title: Oral 5-aminolevulinic acid induced Photodynamic Diagnostic Ureterorenoscopy--does the blood pressure require monitoring?
abstract: BACKGROUND
  Photodynamic Diagnosis has been proven to improve detection of superficial bladder cancer and improve visualisation of resection margins. The use of 5-aminolevulinic acid as the photosensitising agent has been associated with side effects, specifically hypotension. We aimed to evaluate the effect of oral 5-ALA on the blood pressure in a group of patient who underwent Photodynamic Diagnostic Ureterorenoscopy.
  
  
  METHODS
  We carried out an observational study on all patients who underwent PDD-Ureterorenoscopy with oral 5-ALA between July 2009 and September 2011. Pre-administration, hourly post-administration and hourly post-operative blood pressures were noted. Mean arterial blood pressure and the threshold for cerebral ischaemia were calculated as well.
  
  
  RESULTS
  The study includes thirty-eight procedures which involved twenty-four patients with a mean age of 74 (SD±16.95). Hypotension was defined as <80% of the systolic or diastolic baseline blood pressure. Twenty patients were hypotensive pre-operatively after the ingestion of 5-ALA while 21 patients were hypotensive post-operatively. Three patients crossed their MAP threshold pre-operatively and were symptomatic. Fast infusion of intravenous fluids improved their symptoms.
  
  
  CONCLUSIONS
  Hypotension is a common occurrence after the ingestion of 5-ALA. Patients undergoing PDD Ureterorenoscopy should have their blood pressure monitored closely after the ingestion of 5-ALA.
authors: Department of Urology, Ninewells Hospital, Dundee, UK.
authors: J
authors: J
authors: Bondad
authors: O M
authors: OM
authors: Aboumarzouk
authors: H
authors: H
authors: Moseley
authors: S G
authors: SG
authors: Kata
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000622:Aminolevulinic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D008856:Microscopy, Fluorescence / Q000379:methods*; D008991:Monitoring, Physiologic; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000009:adverse effects* / Q000379:methods
chemical_list: D003287:Contrast Media; D000622:Aminolevulinic Acid