On 29 July 2021, Dr Virgina Wilson spoke on the best practice recommended for bladder management in South Africa during a webinar, which was sponsored by the Southern African Spinal Cord Association (SASCA) and the QuadPara Association of South Africa (QASA). The discussion was based on a research paper published in 2019 by Dr Wilson and her team titled: Best Practice Recommendations for Bladder Management in Spinal Cord Afflicted (SCA) Patients.
The research paper aims to identify “significant gaps in practice, and challenges regarding levels of care and access to services and supplies specifically related to the neurogenic bladder”. The goal is to establish a standard of care and mitigate costly complications.
“Patients with spinal cord injuries are a small percentage of the population with a long-term disability,” Dr Wilson said during her address to over 100 healthcare workers.
“So, it is up to us, as clinicians, to really empower and engage with our individual patients to provide them with knowledge on managing their bladder to enable them to fight to receive the best bladder management services,” she added. She highlighted education as key to empowering patients.
“The best you can do is to educate the patient,” she noted, adding that it was important to respect the decisions of the patient, but that with better information, they would be able to make more informed decisions.
“The dangers of indwelling urethral catheters are not really discussed with the patients,” she shared. While they might seem less daunting for a patient, they can harmful. Instead, clean intermittent catheterisation is considered the gold standard.
Education goes beyond simply explaining the risks and benefits of certain bladder management methods. Medical staff also need to ensure that the patient is aware of how to correctly use the equipment. Doctors might prescribe clean intermittent catheters to patients, but the patients reuse them – a dangerous practice.
“There is absolutely no reason to re-use a catheter,” Dr Wilson stated passionately during her presentation. Among her own patients, Dr Wilson has seen individuals face up to 10 urinary tract infections per year by re-using their catheters.
Education is also a team effort. Dr Wilson encouraged doctors to lean on other medical staff (psychologists and counsellors) as well as peers to assist in communicating the risks and benefits with the patients – in a language that they could understand.
The full presentation by Dr Wilson can be viewed here: