What is the next step after placing a Foley (urinary) catheter for urinary retention following a hip fracture?

Management of Urinary Retention Following Hip Fracture: Next Steps After Foley Catheter Placement

Urinary catheters should be removed as soon as possible after placement to reduce the risk of urinary tract infection. 1, 2

Immediate Post-Catheterization Management

• Remove the Foley catheter within 24-48 hours after placement to minimize the risk of urinary tract infection 3
• Encourage early oral fluid intake rather than routine intravenous fluids to prevent hypovolemia and support normal bladder function 1, 2
• Implement a prompted voiding schedule based on the patient's pattern to retrain the bladder 3
• Perform intermittent catheterization every 4-6 hours to determine residual bladder volumes if retention persists after catheter removal 3

Monitoring and Assessment

• Monitor for signs of urinary tract infection, which is a common complication following catheterization in hip fracture patients 4
• Assess for return to normal voiding patterns, as patients managed with intermittent catheterization resume satisfactory voiding earlier (mean 5.1 days) compared to those with indwelling catheters (mean 9.4 days) 5
• Be vigilant for postoperative cognitive dysfunction, which occurs in 25% of hip fracture patients and can complicate urinary retention management 1, 2

Medication Management

• Avoid or minimize opioid use as they increase the risk of urinary retention 2
• Use caution with cyclizine due to its antimuscarinic side effects that can worsen urinary retention 1, 2
• Consider antimuscarinic medications only for patients with confirmed detrusor overactivity on urodynamic evaluation 3

Special Considerations

• Male patients have a threefold increased risk of postoperative urinary retention compared to females, requiring closer monitoring 6
• Younger patients (under 50) may also have higher rates of urinary retention following hip surgery 6
• Extended use of indwelling catheters is associated with increased risk of rehospitalization for UTI (60% higher odds) and mortality (30% higher odds) 4

Catheter Removal Protocol

1. For uncomplicated cases: remove catheter within 24-48 hours 3
2. Assess voiding pattern after removal:
   • If normal voiding resumes, continue monitoring output
   • If retention occurs, implement intermittent catheterization every 6-8 hours 5
3. Consider intermittent catheterization as the preferred approach for managing persistent retention, as it leads to earlier return of normal voiding compared to reinsertion of indwelling catheters 5, 7

Common Pitfalls to Avoid

• Leaving the catheter in place too long, which increases infection risk and delays return to normal voiding 1, 4
• Failing to address concurrent issues that contribute to retention (constipation, medication side effects, immobility) 2
• Not considering the impact of urinary retention on delirium risk, which affects 25% of hip fracture patients 2
• Overlooking the need for multimodal optimization of postoperative care, including adequate analgesia, hydration, electrolyte balance, and early mobilization 1, 2