This study analyzed the adverse events associated with 5-ALA in PDD and assessed the preoperative use of a1-blockers as a risk factor for hypotension.A total of 203 patients (161 male and 42 female) were enrolled in this study.Five-ALA were received 20 mg/kg. Patient age ranged from 45 to 96 years, with a mean age of 73.3 years.RASI were regularly used to 72 patients (31.0%), and Ca-blockers to 69 patients (34.0%).Antihypertensive medication was taken on the day of surgery among 58 patients (28.6%) as followed by the discretion of the anesthesiologists.A1-blockers were regularly used to 25 patients (12.3%).The details of a1-blockers were as follows: 16 for tamsulosin, 2 for naftopidil, and 7 for silodosin.The duration of medication ranged from 2 mo to 16 years, with a median of 2 years.Spinal anesthesia was performed on 159 patients (78.3%).Hypotension was intraoperatively observed in 63 patients (30.9%), nausea in 62 patients (30.4%), and decreased percutaneous oxygen saturation of <90% in 10 patients (12.3%).Postoperative hypotension was revealed among three of the enrolled patients, whereas preoperative hypotension was not.Table 1 summarizes the results of risk factor anal. for a decrease in SBP during PDD-assisted TURBT.Both analyses revealed general anesthesia, regular use of angiotensin receptor blocker (ARB) combination medicine, Ca-blockers, and preoperative a1-blockers as significant risk factors for hypotension in PDD-assisted TURBT.