Management of Urinary Retention Following Left Subcapital Hip Fracture

Prevalence and Risk Factors

• Postoperative cognitive dysfunction, which occurs in 25% of hip fracture patients, is a risk factor for urinary retention 1, 2

Pharmacological Management

• Oral opioids should be avoided to reduce the risk of urinary retention 1, 2
• The dose and frequency of intravenous opioids should be reduced to minimize the risk of urinary retention 1, 2
• Codeine should be avoided due to its constipating, emetic, and cognitive-impairing effects 1, 2
• Cyclizine should be used with caution due to its antimuscarinic side effects 4

Ongoing Management

• Urinary catheters should be removed as soon as possible to reduce the risk of infection 1, 2, 3
• Early oral fluid intake should be encouraged to prevent hypovolemia 1, 2, 3
• Multimodal optimization of postoperative care, including adequate analgesia, proper hydration, electrolyte balance, appropriate medication management, bowel habit management, and early mobilization, can help reduce the risk of urinary retention 1, 2

Common Pitfalls to Avoid

• The association between urinary retention and increased risk of delirium, which affects 25% of hip fracture patients, should not be overlooked 1, 2