Introduction and Hypothesis <p>Urogenital fistulas are rare but severe complications of gynecological surgery, mainly hysterectomy, with a major impact on quality of life. This study aimed to evaluate the management and outcomes of urogenital fistulas treated in a tertiary referral center, with a focus on vesicovaginal fistulas (VVF) and prognostic factors for surgical success.</p> Methods <p>We retrospectively reviewed all patients managed for urogenital fistula in our institution between January 2010 and December 2024 in a French university hospital. Clinical, etiological, surgical, and functional outcomes were analyzed. Subgroup analysis was performed on patients with VVF to identify predictors of surgical success.</p> Results <p>Among 131 patients identified, 67 were confirmed with urogenital fistulas: 39 VVF (58.2%), 12 urethrovaginal (17.9%), 11 ureterovaginal (16.4%), and five vesicouterine fistulas (7.5%). Median age at diagnosis was 49&#xa0;years [IQR 43–62] and median BMI 27&#xa0;kg/m² [IQR 24–31]. Most cases followed hysterectomy (58%) or other pelvic surgery (26.1%), while 11.6% were obstetric. Primary success after the index repair was 80.6%, while definitive closure was ultimately achieved in 92.5% of patients. In vesicovaginal fistulas, primary success was 89.7%. Predictors of failure included prior radiotherapy (75% vs 10.8%, <i>p</i> = 0.012), oncological etiology (<i>p</i> = 0.013), and longer surgical delay (12&#xa0;months vs 6&#xa0;months, <i>p</i> = 0.027). Major complications (Clavien ≥ III) occurred only in failures (50% vs 0%, <i>p</i> = 0.007).</p> Conclusions <p>VVF repair achieves high success rates in specialized centers. Radiotherapy, oncological etiology, and prolonged delay are significant risk factors for failure, underlining the importance of early referral and multidisciplinary management.</p>