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Vesicovaginal fistula (VVF) formation represents a condition with devastating consequences for the patient and continues to pose a significant challenge to the surgeon. Quick and accurate diagnosis, followed by timely repair is essential to the successful management of these cases. A thorough understanding of the pathophysiology and anatomy of the fistula, potential factors that may compromise healing and experience in the fundamental principles of fistula repair are the vital tools of the fistula surgeon. This review was undertaken to provide an overview of the key areas in VVF investigation and management.