Association of Perioperative Cognitive Dysfunction With Circulating Biomarkers of Neurological Damage in Patients Underging Transurethral Resection of Bladder Tumor

Bladder tumor is one of the most widespread tumors in the world, with increasing prevalence at the global level. It is the most common malignant disease of the urinary system. One of the procedures in patients with bladder tumors is transurethral resection of the bladder. This procedure is most often performed endoscopically under general anesthesia. The number of patients undergoing this type of procedure is increasing.

This patient population has certain characteristics in common. One of them is exposure to common risk factors for the formation of bladder tumors, such as aniline dyes and solvents. These substances are also associated with the onset of neurodegeneration and oxidative stress. For this reason, cognitive dysfunction can be expected in this patient population in addition to bladder cancer.

Another factor that affects the formation of bladder tumors is smoking. The connection between smoking and the formation of bladder tumors is the presence of carcinogenic substances in the urine of people who smoke, including aromatic amines. Likewise, cigarette smoke itself is harmful, as it also contains numerous carcinogenic substances, which are absorbed from the lungs into the bloodstream, and then reach the bladder via the kidneys. Given that urine is present in the bladder for a long time, its mucosa is exposed to these carcinogenic substances. Carcinogenic substances produced during smoking also lead to an indirect increase in risk, because they damage the immune system of people and lead to the development of inflammatory processes. Smoking is also one of the risk factors associated with the weakening of a person's cognitive status.

A significant part of patients with bladder tumor are an elderly population, which is repeatedly exposed to surgical procedures, with numerous comorbidities, with a high risk of postoperative complications and the development of perioperative cognitive deficits, which can further complicate the postoperative course and further treatment. Postoperative cognitive deficit includes cognitive disorders in the postoperative period, which are associated with numerous complications, which can lead to loss of independence in patients, increased morbidity and mortality, and increase the costs of treatment. In the group of patients with a bladder tumor who will undergo transurethral resection of the bladder, no evaluation of risk factors related to perioperative cognitive deficit was performed, nor was there an examination of the perioperative cognitive deficit itself.

Considering that this is an elderly population, it is expected that some patients will already be frail before the operation with the presence of a significant degree of dementia. In them, the identification of factors for postoperative cognitive disorder is essential, with the aim of taking measures to prevent the deterioration of their impaired general health condition. The concept of clinical frailty is becoming more and more important and relevant when providing healthcare services and healthcare to patients.