Reduction Cystoplasty

Abstract

Reduction cystoplasty is a surgical intervention aimed at reducing bladder capacity to a ‘normal’ range. Although removing bladder tissue to improve functional outcomes seems counterintuitive, the premise can be explained in relation to Laplace’s law. This law states that P = k*T/R, where P is the cavitary pressure, k is a constant, T is the wall tension, and R is the radius of the chamber. Assuming wall tension remains constant, intraluminal voiding pressure should increase by 25 % if the volume is decreased by half. Commonly employed techniques of reduction cystoplasty include transection and resection of the superior bladder dome (Klarskov et al.), vesicoplication (Stewart et al.) and detrusor wrap (Zoedler et al.). Documented evidence of the therapeutic benefit of this procedure is scant with numerous small case series with variable pathology, diverse surgical approaches to both the bladder and outlet and with very limited follow-up. Long term studies fail to demonstrate a sustained benefit and suggest reduction cystoplasty has limited long term effects on bladder volume. Overall, reduction cystoplasty has not been definitively proven to yield long-term success in most patients and its use remains debatable.