The onset of a ureterovaginal fistula is a not frequent, though it represents a dreaded and disabling complication of the pelvic surgery. The literature suggests to perform ureteroneocystostomy associated, if necessary, with a bladder suspension technique to Psoas muscle, or endoscopic procedures of ureteral stenting as the "gold standard" to repair this condition. We describe an innovative combined anterograde trans-nephrostomic and retrograde trans-ureteral surgical approach successfully carried out for the treatment of a rare ureterovaginal fistula associated with ipsilateral hydroureteronephrosis secondary to a complete obliteration of the ureteral orifice. We believe that this approach could be considered as a minimally invasive surgical option, an alternative to the traditional ones, for the repair of ureterovaginal fistulae complicated by a complete obliteration of the ipsilateral ureteral meatus.