Oral 5-aminolevulinic acid administration prior to transurethral resection of bladder tumor causes intraoperative hypotension: Propensity score analysis

Nakatani, Shohei; Ida, Mitsuru; Wang, Xiaoying; Naito, Yusuke; Kawaguchi, Masahiko

doi:10.1016/j.pdpdt.2021.102342

Cited by 9 publications

(9 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, it did not affect the occurrence of POD. Previous studies focusing on the relationship between intraoperative hypotension and POD had significant heterogeneity, thus generating conflicting results regarding the association between hypotension and POD [ 8 , 25 , 26 ]. Furthermore, although the exact mechanism of delirium is unclear, neuro-inflammation may play an important role in its development [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hypotension often occurs during anesthesia, but the impact of intraoperative hypotension on POD has not been fully investigated in non-cardiac surgery [8]. Additionally, TUR-BT using 5-aminolevulinic acid (5-ALA) has become a common procedure to facilitate the identification of an accurate resection range and this is associated with a risk of intraoperative hypotension [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Incidence and factors associated with postoperative delirium in patients undergoing transurethral resection of bladder tumor

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Postoperative delirium is an important complication after surgery, including urological surgery. This study evaluated the incidence of postoperative delirium and its associated factors after transurethral resection of bladder tumor in adult patients. Methods Patients aged ≥20 years who underwent elective transurethral resection of bladder tumor under general anesthesia from April 2016 to November 2020 were included. Patient demographic and intraoperative data, including the administration of 5-aminolevulinic acid and hypotension, defined as a mean arterial pressure value < 60 mmHg, were evaluated. The primary outcome was the incidence of postoperative delirium assessed using a chart-based method. The factors associated with postoperative delirium were explored using multiple logistic regression analysis. Postoperative lengths of stay between patients with and without postoperative delirium were compared using the Mann–Whitney U-test. Results Of 324 eligible patients with a median age of 76, 26 patients experienced postoperative delirium, with an incidence rate of 8.0% (95% confidence interval, 5.06–10.9). Age (odds ratio 1.13, 95% confidence interval 1.05–1.22, p = 0.001) and body mass index (odds ratio 0.83, 95% confidence interval 0.71–0.97, p = 0.02) were associated with postoperative delirium. Postoperative length of stay between patients with or without postoperative delirium was not significantly different (6 vs 6 days, p = 0.18). Conclusions The incidence of postoperative delirium after transurethral resection of bladder tumor under general anesthesia in this study was 8.0%. Older age and low body mass index were associated with development of postoperative delirium.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence and factors associated with postoperative delirium in patients undergoing transurethral resection of bladder tumor

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…The aim of the study was to evaluate the influence of (ALA) mediated photodynamic effect on secretory activity (MIF, MCP-1) of colon cancer cells in vitro both in normoxia and in hypoxia-like conditions [ 66 ]. ALA oral administration was used in transurethral resection of bladder tumor and was associated with hypotension during general anesthesia in patients who underwent these conditions [ 67 ]. Verteporfin (VP) is able to inhibit bladder cancer cell growth and invasion in a dosage dependent manner Purlin Chlorin is a tin etiopurpurin and has undergone Phase II clinical trials for cutaneous metastatic breast cancer and Kaposi’s sarcoma in patients with AIDS), also used to treat the non-malignant conditions psoriasis.…”

Section: Photodynamic Therapy In Bladder Cancermentioning

confidence: 99%

Advances in Management of Bladder Cancer—The Role of Photodynamic Therapy

et al. 2022

View full text Add to dashboard Cite

Photodynamic therapy (PDT) is a non-invasive and modern form of therapy. It is used in the treatment of non-oncological diseases and more and more often in the treatment of various types of neoplasms in various locations including bladder cancer. The PDT method consists of local or systemic application of a photosensitizer, i.e., a photosensitive compound that accumulates in pathological tissue. Light of appropriate wavelength is absorbed by the photosensitizer molecules, which in turn transfers energy to oxygen or initiates radical processes that leads to selective destruction of diseased cells. The technique enables the selective destruction of malignant cells, as the photocytotoxicity reactions induced by the photosensitizer take place strictly within the pathological tissue. PDT is known to be well tolerated in a clinical setting in patients. In cited papers herein no new safety issues were identified. The development of anti-cancer PDT therapies has greatly accelerated over the last decade. There was no evidence of increased or cumulative toxic effects with each PDT treatment. Many modifications have been made to enhance the effects. Clinically, bladder cancer remains one of the deadliest urological diseases of the urinary system. The subject of this review is the anti-cancer use of PDT, its benefits and possible modifications that may lead to more effective treatments for bladder cancer. Bladder cancer, if localized, would seem to be a good candidate for PDT therapy since this does not involve the toxicity of systemic chemotherapy and can spare normal tissues from damage if properly carried out. It is clear that PDT deserves more investment in clinical research, especially for plant-based photosensitizers. Natural PS isolated from plants and other biological sources can be considered a green approach to PDT in cancer therapy. Currently, PDT is widely used in the treatment of skin cancer, but numerous studies show the advantages of related therapeutic strategies that can help eliminate various types of cancer, including bladder cancer. PDT for bladder cancer in which photosensitizer is locally activated and generates cytotoxic reactive oxygen species and causing cell death, is a modern treatment. Moreover, PDT is an innovative technique in oncologic urology.

