Alpha‐blockers 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)

Abstract

Aim We aimed to systematically assess the evidence on the efficacy and safety of alpha‐blockers in patients with multiple sclerosis (MS) suffering from neurogenic lower urinary tract dysfunction (NLUTD). Methods The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement was used to perform this systematic review. An electronic search of Cochrane register, Embase, Medline, Scopus (last search 3 March 2018) and screening of reference lists as well as reviews were used to identify the studies. Articles were included if they reported on efficacy/safety of alpha‐blockers for the treatment of NLUTD in patients with MS. Results After screening of 7′015 abstracts, three studies enrolling a total of 50 patients were included: one randomized, placebo‐controlled, single‐blind trial and two prospective cohort studies. Alpha‐blocker treatment was successful in 50% to 96% of the patients. Pooling data from the three included studies, the relative risk for successful alpha‐blocker treatment was 3.89 (95% confidence interval 2.7‐7.0). The general safety profile of alpha‐blockers was favorable with 8% of the patients reporting adverse events. Conclusions Alpha‐blockers may be effective and safe for treating NLUTD in female and male patients with MS but the studies were small and the overall quality of evidence was low. To make definitive conclusions, well designed randomized controlled trials are highly warranted.

Current Surgical Treatment for Neurogenic Lower Urinary Tract Dysfunction in Patients with Chronic Spinal Cord Injury

“…Reflex voiding and voiding by abdominal pressure should be avoided unless the intravesical pressure remains within 40 cmH2O [ 133 ]. Alpha-adrenergic antagonists and urethral sphincter botulinum toxin A injection may be effective in decreasing urethral resistance and improve voiding [ 134 , 135 , 136 , 137 ]. Surgeries such as external sphincterotomy may be considered to reduce urethral resistance in patients’ refractory to conservative treatments.…”

The efficacy and safety of mirabegron for adult and child patients with neurogenic lower urinary tract dysfunction: A systematic review and meta‐analysis

“…As an important treatment for NLUTD, drug therapy has been studied by many scholars. In previous studies, there were evidence‐based articles of efficacy for both anticholinergic drugs 19 and alpha‐blockers 20 . β3 receptor agonist has also been explored in a number of clinical trials for efficacy and safety and previous meta‐analysis study has also provided evidence of mirabegron in the treatment of storage lower urinary tract symptoms/OAB 21 .…”

“…In previous studies, there were evidencebased articles of efficacy for both anticholinergic drugs 19 and alpha-blockers. 20 β3 receptor agonist has also been explored in a number of clinical trials for efficacy and safety and previous meta-analysis study has also provided evidence of mirabegron in the treatment of storage lower urinary tract symptoms/OAB. 21 With the development of relevant studies, it provides data support for us to implement meta-analysis research probing into the efficacy of mirabegron on patients with NLUTD through the changes of urodynamic parameters before and after treatment.…”