The effect of repetitive transcranial magnetic stimulation treatment on lower urinary tract dysfunction in patients with stroke

Objective: This study aims to compare the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) treatment with sham rTMS in patients with post-stroke urinary incontinence. Materials and Methods: Forty patients who developed post-stroke urinary dysfunction were included in the study. Patients were randomly assigned to either the rTMS (n=20) or sham rTMS (n=20) groups. The rTMS group received rTMS treatment at a frequency of 1 Hz with 80% motor threshold stimulation for a total of 15 sessions, 5 days a week for 3 weeks. The sham rTMS group received placebo treatment with a device similar to the rTMS device. Both groups continued their conventional stroke rehabilitation program during the follow-up period. Patients were evaluated before treatment, after treatment, and 8 weeks after treatment. The evaluations included the Danish Prostate Symptom Score, the Incontinence Quality of Life Scale, the International Consultation on Incontinence Questionnaire-Short Form, the Overactive Bladder Symptom Score, the Short Form-36 Health Survey, the Functional Independence Measure, the Barthel Index, and the Beck Depression Inventory, as well as uroflowmetry testing. Results: There was no significant difference between the groups in terms of demographic characteristics (age, gender, stroke type, stroke time) and baseline assessment scores (p>0.05). The rTMS group showed statistically significant improvements in Danish PSS, I-QOL, ICIQ-SF, and OABSS scores at post-treatment and at week 8 compared to the sham rTMS group. In the rTMS group, Danish PSS scores decreased significantly from pre-treatment to post-treatment and at week 8 (p=0.02, p=0.01, respectively), while no significant change was observed in the sham rTMS group (p>0.05). Similarly, I-QOL scores in the rTMS group increased significantly from pre-treatment to post-treatment and at week 8 (p=0.03, p=0.008, respectively), while no significant change was detected in the sham rTMS group (p>0.05). ICIQ-SF and OABSS scores in the rTMS group also decreased significantly from pre-treatment to post-treatment and at week 8 (p=0.01, p=0.005 and p=0.02, p=0.01, respectively), while no significant change was observed in the sham rTMS group for both scores (p>0.05). Additionally, the rTMS group showed significant improvements in the subscales of the SF-36 quality of life scale, FIM and Barthel Index scores compared to the sham rTMS group (p<0.05), while there was no significant difference between the two groups in Beck Depression Inventory scores (p>0.05). According to the objective results obtained in the uroflowmetry evaluation, it was observed that the improvement seen in the long-term follow-up of rTMS treatment in terms of maximum flow rate, voided volume, average flow rate, and residual urine volume was greater compared to the sham rTMS group. No serious side effects related to the treatment were observed in either group. Conclusion: This study suggests that rTMS may be an effective and safe treatment method in relieving symptoms, improving quality of life, and improving bladder function in patients with post-stroke urinary dysfunction. Larger-scale and longer-term studies are needed to confirm these preliminary findings and to evaluate the long-term effects of rTMS.