Cystoclysis is NOT Indicated for Kidney Injury
Cystoclysis (bladder irrigation) has no role in the management of kidney (renal) trauma or acute kidney injury. The term refers to bladder-specific interventions and is not relevant to renal parenchymal or vascular injuries.
Management of Kidney Trauma
Non-Operative Management (Primary Approach)
- Non-operative management (NOM) should be the treatment of choice for all hemodynamically stable or stabilized patients with minor (AAST I-II), moderate (AAST III), and severe (AAST IV-V) renal lesions 1.
- Accurate classification requires CT scan with intravenous contrast and delayed urographic phases in hemodynamically stable patients 1.
- Isolated urinary extravasation alone is not an absolute contraindication to NOM in the absence of other indications for laparotomy 1.
Angioembolization (Interventional Approach)
- Angiography with super-selective angioembolization is indicated in hemodynamically stable or stabilized patients with arterial contrast extravasation, pseudoaneurysms, arteriovenous fistula, or non-self-limiting gross hematuria 1.
- Angioembolization should be performed as selectively as possible to preserve renal function 1.
- Recent evidence demonstrates that angioembolization significantly reduces transfusion needs and preserves renal function better than conservative approaches alone (40% vs. 25% function preservation; p = 0.009) 2.
- In solitary kidney with moderate or severe trauma showing arterial contrast extravasation, angiography with eventual super-selective angioembolization should be considered as first choice 1.
Operative Management (Reserved for Specific Indications)
- Hemodynamically unstable and non-responder (WSES IV) patients should undergo operative management 1.
- Severe renal vascular injuries without self-limiting bleeding require operative intervention 1.
- The presence of non-viable tissue (devascularized kidney) is NOT an indication for operative management in the acute setting absent other indications for laparotomy 1.
Bladder-Specific Interventions (Not Kidney Injury)
When Cystoclysis/Bladder Drainage IS Indicated
The confusion may arise from bladder trauma management, which is distinct from kidney injury:
- Uncomplicated extraperitoneal bladder injuries may be managed non-operatively with urinary drainage via urethral or suprapubic catheter 1.
- Intraperitoneal bladder rupture requires surgical exploration and primary repair 1.
- After surgical management of bladder injuries, urinary drainage with urethral catheter is mandatory in adults 1.
Critical Distinction
Kidney injuries and bladder injuries require fundamentally different management approaches. Bladder drainage (which might be loosely termed "cystoclysis" in older terminology) addresses bladder trauma or urinary diversion needs, not renal parenchymal or vascular injuries 1. For kidney trauma specifically, the management hierarchy is: NOM first, angioembolization for active bleeding, and operative management only for hemodynamic instability or specific vascular injuries 1.