Surgical routes include: transvaginal route, transabdominal route and combined transabdominal-vaginal route. The site of the fistula is the most important basis for the selection of the surgical route. Taking the ureteral ridge of the bladder as the boundary, the posterior region of the bladder triangle, where the fistula is above the ureteral ridge, is in principle taken as the transabdominal route. Fistulas in the ureteral ridge below the bladder triangle, bladder neck and urethra to take the transvaginal route. For complex urogenital fistulas, which are difficult to repair by a single transabdominal or transvaginal route, a combined transabdominal-vaginal route can be chosen. Vesicovaginal fistulas can also be repaired by laparoscopic transabdominal route. The transvaginal route is a route that can be repeated several times, taking the transvaginal route of surgery on the patient less damage, shorter recovery time after surgery, can be carried out at the same time to combat incontinence or correct the prolapse of the operation, the failure of the repair of fashionable can be further choice of transabdominal surgery. The transabdominal route is simple and has a high success rate, but the postoperative recovery time is longer. Patients with extensive scar tissue around the fistula, small bladder capacity or low compliance urinary fistula requiring simultaneous intraoperative bladder enlargement, urinary fistula requiring simultaneous intraoperative ureteral grafting, complex urinary fistula involving other intra-pelvic structures, and combined vaginal stenosis with difficulty in exposing the fistula. Since vesicovaginal fistula repair involves both urology and gynecology, the success rate of fistula repair can only be improved by training physicians who specialize in pelvic plastic surgery.