Efficacy of Acupuncture Therapy plus Related Rehabilitation Therapy on Post-stroke Urinary Incontinence: A Systematic Review and Meta-analysis

Zifeng Dai^1,2*Yuting Wang^2,3Yuzheng Du^2,3Linru Hou^2,3Yufen Li^2,3Kaixuan Ma^2,3Qinfeng Yan^2,3Jian Wen^2,3Xinlei Dong^2,3Xiaolin Chen^2,3Lili Zhang^2,3*

• ¹National Medical Research Center of Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Nankai, China
• ²First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Nankai District, Tianjin, China
• ³National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, tianjing, China

Researchers have increasingly focused on the efficacy of acupuncture therapy plus rehabilitation therapy on post-stroke urinary incontinence. This study intends to fully assess the efficacy of AT plus related RT in treating PSUI. We systematically searched eight databases from their inception until March 2025 for RCTs of AT plus related RT for treating PSUI. Stata 18.0 was utilized for meta-analyses. Thirty-six studies involving 2796 subjects were included, and AT plus related RT was performed in the treatment group. The total effective rate of AT plus RT was higher than RT or AT alone [RR=1.23, 95% CI (1.19, 1.28) , p<0.001]. AT plus RT was superior to related RT or AT in improving the maximum bladder capacity [WMD=44.93, 95% CI (32.00, 57.87), p <0.001], increasing the maximum urinary flow rate [WMD=2.64, 95% CI (1.27, 4.01), p <0.001], mean urine output per time [WMD=44.30, 95% CI (20.31, 68.29), p <0.001], and pelvic floor muscle strength (including fast [WMD=2.64, 95% CI (1.04, 4.25), p =0.001], slow [WMD=6.09, 95% CI (3.44, 8.75), p <0.001], and complex muscle fibers [WMD=5.46, 95% CI (3.60, 7.32) , p <0.001]), and reducing the residual urine volume [WMD=-20.84, 95% CI (-27.53, -14.14), p =0.001], maximal detrusor pressure [WMD=-10.6, 95% CI (-12.72, -8.55), p =0.001], frequency of 24-h UI [WMD=-1.40, 95% CI (-1.92, -0.88), p <0.001], and frequency of 24-h urination [WMD=-3.76, 95% CI (-4.87, -2.66), p <0.001]. Moreover, AT plus RT could lower the International Consultation on Incontinence Questionnaire-Short Form (ICIQSF) score [WMD=-2.40, 95% CI (-2.93, -1.83), p <0.001] the quality-of-life (QOL) score [WMD=-0.72, 95% CI (-1.64, 0.20) , p =0.127] and the National Institutes of Health Stroke Scale (NIHSS) score [WMD=-3.51, 95% CI (-8.20, 1.18), p =0.143], and raise the Incontinence Quality of Life Scale (I-QOL) score [WMD=11.71, 95% CI (8.10, 15.33), p <0.001] and the Barthel index (BI) score [WMD=6.92, 95% CI (-0.22, 14.05), p =0.058]. AT plus RT outperforms related RT or related AT in improving clinical efficacy and bladder function in PSUI patients. However, the number of included studies on AT plus RT was limited, so more high-quality RCTs are needed to validate the findings.