As the nursing home population expands, the number of patients exposed to the risks of chronic indwelling urinary catheters will increase. The physician must therefore be familiar with the characteristic findings in such patients and be able to recognize complications as they arise. Mechanical or local problems, such as asymptomatic bacteriuria, catheter blockage, nondeflatable balloon, and chronic cystitis, are very common. Further studies are needed to define optimum measures to control these problems. The clinician must be aware that pyuria and bacteriuria are universal and not helpful in diagnosis of infection in this population. Use of chronic antibiotics is not recommended and there is no evidence to support elaborate daily care regimens, such as antibiotic ointments or irrigations. Careful consideration of the indications for catheter use on a long-term basis may reduce the population at risk. Physician awareness of the possibility of life-threatening complications, such as squamous cell carcinoma, bacteremia, and bladder perforation, can help avoid serious consequences of the use of urinary drainage devices.