Efficacy differences between SNM and various peripheral nerve electrical stimulation modalities for NLUTD: a Bayesian network meta-analysis.

BACKGROUND

Neurogenic lower urinary tract dysfunction (NLUTD) severely affects patients' quality of life, and conventional therapies have limited efficacy. Direct comparisons between SNM and peripheral nerve electrical stimulation are lacking. This study employed a network meta-analysis to evaluate the efficacy of these two approaches on voiding-related parameters.

METHODS

A computerized search of PubMed, Embase, Scopus, Web of Science, VIP, Wanfang, and CNKI databases was conducted for publicly available randomized controlled trials (RCTs) on sacral neuromodulation and peripheral nerve electrical stimulation for neurogenic lower urinary tract dysfunction, up to May 2026. The Cochrane Handbook version 5.4 (RoB 2) was used for quality assessment of the included studies. Bayesian network meta-analysis was performed using Rstudio (version 4.4.1) to compare and rank the outcomes.

RESULTS

The network meta-analysis showed that for maximum flow rate (Qmax), neuromuscular electrical stimulation (NMES) combined with conventional therapy (SUCRA = 90.5%) ranked highest, significantly better than placebo (MD = 6.5 mL/s, 95% CrI: 0.38, 13) and conventional therapy (MD = 5.6 mL/s, 95% CrI: 3.1, 8.3). For improvement in maximum cystometric capacity (MCC), sacral neuromodulation (SNM) combined with conventional therapy (SUCRA = 96.2%) demonstrated the best efficacy; however, because only six SNM-related RCTs were included, this result should be considered exploratory and cannot yet confirm its superiority over other interventions. In terms of post-void residual (PVR) volume, reduction in 24-h voiding frequency, and improvement in 24-h incontinence episodes, NMES combined with conventional therapy ranked first (SUCRA = 90, 89.5, and 91%, respectively). For mean voided volume (MVV), tibial nerve stimulation (TNS) combined with conventional therapy (SUCRA = 88.6%) performed best. Overall, combination treatment strategies were generally superior to monotherapies, with different techniques showing differential advantages in improving various dimensions of lower urinary tract function.

CONCLUSION

For improving maximum flow rate, post-void residual volume, 24-h voiding frequency, and incontinence episodes, NMES combined with conventional therapy ranked highest; SNM combined with conventional therapy ranked highest for maximum cystometric capacity; TNS combined with conventional therapy ranked highest for mean voided volume. However, these rankings only suggest potential relative advantages and do not establish definitive superiority; in particular, the evidence for SNM is limited, and the results should be considered exploratory.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261324281.