Effects of nonsurgical, minimally or noninvasive therapies for urinary incontinence due to neurogenic bladder: a systematic review and meta-analysis

Abstract

Objective: To determine the effects of nonsurgical, minimally or noninvasive therapies on urge urinary incontinence (UUI) symptoms and quality of life (QoL) in individuals with neurogenic bladder (NGB). Data Sources: Cochrane library, EMBASE, MEDLINE, PEDro, Scopus, and Web of Science databases were searched from inception to September 2021. Review Methods: Randomized controlled trials that compared therapies such as intravaginal electrical stimulation (IVES), transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES), transcutaneous tibial nerve stimulation (TTNS), pelvic floor muscle training (PFMT), and behavioural therapy (BT) to control were included. Study screening, data extraction, and study quality assessments were performed by two independent authors. Results: Fourteen trials with 804 participants were included in the study after screening of 4281 potentially relevant articles. Meta-analyses revealed a significant effect of electrical stimulation on UUI due to multiple sclerosis (standardized mean difference (SMD): −0.614; 95% confidence interval (CI): −1.023, −0.206; p = 0.003) and stroke (SMD: −2.639; 95% CI: −3.804, −1.474; p = 0.000). The pooled analyses of TTNS (weighted mean difference (WMD): −12.406; 95% CI: −16.015, −8.797; p = 0.000) and BT (WMD: −9.117; 95% CI: −14.746, −3.487; p = 0.002) revealed significant effects of these interventions on QoL in people with Parkinson’s disease. However, meta-analyses revealed nonsignificant effects for PFMT (WMD: −0.751; 95% CI: −2.426, 0.924; p = 0.380) and BT (WMD: −0.597; 95% CI: −1.278, 0.083; p = 0.085) on UUI due to Parkinson’s disease. Conclusions: Our meta-analyses found electrical stimulation to be beneficial for improving the symptoms of UUI among people with multiple sclerosis and those with stroke. Our review also revealed that TTNS and BT might improve QoL for people with NGB due to Parkinson’s disease, although the effects of PFMT and BT on UUI warrant further investigation.

Effects of posterior tibial nerve stimulation (PTNS) on lower urinary tract dysfunction: An umbrella review

“…Screening the titles and abstracts, left us with 76 studies which were selected for full‐text screening. Finally, 20 SRs met all the inclusion criteria and entered the study 16–35 . The PRISMA flow diagram of the literature search and results is shown in Figure 1.…”

“…From a total of 20 SRs, 13 of them conducted meta‐analysis 16,17,19,20,23,24,27,29,31–35 . China was the leading origin of publication with five studies 16,31–34 .…”

“…16,19,22,24,27 In addition, several studies investigated the effects of PPTNS on a specific neurological pathology; multiple sclerosis (MS)-induced LUTD was the subject of three SRs, 24,29 and one study included studies regarding TPTNS effects on the QoL in Parkinson's disease. 16 Most of the included studies reported an overall improvement in LUTD following PPTNS, although admitting that these results were derived from moderate to lowquality evidence. Notwithstanding the others, some of the included studies in these SRs showed no significant difference in some urologic functions.…”

“…16,17,19,20,23,24,27,29,[31][32][33][34][35] China was the leading origin of publication with five studies. 16,[31][32][33][34] After that, Iran 23,24,29 and the United Kingdom 19,20,30 both had three publications. The population of studies varied vastly among the included SR.…”

Urinary dysfunction in patients with vascular cognitive impairment

“…A meta-analysis revealed that daily transcutaneous electrical nerve stimulation (TENS) and electroacupuncture at least 5 days per week starting less than 3 months post-stroke may be effective for treating urinary incontinence ( Cruz et al, 2021 ). Another meta-analysis found that TENS may reduce the severity of urinary incontinence ( Thomas et al, 2019 ) and that both TENS and neuromuscular electrical stimulation can reduce symptoms of post-stroke urge incontinence ( Ali et al, 2022 ). One study showed that repetitive 5-Hz transcranial magnetic stimulation (rTMS) to the motor cortex was useful to facilitate the voiding phase in patients with multiple sclerosis ( Centonze et al, 2007 ).…”