Objectives: Photodynamic diagnosis-assisted transurethral resection of bladder tumors with oral 5-aminolevulinic acid administration improves tumor visibility but results in perioperative hypotension. In 2024, the recommended timing of 5-aminolevulinic acid administration was revised to enable oral intake 2-8 h preoperatively, thereby making it easier to adjust the timing of drug administration and surgery. This study aimed to investigate the association between the interval from 5-aminolevulinic acid administration to the start of surgery and perioperative blood pressure.
Methods: We retrospectively analyzed 112 consecutive patients who underwent photodynamic diagnosis-assisted transurethral resection of bladder tumors from July 2022 to June 2024. Patients were categorized based on the time between oral 5-aminolevulinic acid administration and spinal or general anesthesia induction into the control (< 4 h) and extended time (≥ 4 h) groups. The perioperative blood pressure and severity of hypotension were compared between the two groups.
Results: The extended time group comprised fewer cases of moderate to severe hypotension than the control group (38% and 61%, respectively; p = 0.039). Blood pressure was significantly higher at several time points intraoperatively in the extended time group. Further, the extended time group required fewer doses of vasopressor agents (p = 0.025).
Conclusions: An interval of more than 4 h from oral 5-aminolevulinic acid intake to anesthesia administration may reduce the risk of perioperative hypotension during photodynamic diagnosis-assisted transurethral resection of bladder tumors.
Keywords: aminolevulinic acid; blood pressure; hypotension; transurethral resection of bladder; urinary bladder neoplasms.
© 2025 The Japanese Urological Association.