Cystometric evaluation of elderly nursing home patients with indwelling urinary catheters

Due to uncertainties concerning the use of indwelling urinary catheters in institutionalized patients, 15 catheterized nursing home patients (10 women, 5 men, mean age = 85.7 years) were evaluated with cystometric studies in order to determine bladder function. The reasons for indwelling catheter use documented in the medical records were urinary retention (n = 12), urinary incontinence (n = 1) and the promotion of pressure ulcer healing (n = 1). In one case, no reason for catheterization was recorded. Five patients had non-contractile bladders while 2 had voluntary bladder contractions of low amplitude. Three other patients had voluntary bladder contractions, although 2 of them had elevated voiding pressures, suggesting bladder outlet obstruction. All 3 of these patients had their catheters removed. (The 2 patients with elevated voiding pressures received treatment of the obstructions.) The remaining 5 patients had involuntary contractions of the bladder. It is uncertain whether the finding of involuntary bladder contractions can be used to predict the ability of the bladder to empty. Patients with voluntary bladder contractions without evidence of bladder outlet obstruction probably will not experience difficulty after the catheter is discontinued. Patients with evidence of bladder outlet obstruction will need additional intervention prior to catheter removal. Patients with a poorly contractile or a non-contractile bladder would need to be closely monitored for the development of urinary retention after discontinuation of the catheter. An evaluation of urinary function should be undertaken in any nursing home patient with unclear reasons for catheterization.