Surgical repair is the primary treatment for urethral fistulae. If the patient presents with vaginal distention or fecal residue, further workup is needed to clarify the presence of a coexisting rectovaginal fistula. The basic principles of optimal urethral fistula repair are: (1) adequate exposure of the fistula, debridement, and removal of inactivated and ischemic tissue; (2) removal of foreign bodies (e.g., sutures, synthetic materials, etc.) whenever possible; (3) careful separation of the two organ gaps involved; adequate tissue freeing and tension-free sutures; (4) adequate hemostasis of the wound; (5) close sutures layer by layer at the appropriate anatomic level to avoid mislayer closure; (6) multiple layers of sutures (7) Intraoperative use of grafts with vascular tips if necessary; (8) Adequate urinary drainage after repair surgery; (9) Prevention and treatment of infection (appropriate antibiotics); (10) Correction of obstructive lesions, if present. Fistulas can recur if the tissue at the repair is ischemic and necrotic, and recurrent urinary fistulas are the most common and complex complication. Other delayed complications include altered vaginal morphology, small bladder syndrome, pubococcygeal inflammation, stress and urge incontinence, and difficulty with intercourse. Preoperative cystoscopy and vaginal examination are mandatory, in addition to a basic normal urinary routine, and there is no significant inflammatory edema around the fistula, with a high success rate of mature fistula repair surgery. A mature fistula is characterized by a clear size of the fistula hole and smooth edges of the fistula. (1) Fistulas caused by tumors or radiation therapy should not be repaired until the tumor is cured. (2) Urinary fistulas combined with bladder stones are not easily repaired. Stones can be removed via urethral lithotripsy or suprapubic cystotomy, not through the vaginal fistula hole. (3) Tuberculous urinary fistula should be treated with anti-tuberculosis treatment first, and repair surgery should not be performed during tuberculosis inflammation. (4) The bladder and vaginal inflammation are not easily repaired.