A vesicovaginal fistula (VVF) is an epithelialized or fibrous communication between the bladder and vagina. It represents a distressful and difficult situation for both the patient and the physician. This debilitating condition has plagued women with obstructed labor and traumatic delivery for thousands of years. The first recorded references of VVFs were made in 1550 BC in ancient Egypt.1 Avicenna, renowned Arabic physician, was the first person to document the relationship between VVFs and obstructed labor in 1037.2 The first reference in European literature to urinary fistulas was made by Platter in 1597.3 Many attempts at fistula closure followed. However, successful cases were rare. Over many decades, the principles of treatment slowly began to emerge. In 1852, James Marion Sims established the foundations of VVF repair after a series of experimental surgeries on slaves beginning in 1845 in Montgomery, Alabama.4 These fundamentals included proper exposure with the knee-chest position, use of a weighted vaginal retractor, silver wire sutures, tension-free closure of the defect, and proper postoperative bladder drainage.

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