show abstract

“…4 By contrast, the oral administration of 5-ALA is more convenient as it does not require preoperative bladder infusion. Several recent studies have reported intraoperative hypotension as an adverse event of oral 5-ALA. [5][6][7][8][9][10][11][12] Hypotension can persist after anesthesia induction and may require continuous administration of vasopressors, including noradrenalin. 7,9,10 Hypotension, even for short periods, can pose a great risk to older adults who undergo surgery because of the close association between intraoperative hypotension and postoperative adverse events, including acute renal failure, myocardial infarction, and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…By contrast, the oral administration of 5‐ALA is more convenient as it does not require preoperative bladder infusion. Several recent studies have reported intraoperative hypotension as an adverse event of oral 5‐ALA 5–12 . Hypotension can persist after anesthesia induction and may require continuous administration of vasopressors, including noradrenalin 7,9,10 .…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictors of intraoperative hypotension during transurethral bladder tumor resection with oral 5‐aminolevulinic acid

Ishikawa,

Tanaka,

Fujiwara

et al. 2023

Int J of Urology

View full text Add to dashboard Cite

ObjectivesTo analyze the incidence and risk factors of intraoperative hypotension related to photodynamic diagnosis‐assisted transurethral resection of bladder tumor (PDD‐TURBT) with oral 5‐aminolevulinic acid (5‐ALA).MethodsWe retrospectively analyzed 487 patients with bladder tumors who underwent PDD‐TURBT (n = 184) or conventional TURBT (conv‐TURBT) (n = 303) between 2018 and 2021. Intraoperative hypotension was defined as hypotension requiring vasopressors during TURBT, and its incidence was compared between the two groups. Potential risk factors of intraoperative hypotension, including preoperative change in mean arterial pressure (MAP), were further investigated in patients receiving PDD‐TURBT.ResultsThe median age was 72 years, 392 patients (81%) were male, and 203 (42%) had hypertension. TURBT was performed under general and spinal anesthesia in 76 (16%) and 411 (84%) patients, respectively. The incidence of intraoperative hypotension was significantly higher in PDD‐TURBT compared to conv‐TURBT (43% vs. 17%, respectively). The median change in MAP until the induction of anesthesia was +6.5 mmHg (range: −29.0 to +46.3) in the PDD‐TURBT group and +14.7 mmHg (range: −35.3 to +67.7) in the conv‐TURBT group, showing a significantly smaller increase in the PDD‐TURBT group (p < 0.001). In the multivariable analysis for PDD‐TURBT patients, advanced age, general anesthesia, and lower MAP change (<+6.5 mmHg) until anesthesia induction were significantly associated with intraoperative hypotension (p = 0.0104, <0.001, and <0.001, respectively).ConclusionsIntraoperative hypotension occurred more frequently in patients who underwent PDD‐TURBT than in those who underwent conv‐TURBT. Using oral 5‐ALA decreases preoperative blood pressure elevation and may be responsible for intraoperative hypotension.

show abstract

Oral 5-aminolevulinic acid administration prior to transurethral resection of bladder tumor causes intraoperative hypotension: Propensity score analysis

Cited by 9 publications

References 20 publications

Incidence and factors associated with postoperative delirium in patients undergoing transurethral resection of bladder tumor

Incidence and factors associated with postoperative delirium in patients undergoing transurethral resection of bladder tumor

Advances in Management of Bladder Cancer—The Role of Photodynamic Therapy

Incidence and predictors of intraoperative hypotension during transurethral bladder tumor resection with oral 5‐aminolevulinic acid

Contact Info

Product

Resources

About