The primary indication for an adult woman to undergo a transvaginal bladder neck closure is an eroded and destroyed bladder neck/urethra, often secondary to a chronic, indwelling catheter. Adequate mobilization of the urethra and bladder neck and removal of nonviable tissue allows for a tension-free and watertight, and multilayer closure. Surgical outcomes can be optimized by ensuring closure with a wide and well-vascularized vaginal flap and liberal use of intraoperative botulinum toxin or postoperative anticholinergics. The most common complication is vesicovaginal fistula, which often necessitates repeat closure with placement of a local flap or a transabdominal approach.