Medical professionals agree that hydrophilic single-use catheters are the safest option for individuals requiring clean intermittent catheterisation. Medical aids are, however, unwilling to cover the cost.
Following a spinal cord injury (SCI), one of the greatest challenges is to manage incontinence. Urinary incontinence and the management of the paralysed bladder are sub-specialities within rehabilitation medicine and are normally the domain of the rehabilitation medical professional or a urologist with a sound understanding of the needs and challenges of the patient.
About 30 years ago, the morbidity and mortality rates among SCI persons were high, mainly as a result of poor understanding of the neuropathic bladder and the different management strategies required for each newly injured individual. Today, medical professionals have a greater understanding of the neuropathic bladder and its management – which is not a one-size-fits-all scenario.
A debate is raging between medical aid funds and the prescribers and users of catheters for clean intermittent catheterisation (CIC). Currently, if your bladder is suited to emptying by CIC, either by yourself or with the assistance of a care attendant, there are several options available regarding the type to be used. The choice of catheter could have a significant cost impact.
The most cost-effective means of CIC is with a non-coated PVC catheter. These are normally supplied by the state, but the lack of a coating can cause problems such as urethral injury and infection. The non-coated PVC catheter is designed to be used once but is often reused.
There are also reusable silicone-coated catheters that need to be changed usually every three to four months (but sometimes are used for up to six months), which are the next best option when it comes to cost. These catheters cost in the region of R350 to R700 each, depending on where they are sourced. However, unless managed with due care particularly in regard to cleanliness, these can lead to an increased risk of infection and bladder stones.
Today, thanks to medical advances, a series of catheters designed for single use that are sterile and pre-lubricated (hydrophilic single-use catheters) have become available. These are easier to use and more convenient. They are regarded as “the gold standard”, as infection rates are reduced and the user’s long-term bladder and kidney health is better preserved. In an ideal world, everyone requiring CIC would use hydrophilic single-use catheters.
However, these hydrophilic single-use catheters can cost up to R35 each. Their use should be covered under the prescribed minimum benefits (PMB) portion of a medical aid fund, but, while both the prescribers and the users of hydrophilic-coated catheters agree on their benefits, prescribed minimum benefits legislation directs the funder to cover costs only in relation to what the state would supply in the same circumstances.
Some funders are now prepared to pay for a limited number, but, hopefully, in the near future, more funders will approve them and single-use hydrophilic catheters will become the norm.
Dr Ed Baalbergen is the medical officer at the Vincent Pallotti Rehabilitation Centre (Cape Town) and is a member of the International Spinal Cord Society and the Southern African Neurological Rehabilitation Association. email: ed.baalbergen@lifehealthcare.co.za
