The repair of a urethral-vaginal fistula complicated by stress incontinence is demonstrated with the combined surgical technique of transvaginal needle suspension and urethral-vaginal fistula repair utilizing a vaginal flap technique. The technique of the modified Pereyra transvaginal needle suspension with bone fixation to the pubic tubercle is demonstrated. After the needle suspension is completed, the urethral-vaginal fistula repair is performed with a transvaginal technique. The fistula is closed in three layers utilizing the vaginal flap advancement technique in conjunction with a Martius labial fat graft to reinforce the fistula repair site. Simultaneous surgical correction of both the stress incontinence and the urethral vaginal fistula eliminated both problems for this patient.