Bladder fistulas: A urological crisis in poorer countries

Bladder fistulas are a serious and often overlooked health problem. They happen when there is an abnormal hole between the bladder and another part of the body, usually due to childbirth complications. In wealthy countries, this condition is very rare because women have good access to safe childbirth and surgery. But in many poorer countries, especially in parts of Africa and South Asia, bladder fistulas are still common.

For example, in Uganda, around 140,000 women are currently living with this condition. In Bangladesh, there are about 70,000 new cases every year. The European Association of Urology (EAU) is working to bring more attention to this issue and push for better care and prevention around the world.

What is a vesicovaginal or bladder fistula?

A vesicovaginal or bladder fistula is an unusual passage between the bladder and the vagina, that leads to the uncontrollable leaking of urine. In most cases, the cause comes from prolonged obstructed labour, where a woman is in labour for several days without access to emergency obstetric care such as caesarean section. The sustained pressure cuts off blood supply to the bladder and vaginal walls, which causes healthy tissue to die and a fistula to form.

A vesicovaginal, or bladder, fistula is a condition where a hole forms between the bladder and the vagina. This causes urine to leak out uncontrollably.

The most common cause is long, difficult labour that goes on for days without medical help, like a C-section. The baby’s head presses against the mother’s pelvis for too long, cutting off blood flow to the bladder and vaginal walls. Without enough blood, the tissue dies and a hole (fistula) forms.

From a urological perspective, this condition is catastrophic: women suffer from relentless incontinence, urinary tract infections, skin breakdown, and in severe cases, kidney damage. Psychologically and socially, the consequences are often worse — affected women can be isolated, stigmatised, and abandoned by their families and communities.

A widespread problem in the Global South

While bladder fistulas are rare in first world countries, the situation is alarmingly different in parts of the developing world:

• In countries like Ethiopia, Nigeria, South Sudan, and the Democratic Republic of Congo, thousands of new cases occur each year.
• The World Health Organization estimates 50,000 to 100,000 new obstetric fistula cases annually, with millions of women living untreated due to lack of surgical services.
• In Afghanistan, Bangladesh, and parts of rural India, early marriage and adolescent pregnancies combined with poor access to healthcare further drive incidence.
• In areas affected by conflict or humanitarian crises, health systems can collapse. This often results in higher rates of birth injuries — including bladder fistulas.

What’s more concerning is that many of these cases remain untreated for years, if not a lifetime. This is largely due to a lack of trained urologists or fistula surgeons, inadequate surgical infrastructure, and socio-economic barriers to care.

Europe’s responsibility in a global context

Although Europe has largely eliminated obstetric fistula through investment in safe maternity care, we cannot afford to view this condition as a problem of the past or of distant regions. 

Support can take many forms:

• Collaborative training programs for local surgeons in high-burden countries.
• Deployment of mobile surgical teams to rural or post-conflict areas.
• Donations of equipment and resources to hospitals in need.
• Research and publication to keep fistula on the global urological agenda.

Ending obstetric and bladder fistulas is possible with timely obstetric care and treatable with competent urological surgery. 

Conclusion

Bladder fistulas remain a tragic reality for many women in low-resource settings, highlighting deep global inequalities in maternal and surgical care. Addressing this crisis requires sustained collaboration, support, and shared knowledge—reminding us that improving women’s health worldwide is a responsibility that crosses all borders.