Urinary fistula

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.