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.

Department of Health Sciences and Technology Brain Research Institute Swiss Federal Institute of Technology Zürich University of Zürich Zürich Switzerland

Department of Neuro Urology Balgrist University Hospital University of Zürich Zürich Switzerland

Department of Urology Cantonal Hospital Luzern Luzern Switzerland

Department of Urology Dalhousie University Halifax Nova Scotia Canada

Department of Urology Inselspital Bern University Hospital Bern Switzerland

Department of Urology Pitié Salpêtrière Academic Hospital School of Medicine Sorbonne University Paris France

Department of Urology Salisbury District Hospital Salisbury Wiltshire United Kingdom

Department of Urology University Hospital in Ostrava and Department of Surgical Studies University of Ostrava Ostrava Czech Republic

Department of Urology University Hospital Lausanne Lausanne Switzerland

Medignition Inc Research Consultants Zürich Switzerland

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