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The occurrence of a vesicovaginal fistula is rare in the developed world, and usually follows gynaecological surgery for benign conditions. In the developing world it is still a common occurrence, usually as a result of prolonged labour, foetal demise and ischaemic necrosis of the vaginal and bladder walls. Regardless of the cause, and accurate diagnosis and the most appropriate management for the fistula is important to define, whether it be by conservative therapy or a surgical approach. Most gynaecologists favour the vaginal approach to fistula repair, whilst urologists generally opt for an abdominal operation. Where other abdominal procedures are necessary an abdominal approach would be sensible. Surgery, if required should be performed by a surgeon trained in fistula repair, and there is an argument for referring such patients to a regional centre for treatment.