Phé Véronique, Schneider Marc P, Peyronnet Benoit, Abo Youssef Nadim, Mordasini Livio, Chartier-Kastler Emmanuel, Bachmann Lucas M, Kessler Thomas M
Department of Urology, Pitié-Salpêtrière Academic Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie Medical School, Sorbonne Universités, Paris 6 University, Paris, France.
Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
Neurourol Urodyn. 2018 Jan;37(1):67-82. doi: 10.1002/nau.23314. Epub 2017 Jun 15.
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).
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).
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.
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.
系统评估香草酸类药物治疗多发性硬化症（MS）患者神经源性下尿路功能障碍（NLUTD）的有效性和安全性的所有现有证据。
本系统评价和荟萃分析按照系统评价和荟萃分析的首选报告项目（PRISMA）声明进行。通过电子检索Cochrane注册库、Embase、Medline、Scopus（最后一次检索时间为2016年1月8日）来识别研究。
在筛选了7848篇摘要后，纳入了4项随机对照试验（RCT）和3项前瞻性队列研究。三项评估膀胱内注入辣椒素的RCT的汇总数据显示，每24小时尿失禁发作的标准化平均差为-2.16（95%置信区间[CI]-2.87至-1.45），每24小时排尿次数的标准化平均差为-0.54（95%CI-1.03至-0.05）。对最大膀胱测压容量和最大膀胱贮尿期逼尿肌压力没有统计学上的显著影响。总体而言，超过50%的患者报告了不良事件，最常见的是盆腔疼痛、面部潮红、尿失禁加重、自主神经反射异常、尿路感染和血尿。RCT和非RCT中均存在偏倚和混杂风险。
初步数据表明，膀胱内注入香草酸类药物可能对治疗MS患者的NLUTD有效。然而，安全性似乎不佳，证据的总体质量较低，目前没有获得许可的药物，因此需要设计良好、样本充足且有足够效力的RCT。
