Management of urinary retention after surgical repair of hip fracture.
OBJECTIVE
To compare the use of indwelling catheters and intermittent catheterization in the management of urinary retention after surgical repair of hip fractures.


METHODS
Randomized open trial.


METHODS
Orthopedic unit in a general hospital.


METHODS
Patients 60 years or more admitted to hospital for surgical repair of a hip fracture between November 1986 and December 1987. Of the 76 who were eligible and agreed to participate 5 became medically unstable, 2 died before surgery, and 2 did not have urinary retention after surgery. The remaining 55 women and 12 men were randomly assigned to one of two treatment groups.


METHODS
An indwelling catheter inserted preoperatively was removed 48 hours after surgery (group 1); the procedure was repeated if necessary after 24 hours. Intermittent catheterization was performed every 6 to 8 hours (group 2); the frequency was adjusted to avoid bladder distension.


METHODS
Pattern of return to satisfactory voiding within 5 postoperative days.


RESULTS
Of the patients in group 1, 37% resumed voiding within the 5-day postoperative period, as compared with 66% in group 2 (p less than 0.025). The mean numbers of days for return to satisfactory voiding were 9.4 and 5.1 respectively (difference 4.3 days, p less than 0.01, 95% confidence interval 0.7 to 8.0 days). Urinary tract infections developed in 31% of those in group 1 and 38% of those in group 2; the difference was not significant.


CONCLUSIONS
Satisfactory voiding resumes earlier with the use of intermittent catheterization, if begun at the onset of urinary retention and repeated at regular intervals, than with the use of an indwelling catheter in elderly patients who have undergone surgical repair of hip fractures.
Skelly
J M
JM
Faculty of Nursing, Department of Medicine, McMaster University, Hamilton, Ont.
Guyatt
G H
GH
Kalbfleisch
R
R
Singer
J
J
Winter
L
L
D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000592:standards*; D002985:Clinical Protocols / Q000592:standards; D005260:Female; D006620:Hip Fractures / Q000150:complications*; D006769:Hospitals, General; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D016016:Proportional Hazards Models; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology