Each year, millions of Americans diagnosed with bladder dysfunction, primarily older adults in acute-care hospitals, long-term care settings, or their homes, use a urinary drainage system (UDS) to drain and collect urine. A UDS can be an integral part of managing urinary retention and urinary incontinence in certain patients, but the actual number of patients who use a catheter indefinitely to manage urinary incontinence or because of chronic urinary retention has not been well documented in the medical or nursing research. The care of UDS has traditionally been the domain of nursing staff, who assume responsibility for the majority of catheterization procedures and subsequent management. Despite this, knowledge of UDS management is often poor and rarely supported by evidence-based research. This article will provide an overview of the current indications, complications, and management of the indwelling UDS.