OBJECTIVES To systematically review all available evidence on efficacy and safety of cannabinoids for treating neurogenic lower urinary tract dysfunction (NLUTD) in patients with multiple sclerosis (MS). PATIENTS AND METHODS The review 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 on 11 November 2016). RE-SULTS After screening 8469 articles, two randomized controlled trials and one open label study enrolling a total of 426 patients, were included. Cannabinoids relevantly decreased incontinence episodes in all three studies. Pooling data showed mean difference in incontinence episodes per 24 hours to be -0.35 (95% confidence interval -0.46 to -0.24). Mild adverse events were frequent (38-100%), but only two patients (0.7%) reported a serious adverse event. CONCLUSIONS Preliminary data imply, that cannabinoids might be an effective and safe treatment option for NULTD in patients with MS. However, evidence base is poor and more high-quality, well-designed, adequately powered and sampled studies are urgently needed to reach definitive conclusions. Accepted Article Accepted ArticleThis article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/bju.13759 This article is protected by copyright. All rights reserved. Accepted Article Accepted ArticleThis article is protected by copyright. All rights reserved.

Aims To systematically assess all available evidence on efficacy and safety of desmopressin for treating nocturia in patients with multiple sclerosis (MS). Methods This systematic review 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 March 3, 2018) and by screening of reference lists and reviews. Results After screening of 7015 abstracts, 8 prospective, and 1 retrospective studies were included enrolling a total of 178 patients. The mean patient age ranged between 43 and 51 years. A significant decrease in the number of micturitions per night was reported in 5 studies. An increase in the maximum hours of uninterrupted sleep was only found in two studies. A significant reduction of the volume of nocturnal incontinence was described in one study. The patient satisfaction rates ranged from 56% to 82%. The rate of adverse events was between 0% and 57.9%. The rate of hyponatremia ranged from 0% to 23.5% and other commonly reported adverse events were headache, nausea, fluid retention, rhinitis/epistaxis, malaise, and swollen ankles. Risk of bias and confounding was relevant in all studies. Conclusions Preliminary data suggest that desmopressin might be effective for treating nocturia in patients with MS. However, adverse events are relatively common, the overall quality of evidence is low and the number of studied patients is very limited. Further studies with newer formulations of desmopressin are highly warranted.

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, Abbreviations: LUTS, lower urinary tract symptoms; MS, multiple sclerosis; DO, detrusor overactivity; NLUTD, neurogenic lower urinary tract dysfunction; NDO, neurogenic detrusor overactivity; RCT, randomized controlled trial; MCC, maximum cystometric capacity.Véronique Phé and Marc P. Schneider contributed equally and share the first authorship.Roger Dmochowski led the peer-review process.Neurourology and Urodynamics. 2018;37:67-82.wileyonlinelibrary.com/journal/nau

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