Urethrovaginal fistula (UVF) is an abnormal connection between the urethra and vagina. UVF may occur postpartum and are associated with operative vaginal delivery, after surgery for urethral diverticulum, anterior vaginal wall prolapse, or urinary incontinence, and after radiation therapy (1). It is a rare complication in the developed world and is most often due to iatrogenic injury from pelvic surgery (2). 
Here we present a video of UVF repair  with Martius flap.

A 27-year-old female patient who developed UVF after a vaginal delivery one year ago and had previously undergone two unsuccessful UVF surgeries.
The urethra was carefully mobilized from the lateral walls together with the paraurethral tissues. Fibrotic and devitalized tissues were excised to reach healthy margins. A 16 Fr Foley catheter was inserted to maintain luminal calibration. The urethral mucosa was reconstructed from the bladder neck distally using interrupted 4-0 polyglactin (Vicryl) sutures over the catheter. Meticulous mucosal approximation with slight eversion allowed the creation of a well-calibrated neourethra. Following urethral reconstruction, the bladder mucosa was everted toward the vestibular region to ensure anatomical continuity.
Martius Flap Interposition
To enhance vascular support and reduce recurrence risk, a Martius labial fat pad flap was prepared. A 6 cm vertical incision was made along the medial aspect of the left labium majus. The approximately 8 cm flap was tunneled subcutaneously into the vaginal field and placed  over the urethral structure  It was secured to the urethral reconstruction site and surrounding periurethral tissues using 3-0 Vicryl sutures.  Finally, procedure was completed with the insertion of both a suprapubic and urethral catheters

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The operating time was 90 minutes. There were no intraoperative or postoperative complications. Patient was discharged on post op day 3. The urethral catheter was removed on postoperative day 7. However,  the suprapubic catheter was maintained for 3 weeks then removed after  cystoscopic evaluation demonstrated a patent urethra with intact mucosal continuity. 
At 3 months follow up, patient was asymptomatic and sexual active without any problem.

UVF repair with Martius flap  is an effective technique with no significant complications. The success of surgery is depend on surgeon experience.

Marshall VF, Jeffs JD, Sarafyan WK: Urogenital sinus abnormalities in the female patient. J Urol 122:508, 1979
Wong MJ, Wong K, Rezvan A, et al. Urogenital fistula. Female Pelvic Med Reconstr Surg. 2012