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Genitourinary fistulae (GuF) are one of the oldest described causes of incontinence. They are associated with significant social and psychological debilitation. In developed countries, they most commonly occur after iatrogenic injury to the urinary tract during gynaecological surgery for benign conditions, whereas in developing countries the most common cause remains prolonged obstetric labour. The most frequent type of GuF occurs between the bladder and vagina. GuF require careful evaluation to confirm the diagnosis and assess the number, location, and anatomy of defects, as well as any associated injuries before operative management is undertaken. The surgical approach to each fistula is individualized and relies upon the use of healthy vascularized tissue to repair defects, preferably with interposition of a tissue flap to augment repairs.

Urinary incontinence (UI) is a highly prevalent and bothersome problem that affects men and women of all ages. The aetiological spectrum of UI is wide, encompassing dysfunctions of the lower urinary tract, its neural control, the pelvic floor as well as other factors such as the side effects of pharmacotherapy. Although not life-threatening, UI frequently impacts upon the quality of life, psychological and emotional well-being of affected individuals. Additionally, UI imposes a tremendous economic burden on both the individual and the wider society in costs of nursing care, treatments, and lost productivity. The purpose of this chapter is to provide a broad overview of the epidemiology, aetiopathophysiology of UI, and to discuss the approach to the assessment, investigation, and initial management of the patient presenting with UI.

Urethral diverticula (UD) are not uncommon, affecting up to 6% of the female population, but are in the majority of cases asymptomatic and of no clinical significance. They are thought to arise as a consequence of infection, obstruction, and subsequent rupture of a periurethral gland. UD often pose a significant diagnostic challenge, as symptoms are largely non-specific and easily confused with other conditions such as bladder pain syndrome and recurrent urinary tract infection. As such, both misdiagnosis and delayed diagnosis are common, to the frustration of both patients and surgeons. Traditional methods of diagnosis, such as voiding cystourethrogram, relied upon urethral catheterization and contrast instillation, and were associated with poor anatomical detail. Recent advances in imaging, particularly magnetic resonance imaging, have improved the diagnosis and staging of UD, and have allowed for more accurate preoperative planning.