Electroacupuncture for post-stroke urinary incontinence: a systematic review and meta-analysis with trial sequential...

Area of Science:

• Neurology
• Urology
• Integrative Medicine

Background:

• Post-stroke urinary incontinence (PSUI) presents a significant challenge in patient recovery and quality of life.
• The efficacy of electroacupuncture (EA) for managing PSUI remains incompletely understood, necessitating rigorous evaluation.
• This systematic review and meta-analysis aims to consolidate current evidence on EA's effectiveness for PSUI.

Approach:

• A comprehensive search of eight databases identified 15 randomized controlled trials (RCTs) involving 1,414 patients.
• Data extraction, risk of bias assessment (Cochrane Handbook 5.1.0), and meta-analysis (Review Manager 5.4.1) were performed by two independent reviewers.
• Publication bias, sequential analysis (TSA 0.9.5.10 Beta), and evidence certainty (GRADE) were assessed to ensure robust findings.

Key Points:

• EA demonstrated efficacy in reducing 24-hour urinary incontinence and improving maximum cystometric capacity (MCC) compared to sham EA, with sustained effects at 3-month follow-up.
• Combined EA with basic treatments significantly reduced 24-hour urinary incontinence, improved MCC, and decreased residual urine volume (RUV).
• EA, when added to basic treatments and active interventions, increased responder rates, reduced incontinence, and improved quality of life scores, with only mild adverse effects reported.

Conclusions:

• Electroacupuncture shows potential for improving post-stroke urinary incontinence, with observed benefits in incontinence reduction and bladder function.
• Despite positive findings, the overall certainty of evidence is low to very low, primarily due to methodological limitations in the included studies.
• High-quality randomized controlled trials are essential to definitively establish the efficacy and safety of EA for PSUI management.