Vesicovaginal fistulas (VVFs), as well as other urogenital fistulas, are very debilitating to patients. Early referral to individuals experienced in the management of fistula should be made, as the first repair attempt has the highest chance of closure via the vaginal route. Successful repair can be expected in 80–90% of patients, but multiple surgeries may be required. Surgical treatment of benign pelvic condition causes approximately 90% VVF with total abdominal hysterectomy being the most common cause. The best management of urogenital fistulae, other than prevention, is the recognition and repair of the injury at the primary surgery. The timing of fistula repair is dependent on the surgical-readiness of the surrounding tissue. If the tissue is healthy, early repair can be done. Abdominal repair of VVF is indicated in cases of high and inaccessible fistula, multiple fistula, involvement of uterus or bowel and the need for urethral reimplantation.