheter is out.
Common while a catheter is in.
The most common problem, especially after repeat procedures and for longer scars.
Less common
Treated with antibiotics.
Fluid used during the procedure can seep through the cut into nearby tissue and cause swelling of the penis or scrotum that settles in a day or two.
Repeated cutting or stretching can lengthen the scar, which can make a later urethroplasty more involved.
Uncommon. Reported more often after deep cuts.
Rare
The scope or wire makes a channel outside the true urethra. It usually heals with a catheter.
Very rare, mainly when the stricture is close to the sphincter muscle.
A bloodstream infection that needs hospital treatment is rare.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- You cannot pee after the catheter comes out, or the catheter stops draining and your bladder feels full and painful
- Bright red urine with clots, or bleeding that soaks through your clothes
- The catheter falls out in the first days. Call your urology team, and do not let anyone else push a new one in
- Swelling of the penis or scrotum that keeps getting bigger, redder or more painful
- Burning with urination along with fever or pain in your side
- Your stream slowing down again over weeks or months. This is not an emergency, but book a visit
Questions to ask your surgeon
- How long is my stricture, and where is it?
- Is a scope procedure my best option, or should I consider urethroplasty now?
- Given my scar and history, what are the chances this lasts?
- Will you cut, stretch, or use a drug-coated balloon, and why?
- How long will I have a catheter?
- Will I need to self-dilate afterward, how often, and for how long?
- Does the drug-coated balloon affect fertility or my partner?
- Is the drug-coated balloon covered by my insurance?
- How will we know if the stricture is coming back?
- If it comes back, will you refer me to a reconstructive urologist?
Words you may hear
- Urethral stricture
- A section of scar that narrows the urethra.
- DVIU
- Direct vision internal urethrotomy: cutting a stricture from the inside through a scope.
- Cold knife
- A tiny blade that cuts without heat.
- Dilation
- Stretching a narrowing open with a balloon or smooth rods.
- Drug-coated balloon
- A dilation balloon coated with medicine that slows scar regrowth.
- Paclitaxel
- The medicine on the drug-coated balloon. It slows the growth of scar-forming cells.
- Guidewire
- A thin, flexible wire passed through a narrowing to guide instruments safely.
- Self-dilation
- Passing a soft catheter yourself on a schedule to keep a stricture open.
- Urethroplasty
- Open surgery to repair a stricture, with the best long-term results.
- Retrograde urethrogram
- An X-ray taken while dye is gently put into the urethra from the tip of the penis.
- Uroflow
- A test that measures how fast urine comes out.
- Post-void residual
- Urine left in the bladder after you pee, measured with a quick ultrasound.
- Recurrence
- The stricture narrowing again after treatment.
Common questions
Is this a cure?
Sometimes. For a short first stricture, a single procedure can last for years. Many strictures do come back, though, and the chance of lasting success falls with each repeat.
Why not just repeat it each time the stricture comes back?
Each repeat is less likely to last, and repeated cutting can lengthen the scar. Guidelines recommend offering urethroplasty after a recurrence because it has much better long-term results.
Is the medicine in the balloon chemotherapy?
Paclitaxel is also used, at much higher doses, as a chemotherapy drug. The balloon delivers a small amount into the wall of the urethra and does not cause chemotherapy side effects such as hair loss. Because traces can appear in semen for a short time, men are usually asked to use condoms for a period afterward.
Will I need a catheter?
Most men have a catheter for a few days after a urethrotomy or a drug-coated balloon. After a simple dilation, some men go home without one.
How soon can I go back to work?
Most men return in 2 to 5 days, sometimes with the catheter still in.
Can I still have urethroplasty later if this does not work?
Yes. Urethroplasty remains possible and works well, although earlier referral after a recurrence keeps the repair simpler.
Sources this page draws on
- American Urological Association (AUA), Urethral Stricture: AUA Guideline
- European Association of Urology (EAU), Guidelines on Urethral Strictures
- The Journal of Urology, Urethrotomy has a much lower success rate than previously reported (2010)
- The Journal of Urology, One-year results for the ROBUST III randomized controlled trial evaluating the Optilume drug-coated balloon for anterior urethral strictures (2022)
- Urology Care Foundation, Urethral Stricture Disease
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.