Yu Zifu, Yang Xiaoxia, Ma Tiantian, Qin Fang, Ren Lili, Gao Shiai, Chen Jinhui, Liu Xihua
College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
Arch Phys Med Rehabil. 2025 Jun;106(6):961-972. doi: 10.1016/j.apmr.2024.12.016. Epub 2024 Dec 28.
To assess the available evidence of noninvasive 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).
A comprehensive search of 10 databases from inception until August 30, 2023, was conducted.
Randomized controlled trials (RCTs) assessing the effects of conventional treatment (CT) and CT combined with sham stimulation, 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, bladder & STENS, transcutaneous tibial nerve stimulation (TTNS), transcutaneous electrical acupoint stimulation, pelvic floor electrical stimulation, or pelvic floor biofeedback therapy on postvoid residual volume (PVR), maximum cystometric capacity (MCC), number of voids per 24 hours (V24), mean urine volume per micturition, (MUV), maximum urinary flow rate (Qmax), maximum detrusor pressure (MDP), maximum voiding volume, number of leakages per 24 hours (L24), lower urinary tract symptoms score, and SCI-quality of life (SCI-QoL) score in patients with NLUTD after SCI were included.
Two researchers independently extracted data on study characteristics and outcomes following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The Cochrane risk of bias tool (2.0) was used to assess the quality of RCTs.
Fifty-two 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, 64.51-231.06). CT+SNMS ranked high in improving V24 (MD, 2.76; 95% CI, 1.26-4.25) 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, 39.73-126.88) and increasing Qmax (MD, 5.91; 95% CI, 2.99-8.84). Improvement in MDP was highly ranked by CT+TTNS (MD, 9.46; 95% CI, 2.15-16.76).
CT combined with magnetic stimulation therapy provided more benefits than its combination with electrical stimulation. TMS+SNMS seemed to be a promising noninvasive neuromodulation technique in managing NLUTD after SCI. High-quality RCTs should be conducted in the future to validate these findings.
评估无创或微创神经调节疗法在改善脊髓损伤（SCI）后神经源性下尿路功能障碍（NLUTD）患者尿动力学结果、排尿日记及生活质量方面的现有证据。
对10个数据库从创建至2023年8月30日进行了全面检索。
纳入评估常规治疗（CT）以及CT联合假刺激、经颅磁刺激（TMS）、骶神经磁刺激（SNMS）、TMS + SNMS、骶部脉冲电磁场疗法（SPEMFT）、骶部经皮电神经刺激（STENS）、骶部皮节经皮电神经刺激、膀胱与STENS、经皮胫神经刺激（TTNS）、经皮穴位电刺激、盆底电刺激或盆底生物反馈疗法对SCI后NLUTD患者的残余尿量（PVR）、最大膀胱容量（MCC）、每24小时排尿次数（V24）、每次排尿平均尿量（MUV）、最大尿流率（Qmax）、最大逼尿肌压力（MDP）、最大排尿量、每24小时漏尿次数（L24）、下尿路症状评分及SCI生活质量（SCI - QoL）评分影响的随机对照试验（RCT）。
两名研究人员按照系统评价和Meta分析的首选报告项目指南独立提取有关研究特征和结果的数据。采用Cochrane偏倚风险工具（2.0）评估RCT的质量。
纳入了52项RCT，共2884名参与者。CT + TMS能够显著降低PVR（平均差[MD]， - 132.14；95%置信区间[CI]， - 230.97至 - 33.31）并增加MUV（MD，147.79；95% CI，64.51 - 231.06）。CT + SNMS在改善V24（MD，2.76；95% CI，1.26 - 4.25）和减少L24方面排名靠前（MD， - 2.73；95% CI， - 4.46至 - 1.01）；CT + TMS + SNMS在最大程度降低SCI - QoL评分方面效果最佳（MD， - 1.52；95% CI， - 2.97至 - 0.25），在降低PVR和改善MCC方面均排名第二；CT + SPEMFT在改善MCC（MD，83.31；95% CI，39.73 - 126.88）和增加Qmax方面具有显著优势（MD，5.91；95% CI，2.99 - 8.84）。CT + TTNS在改善MDP方面排名靠前（MD，9.46；95% CI，2.15 - 16.76）。
CT联合磁刺激疗法比联合电刺激疗法带来更多益处。TMS + SNMS似乎是一种有前景的无创神经调节技术，可用于管理SCI后的NLUTD。未来应开展高质量RCT以验证这些发现。
