Comprehensive analysis of perioperative hypotension in photodynamic diagnosis-assisted transurethral resection of bladder tumor with 5-aminolevulinic acid.

OBJECTIVE: Intraoperative hypotension remains a serious adverse event of photodynamic diagnosis-assisted transurethral resection of bladder tumor with oral administration of 5-aminolevulinic acid. We conducted a re-analysis of perioperative hypotension in photodynamic diagnosis-assisted transurethral resection of the bladder tumor with oral 5-aminolevulinic acid to ascertain its safety. METHODS: A total of 407 cases who underwent transurethral resection of bladder tumors in our institution were reviewed (274 cases for the PDD group with photodynamic diagnosis and 133 for the white light (WL) group without). A classification of hypotension severity was devised to identify risk factors for clinically troublesome hypotension. The distribution of hypotension severity in each of the PDD and WL groups was compared. Additionally, the patient background and perioperative data by hypotension severity were compared only in the PDD group. RESULTS: More patients with moderate and severe hypotension were noted in the PDD group. The renal function was lower with increasing hypotension severity in the PDD group. More patients on general anesthesia were included in the mild and moderate hypotension group, whereas more patients on spinal anesthesia were included in the severe hypotension group. Furthermore, the frequency of side effects other than hypotension tended to increase with hypotension severity. CONCLUSIONS: Renal function impairment and the other adverse effects of 5-aminolevulinic acid may be risk factors for severe hypotension. Mild or moderate hypotension may be caused by general anesthesia and severe hypotension may be caused by spinal anesthesia. To elucidate specific risk factors, further case-control studies are warranted.

Favorable Impact on Postoperative Abdominal Symptoms in Robot-assisted Radical Prostatectomy Using Enhanced Recovery After Surgery Protocol.

Background/Aim: This study aimed to examine the effectiveness of enhanced recovery after surgery (ERAS) protocols in robot-assisted radical prostatectomy (RARP). Moreover, this study focused on postoperative abdominal symptoms and compared the perioperative parameters between the ERAS and conventional groups in RARP patients. Patients and Methods: A retrospective analysis was performed on 37 consecutive prostate cancer patients who underwent RARP between January 2020 and September 2021. The ERAS and conventional protocols were received by 16 and 20 patients, respectively, excluding one patient with surgical complications. Results: The incidence and cumulative frequency of postoperative abdominal distention were significantly lower in the ERAS group (p=0.041 and p=0.039, respectively). Although not significant, the first flatus and defecation time tended to be shorter in the ERAS group (p=0.115 and p=0.074, respectively). Conclusion: The ERAS protocol contributes to the reduction in postoperative abdominal distension for patients undergoing RARP.