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) |
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| Authors: | Véronique Phé Marc P. Schneider Benoit Peyronnet Nadim Abo Youssef Livio Mordasini Emmanuel Chartier‐Kastler Lucas M. Bachmann Thomas M. Kessler |
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| Affiliation: | 1. Department of Urology, Pitié‐Salpêtrière Academic Hospital, Assistance Publique‐H?pitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris 6 University, Paris, France;2. Neuro‐Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland;3. Brain Research Institute, University of Zürich, and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland;4. Department of Urology, Pontchaillou Hospital, Rennes, France;5. Department of Urology, Cantonal Hospital Lucerne, Lucerne, Switzerland;6. Medignition Inc., Research Consultants, Zürich, Switzerland |
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| Abstract: | 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. |
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| Keywords: | capsaicin meta‐analysis multiple sclerosis (MS) neuro‐urology neurogenic lower urinary tract dysfunction (NLUTD) resiniferatoxin systematic review vanilloids |
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