From the Guidelines
Bladder training with a catheter in place after hip surgery is not typically helpful for a male who cannot void, as the primary approach should focus on addressing the underlying cause of urinary retention and removing the catheter as soon as possible to allow for spontaneous voiding and subsequent bladder training. The catheter should remain in place until the patient can void independently, which usually resolves within a few days post-surgery. According to the Canadian Stroke Best Practice Recommendations: Acute Inpatient Stroke Care Guidelines, update 2015 1, if used, indwelling catheters should be assessed daily and removed as soon as possible to minimize the risk of infections.
Some key points to consider in the management of urinary retention after hip surgery include:
- Addressing the underlying cause of urinary retention, which may be related to anesthesia, pain medications, or swelling from surgery
- Removing the catheter as soon as possible to allow for spontaneous voiding
- Implementing a bladder-training program after catheter removal, including timed and prompted toileting on a consistent schedule, as recommended by the Canadian Stroke Best Practice Recommendations: Acute Inpatient Stroke Care Guidelines, update 2015 1
- Considering medications like tamsulosin (0.4 mg daily) to relax the bladder neck and prostate, facilitating urination, if urinary retention persists
- Physical therapy focusing on pelvic floor exercises may also help once the catheter is removed, as it can help improve bladder control and reduce the risk of urinary incontinence.
It is essential to prioritize the removal of the catheter and the implementation of a bladder-training program to minimize the risk of urinary tract infections and other complications associated with long-term catheter use, as highlighted in the diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the infectious diseases society of America 1. By following these guidelines and prioritizing the patient's safety and well-being, healthcare providers can help reduce the risk of morbidity, mortality, and improve the patient's quality of life.
From the Research
Bladder Training with a Catheter
- The effectiveness of bladder training with a catheter in place after hip surgery is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that intermittent catheterization may be a better option than indwelling catheterization for patients with urinary retention after hip surgery, as it may reduce the risk of urinary tract infections 2, 3.
- One study found that simple nursing interventions, such as the sound of running tap water and caffeinated hot beverages, can reduce the need for bladder catheterization after total hip replacement 4.
- Another study found that alpha blockers, such as tamsulosin, can reduce the incidence of postoperative urinary retention and the need for catheterization after surgery 5, 6.
- The use of alpha blockers prior to removal of a urethral catheter for acute urinary retention in men may also improve the success rates of trial without catheter and reduce the incidence of adverse effects 6.
Intermittent Catheterization
- Intermittent catheterization may be a better option than indwelling catheterization for patients with urinary retention after hip surgery, as it may reduce the risk of urinary tract infections 2, 3.
- Patients who were treated with intermittent catheterization had earlier voiding satisfaction and did not have repeated urinary retention compared to patients with indwelling urethral catheter 3.
Nursing Interventions
- Simple nursing interventions, such as the sound of running tap water and caffeinated hot beverages, can reduce the need for bladder catheterization after total hip replacement 4.
- These interventions may help to induce voiding in patients with postoperative voiding difficulties and reduce the need for catheterization.