Vesico-vaginal fistula (VVF) is the most common type of acquired urinary fistula. A fistula is formed anywhere between the genital and urinary tracts. In developing countries, the majority of fistulas are caused by birth injuries, and the main cause of VVF is obstructive delivery with prolonged labor due to fetal head-pelvic asymmetry and fetal compression causing ischemic necrosis of the anterior vaginal wall, bladder, bladder neck, and proximal urethra. In contrast, in developed countries, the main cause of VVF formation is due to damage to the bladder from pelvic surgery such as obstetrics and gynecology and urology. Other causes of VVF include malignancy, pelvic radiotherapy, tuberculosis, and medically corrosive urinary fistulas. Simple and complex fistulas are classified according to the ease of treatment. A simple fistula is a single fistula with a hole less than 0.5 cm that is not caused by radiotherapy; a complex fistula is a fistula that has failed to be repaired, has a hole greater than 2.5 cm, or is located in the proximal urethra, bladder neck, or bladder triangle, usually caused by chronic disease, malignancy, synthetic sling exposure, or radiotherapy; fistulas Urethral fistulas with a diameter between 0.5 cm and 2.5 cm are usually classified as complex fistulas.