Intravesical vanilloids for treating neurogenic lower urinary tract dysfunction in patients with multiple sclerosis: A systematic review and meta‐analysis. A report from the Neuro‐Urology Promotion Committee of the International Continence Society (ICS)

Aims

To systematically assess all available evidence on efficacy and safety of vanilloids for treating neurogenic lower urinary tract dysfunction (NLUTD) in patients with multiple sclerosis (MS).

Methods

This systematic review and meta‐analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. Studies were identified by electronic search of Cochrane register, Embase, Medline, Scopus, (last search January 8, 2016).

Results

After screening of 7848 abstracts, 4 randomized controlled trials (RCTs) and 3 prospective cohort studies were included. Pooled data from three RCTs evaluating intravesical capsaicin showed the standardized mean difference to be ?2.16 (95% confidence interval [CI] ?2.87 to ?1.45) in incontinence episodes per 24 h and ?0.54 (95%CI ?1.03 to ?0.05) in voids per 24 h. There was no statistically significant effect on maximum cystometric capacity and maximum storage detrusor pressure. Overall, adverse events were reported by >50% of the patients, most commonly were pelvic pain, facial flush, worsening of incontinence, autonomic dysreflexia, urinary tract infection and haematuria. Risk of bias and confounding was relevant in both RCTs and non‐RCTs.

Conclusions

Preliminary data suggest that intravesical vanilloids might be effective for treating NLUTD in patients with MS. However, the safety profile seems unfavorable, the overall quality of evidence is low and no licensed substance is currently available warranting well‐designed, adequately sampled and properly powered RCTs.     

Nystagmus and oscillopsia

The ocular motor system consists of several subsystems, including the vestibular ocular nystagmus saccade system, the pursuit system, the fixation and gaze-holding system and the vergence system. All these subsystems aid the stabilization of the images on the retina during eye and head movements and any kind of disturbance of one of the systems can cause instability of the eyes (e.g. nystagmus) or an inadequate eye movement causing a mismatch between head and eye movement (e.g. bilateral vestibular failure). In both situations, the subjects experience a movement of the world (oscillopsia) which is quite disturbing. New insights into the patho-physiology of some of the ocular motor disorders have helped to establish new treatment options, in particular in downbeat nystagmus, upbeat nystagmus, periodic alternating nystagmus, acquired pendular nystagmus and paroxysmal vestibular episodes/attacks. The discussed patho-physiology of these disorders and the current literature on treatment options are discussed and practical treatment recommendations are given in the paper.     

慢性肾炎患者治疗前后血浆leptin和血清TNF-α、NPY水平的变化及其临床价值

目的:探讨慢性肾炎患者治疗前后血浆leptin和血清TNF-α、NPY含量的变化及意义。方法:应用放射免疫分析对32例慢性肾炎患者进行了治疗前后血浆leptin和血清TNF-α、NPY测定,并与35例正常人作比较。结果:慢性肾炎患者治疗前血浆leptin和血清TNF-α、NPY含量均非常显著地高于正常人组(P<0.01),经中西医结合治疗6个月后与正常人组比较仍有显著性差异(P<0.05),且leptin水平与TNF-α、NPY水平呈正相关(r=0.6012、0.5984,P<0.01)。结论:检测慢性肾炎患者血浆leptin和血清TNF-α、NPY含量的变化对临床治疗和预后判断均具有重要的临床价值。