There are four main causes of vesicovaginal fistula: 1. gynecologic injury: excessive pressure on the bladder and vagina during obstructed labor or prolonged labor leads to vesicovaginal fistula; 2. surgical injury; 3. radiation injury, mostly after radiation therapy for gynecologic malignancies; 4. pelvic malignancy. It is common when advanced pelvic malignancies erode the bladder and vagina. The occurrence of vesicovaginal fistula can occur at the time of injury, or within days and weeks after injury. In developing countries, the most common cause is birth injury, obstructive delivery with prolonged labor due to fetal head-pelvis asymmetry, and fetal compression causing ischemic necrosis of the anterior vaginal wall, bladder, bladder neck, and proximal urethra. In developed countries, obstetrics and gynecology, urology and other pelvic surgery damage to the bladder is the main cause, the most common surgery is hysterectomy in obstetrics and gynecology, other surgeries are anterior vaginal wall suspension, anterior vaginal wall bulge repair and various types of urinary incontinence surgery. With the continuous improvement of economic and medical conditions in China at this stage, the number of vesicovaginal fistulas due to obstetric delivery injuries is decreasing year by year, while the number of vesicovaginal fistulas due to medically induced injuries, especially after total transabdominal hysterectomy (benign or malignant diseases), is significantly increasing.