Background: Direct visual internal urethrotomy (DVIU) and urethral dilatation are the most commonly performed procedures for urethral stricture disease. This approach is appealing both for urologists and patients as it is minimally invasive. The objective of this paper is to outline the current scientific evidence supporting this approach for its use in the management of urethral strictures in patients with multiple morbidities who would not tolerate prolonged surgeries well and to share our own experiences. Methods: We performed a retrospective study of cystoscopy-guided internal urethrotomies performed between 2009 and 2014 on patients with co morbid conditions. Results: Overall, urethral stricture stabilized in 76.7% of patients with 1 or 2 internal urethrotomies within 24 months of follow-up.Conclusion: Direct vision cold knife urethrotomy is a safe technique that should be exercised as a therapeutic trial in patients with co morbidities as an alternative giving a safer and easier option.