We report a case of complicated urethravesicovaginal fistula for 15 years. A 50 years old woman presented with continous urine leakage after home delivery which first took place 15 years ago after a delivery at home. She had a small and contracted bladder with urethravesicovaginal fistula. We developed a vaginal flap which was constructed as a tube to make a new urethra. The new urethra from vaginal tube was anastomosed to the repaired bladder base and external urethral meatus. The reconstruction was supported by Martius flap. Simple anatomic repair of complicated fistulas are not promising and should be avoided. Vaginal flaps and labial flaps are useful for reconstructing urethra and bladder base.

Keywords: complicated fistula, vaginal flap, martius flap, reconstruction