Objective: To assess the available evidence of non-invasive or minimally invasive neuromodulation therapies in improving urodynamic outcomes, voiding diaries, and quality of life in patients with neurogenic lower urinary tract dysfunction (NLUTD) after spinal cord injury (SCI).
Data sources: A comprehensive search of 10 databases from inception until August 30, 2023 was conducted.
Study selection: Randomized controlled trials (RCTs) assessing the effects of conventional treatment (CT) and CT combined with sham stimulation (SS), transcranial magnetic stimulation (TMS), sacral nerve magnetic stimulation (SNMS), TMS+SNMS, sacral pulsed electromagnetic field therapy (SPEMFT), sacral transcutaneous electrical nerve stimulation (STENS), sacral dermatomal transcutaneous electrical nerve stimulation (SDTENS), bladder & sacral transcutaneous electrical nerve stimulation (B&STENS), transcutaneous tibial nerve stimulation (TTNS), transcutaneous electrical acupoint stimulation (TEAS), pelvic floor electrical stimulation (PFES), or pelvic floor biofeedback therapy (PFBFBT) on postvoid residual volume (PVR), maximum cystometric capacity (MCC), number of voids per 24 h (V24), mean urine volume per micturition, (MUV), maximum urinary flow rate (Qmax), maximum detrusor pressure (MDP), maximum voiding volume (MVV), number of leakages per 24 h (L24), lower urinary tract symptoms (LUTS) score, and spinal cord injury-quality of life (SCI-QoL)score in patients with NLUTD after SCI were included.
Data extraction: Two researchers independently extracted data on study characteristics and outcomes following the PRISMA guidelines. The Cochrane risk of bias tool (2.0) was used to assess the quality of RCTs.
Data synthesis: 52 RCTs with 2884 participants were included. CT+TMS was able to remarkably decrease PVR (mean difference [MD], -132.14; 95% confidence interval [CI], -230.97 to -33.31) and increase MUV (MD, 147.79; 95% CI, 64.51 to 231.06). CT+SNMS ranked high in improving V24 (MD, 2.76; 95% CI, 1.26 to 4.25) and reducing L24 (MD, -2.73; 95% CI, -4.46 to -1.01); CT+TMS+SNMS maximized the reduction of SCI-QoL scores (MD, -1.52; 95% CI, -2.97 to -0.25) and ranked second in both reducing PVR and improving MCC; CT+SPEMFT had a significant advantage in improving MCC (MD, 83.31; 95% CI, 39.73 to 126.88) and increasing Qmax (MD, 5.91; 95% CI, 2.99 to 8.84); Improvement in MDP was highly ranked by CT+TTNS (MD, 9.46; 95% CI, 2.15 to 16.76).
Conclusions: CT combined with magnetic stimulation therapy provided more benefits than its combination with electrical stimulation. TMS+SNMS appeared to be a promising non-invasive neuromodulation technique in managing NLUTD after SCI. High-quality RCTs should be conducted in the future to validate these findings.
Keywords: Network meta-analysis; Neurogenic lower urinary tract dysfunction; Neuromodulation; Spinal cord injury.
Copyright © 2024. Published by Elsevier Inc.