Uro-genital fistula is a debilitating condition that predominantly affects women in low-resource settings, often resulting from prolonged obstructed labor or iatrogenic injuries. This study aimed to assess the frequency of risk factors and patterns of uro-genital fistulas presenting in a tertiary care hospital, highlighting areas for intervention to improve maternal health outcomes. Methods A cross-sectional study was conducted at Lady Reading Hospital, Peshawar, from January 2023 to January 2024. A total of 110 patients diagnosed with uro-genital fistulas were included. Data on demographic characteristics, obstetric history, clinical presentations, and surgical outcomes were collected using a structured proforma. Descriptive statistics and chi-square tests were used for analysis, with a p-value <0.05 considered statistically significant. Results The majority of patients (47.3%) were aged 21–30 years, with 77.3% residing in rural areas. Most patients (71.8%) experienced prolonged obstructed labor, and 70.9% had not received antenatal care. Vesico-vaginal fistulas were the most common type, accounting for 77.3% of cases, followed by uretero-vaginal (13.6%) and recto-vaginal (7.3%) fistulas. Surgical repair was successful in 86.4% of patients, with complications observed in 22.7%. Complete functional recovery was achieved in 72.7% of cases. Conclusion Uro-genital fistulas remain a significant public health challenge in resource-limited settings, driven by preventable obstetric complications and inadequate access to maternal healthcare. Strengthening antenatal and emergency obstetric services, along with expanding access to skilled surgical care, is essential to reduce the burden of this condition.