All about bladder health

In this edition of Spinal WA eNews,


The big issue of the bladder

As most of you reading this will be absolutely aware, bladder problems and urinary tract infections (UTIs) are rated as among the greatest long-term challenges people with spinal cord injury (PwSCI) face. The bladder won't drain as and when you'd like it to, but may empty at will when you don't... bringing frustration and costing valuable time and money to keep up with catheters, ongoing tests, treatments, and appointments. And UTIs can be devastating, hard to get rid of and a major way to land you back in hospital.

A multi-disciplinary team tackling UTIs through research

        Louise Goodes                Prof Sarah Dunlop             Gabby Simpson
                                School of Biological Sciences, UWA

My colleagues and I formed the SCI Research Team (SCIRT – such an apt acronym for our all-female squad!), focusing our energies on understanding the neurogenic bladder better and, through research, doing something tangible to reduce UTIs. Our collaborative research recently demonstrated that inpatient bladder care is of a very high standard in WA, closely reflecting published evidence, and many PwSCI living in the community continue to tap into the vast expertise held by our Spinal Urology clinicians. But the system isn’t perfect. We also learned that many have experienced various obstacles to accessing or fully benefiting from this care.

Clinical research is so hard to do!

I could write a very tedious book on the challenges of securing funding and jumping across the endless red tape required before even starting a project in our hospitals. But getting into the actual research is brilliant and gratifying. One shiny gem out of the long rough of applications and baseline studies is that we now know very early UTIs after SCI can set people up for higher numbers of ongoing UTIs. Findings like this enabled us to meet the publishing challenge – so vital if there’s any chance of attracting funding for the next step – in this case, preventing those first infections. (If you’d like to read more on our early research, please see our paper: Goodes et al, 2019)

A WA clinical trial of a new approach to prevent early UTIs  

With a better understanding of the issues surrounding SCI bladder health in WA, and after more paperwork than you might possibly imagine, we are now undertaking a clinical trial of a promising new treatment. It involves getting in early – during the first 10 days after SCI – and replenishing the naturally protective ‘GAG’ layer of the bladder wall, which starts breaking down immediately after SCI. Our first patient has just enrolled, and we hope that preventing early UTIs will minimise further infections and bladder-related
 complications throughout his recovery journey. Here you can read more about ‘GAG’ therapy, which has helped reduce UTIs in other patient groups.
Image: GAGs, short for glycosaminoglycans   

The diverse lived experience of SCI bladder health and self-care

As well as working in the hospital with new patients, we continue to learn from the experts in SCI bladder health in the community – those actually going through it. If you’re reading this, please think about adding your story to the mix. We’re conducting over-the-phone interviews and would really value your input. Gift cards are provided as a thank you to those helping us build an accurate picture of what is working well – and what is not – when it comes to ongoing post-SCI bladder management.
But what else do we know so far??

With all this work still ongoing, I’m sure PwSCI just want to hear what our research has uncovered that’s actually useful now! This is fair and so here are some pearls of our wisdom (lol):
  • Intermittent catheterisation (IC) at least every 6 hours, combined with balancing fluids to keep bladder volumes under 500ml, is the "best practice" way to empty the bladder for many PwSCI. Suprapubic catheterisation may be more suitable for those with limited hand function.
  • If you are on self-IC, a high bladder volume (≥800mls) and temporary IDC are both associated with increased risk of UTI during the week following.
  • PwSCI in the WA community experience a range of barriers to optimal bladder care and support
From research to rolling out real change

By sharing everything we learn with policy and decision-makers in WA Health and other agencies, and continuing to work with our brilliant WA doctors and nurses, the knowledge will inform the design of targeted education and treatment programs to improve bladder health and quality of life for people impacted by SCI now and in the future.

Article written by Louise Goodes, Clinical Research Coordinator, Spinal Cord Injury at The University of Western Australia

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