Postradiation fistulas are the severe complication of the treatment of oncological disease with the rate 1-10% after radiation therapy. Evidence related to the treatment of postradiation fistulas, being complicated problem, is sparse. Efficacy of the surgical interventions is relatively low, although the operation technique and suture materials are evolving. The recurrence rates could be in the range from 15 up to 70%; this leads to repeated surgeries. At that closing the fistula in recurrent setting is becoming more complicated with every next intervention, while the scarring of the operation zone could be prominent and the scars itself more crude, leading to the problems with blood microcirculation and healing disturbances. The main aggravating factors during the reconstructive operations due to postradiation fistulas are reduced blood supply of tissues, significant reduction in the bladder volume, involvement of the pelvic ureters in the scarring, wide defects of the bladder fundus and problems with urine derivation. The timing of the operation is crucial, therefore primary reconstruction is recommended not earlier than 12 months after fistula formation due to the necessity of postradiational tissue reaction stabilization. All these considerations warrant further development of the therapy approaches in patients with postaradiation urogenital fistulas.