Risk factors of severe prolonged hypotension induced by 5-aminolevulinic acid during photodynamic diagnosis-assisted transurethral resection of bladder tumor

Abstract

Background: To identify the risk factors of severe prolonged hypotension induced by 5-aminolevulinic acid (ALA) for non-muscle invasive bladder cancer patients undergoing photodynamic diagnosis (PDD)-assisted transurethral resection of bladder tumor (TURBT).

Methods: We retrospectively performed multivariate analyses to identify the clinical risk factors for ALA-induced severe prolonged hypotension, defined as requiring: (1) prolonged vasopressor treatment, (2) frequent treatment with vasopressor, and (3) continuous noradrenaline administration (systolic blood pressure < 80 mmHg) in bladder cancer patients undergoing PDD-TURBT.

Results: A total of 245 patients who underwent PDD-TURBT were included in the final analysis. Risk factors (p < 0.05) by multivariate analyses were high body mass index, concomitant atrial fibrillation, low estimated glomerular filtration rate and short ALA exposure time. Predisposing risk factors (0.05 ≤ p < 0.2) on multivariate analysis included concomitant hypertension and use of calcium channel blockers. Analyses of the effect of combination of the four risk factors on the duration of vasopressor treatment showed patients with two or three risk factors significantly more frequently received vasopressor treatment for a duration of ≥ 60 min than those without risk factors (p < 0.05).

Conclusions: We identified independent risk factors and combinations of multiple factors related to ALA-induced severe prolonged hypotension in bladder cancer patients undergoing PDD-TURBT. In patients with multiple risk factors, it is advisable to maintain a longer interval between ALA administration and anesthesia to avoid severe prolonged hypotension.

Keywords: 5-aminolevulinic acid; Hypotension; Non-muscle invasive bladder cancer; Photodynamic diagnosis; Severe prolonged hypotension; Transurethral resection of bladder tumor.