Introduction: The management of uro-genital fistulas of gynecological and obstetrical origin is a common practice in urology. This study aimed to investigate the epidemiological, clinical, and therapeutic aspects of these fistulas at the CNHU HKM in Cotonou. Patients and Methods: This was a retrospective, descriptive, and cross-sectional study examining the epidemiological, clinical, and therapeutic aspects of uro-genital fistulas of gynecological and obstetrical origin at the CNHU HKM in Cotonou from 2013 to 2023. Results: A total of 94 cases were collected during the study period. The average annual incidence was 12.6 cases, with a range from 1 to 37 cases. The most affected women were primarily traders (24.47%), aged between 25 and 45 years (76.59%), uneducated (43.62%), multiparous (68.09%), and with low financial income (48.94%). Uro-genital fistulas were predominantly vesico-vaginal fistulas (72.34%), mostly secondary to cesarean sections (54.26%), with 52.13% of these procedures performed urgently. Surgical treatment was predominant in 47.87% of cases. The surgical approach included 41.48% of cases treated through vaginal repair and 41.48% through abdominal repair. The success rate of surgical interventions was 87.23%. Conclusion: The management of uro-genital fistulas of gynecological and obstetrical origin remains a challenge for urologists in Africa.