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The pelvis is not only a functional bone but has great importance in obstetrics. Because of bipedal locomotion, the shape and size of the pelvis became more straight. In this situation the only way to delivery large brained fetus is that the fetal head has to perform complex rotation and turning movements (cardinal movements) during the progress in the birth canal. The problem may arise from cephalopelvic disproportion (CPD) that is present when the fetal head is too large to pass through the pelvis. CPD and related obstructed labor is responsible for 2–8% of maternal mortality worldwide and furthermore can cause poor progress of labor and can be indication for operative vaginal delivery (OVD) or primary cesarean section (CS).

Vesicovaginal fistula is a rare but feared complication of hysterectomy and other major pelvic surgery in the developed world; it is a devastating complication of obstructed labor in the developing world. This chapter presents a representative case and reviews the preoperative evaluation and surgical technique required to assure successful repair. Vesicovaginal fistula presents an ideal challenge to the surgeon versed in native tissue repairs as traditional, time-honored procedures remain the gold standard.