Study Objective To present a rare case and the difficult diagnosis and surgical approach of an urinary bladder fibroid. Design Case report for anatomical study and description of the procedure using video. Setting Under general anesthesia, dorsolithotomy position, arms alongside the body and legs abducted. Foley catheter was placed at the onset of the surgery. Patients or Participants 57, female, who had undergone total abdominal hysterectomy due to fibroids, complained of pelvic pressure pain and increased urinary frequency. Physical examination showed movable bulging in the anterior vaginal wall. MRI and Cystoscopy revealed a mass protruding into the posterior wall of the bladder. Initial hypothesis was a parasitic vaginal cuff fibroid. Interventions Using robot-assisted laparoscopy, we started by releasing adhesions and dissecting landmarks. Further, as the tumor localization was posterior to the bladder, we opted for identificating the vaginal cuff and dissecting the vesicovaginal space. However, the plan showed to be bloody and barely defined and the tumor seemed to be more caudal than it initially looked. At this point, a bladder tumor hypothesis was raised and we chose to try to access it transvesically, by making a cystotomy on the fundus of the bladder. As soon as we accessed the bladder and observed the tumor localization, we had to change our strategy once again, as the transvesical approach could harm the ureters on its implantation. The tumor was movable into the vagina when pushed by the laparoscopic forceps, so that our last move wasperforming a vaginal approach to resect the tumor, through a colpotomy on the anterior vaginal wall. Measurements and Main Results Patient had no surgical complications. She returned asymptomatic. The histologic diagnosis: leiomyoma with no signs of malignancy. Conclusion Leiomyoma of the bladder accounts for 0.43% of all neoplasm of the bladder. These tumors can be treated successfully using different surgical approaches, and has a good prognosis after complete resection.