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An increased risk of urinary incontinence in bitches has often been associated with previous ovariohysterectomy but remains controversial. The objective of this study was to evaluate the strength of evidence for an association between neutering or age at neutering and urinary incontinence in bitches and to estimate the magnitude of any effect found. A systematic review of peer-reviewed original English analytic journal articles was conducted, based on Cochrane guidelines (Higgins and Green 2009) Of 1,853 records screened, seven studies were identified that examined the effect of neutering or age at neutering on the risk of urinary incontinence but four were judged to be at high risk of bias. Of the remaining three studies, which were at moderate risk of bias, there was some weak evidence that neutering, particularly before the age of three months, increases the risk of urinary incontinence. However, overall the evidence is not consistent nor strong enough to make firm recommendations on the effect of neutering or age at neutering on the risk of urinary incontinence.