Effectiveness and Safety of Acupuncture for Post-Stroke Neurogenic Bladder: A Systematic Review and Meta-Analysis

Objective: This review is to systematically evaluate the clinical effectiveness and safety of acupuncture therapy for patients with post-stroke neurogenic bladder (PSNB). Methods: We included randomized controlled trials (RCTs) evaluating any type of acupuncture treatment for PSNB. Data extraction and quality assessment using Cochrane Risk of Bias 2.0 were performed. Meta-analysis was conducted for total effective rate (TER) and urodynamic parameters. Results: Ten RCTs involving 727 participants were included. Meta-analysis showed that acupuncture was associated with a reduction in residual urine volume (RUV), and increases in maximum cystometric capacity (MCC), and maximal urinary flow rate (Qmax). Acupuncture also showed a higher TER compared to control groups (RR = 1.23, 95% CI 1.15, 1.33, p < 0.001). However, wide 95% prediction intervals for urodynamic parameters indicated substantial uncertainty for future clinical applications. Adverse events were mild and infrequent, but only partly reported in two studies among included trials. Conclusions: Acupuncture as an adjunctive therapy suggests potential trends for improving clinical efficacy and urodynamic parameters in PSNB patients. However, no definitive conclusions can be drawn regarding its clinical efficacy or safety due to the very low certainty of evidence, high methodological heterogeneity, and limited reporting of adverse events. Therefore, these results must be interpreted with extreme caution. Further high-quality, large-scale randomized controlled trials with standardized protocols are essential to establish robust evidence regarding its clinical effectiveness and safety. Protocol registration: PROSPERO CRD42025643092.