This report concerns an extremely rare type of fistula, a vesicouterine fistula, in a 59-year-old female occurring twenty years following brachytherapy for cervical cancer. The patient presented with a history of recurrent urinary tract infections, sensation of incompletely emptying the bladder, nocturia and constant leakage of urine for several months. Cystoscopy revealed a fistulous opening and an exophytic lesion on the posterior bladder wall. Contrast computerized tomography demonstrated a fistulous tract between the posterior bladder wall and the anterior aspect of the uterine cavity. She underwent a hysterectomy, excision of the bladder fistula and interposition of a vascularized rectus muscle graft. Histology of the cervix and bladder only revealed inflammatory changes with no evidence of malignancy. The diagnosis and investigation of this extremely rare condition are discussed, and the management strategies outlined.