重复经颅磁刺激联合中频电疗法治疗脑卒中后神经源性膀胱的疗效观察

doi:10.3969/j.issn.1006-5725.2026.11.002

Abstract

Abstract:

Objective To explore the clinical efficacy and practical application value of repetitive transcranial magnetic stimulation （rTMS） combined with medium-frequency electrotherapy in the rehabilitation management of patients with post-stroke neurogenic bladder. Methods From October 2024 to December 2025， patients with PSNB were randomly assigned to a control group （n = 30， receiving conventional treatment， rehabilitation， and medium-frequency electrotherapy） and an observation group （n = 30， receiving conventional treatment， rehabilitation， rTMS， and medium-frequency electrotherapy）. Both groups underwent treatment for 2 weeks and were then followed up for 1 month. The clinical indicators of the two groups were compared before and after treatment， including urodynamic parameters ［initial urge volume （FDV）， maximum bladder capacity （MCC）， filling phase bladder pressure （P_{ves at MCC}）， maximum urine flow rate （Q_max）， maximum detrusor pressure at maximum urine flow rate （P_detQmax）］， residual urine volume （RUV）， voiding diary （average daily voiding frequency， average daily leakage frequency， single void volume）， neurogenic bladder symptom score （NBSS）， and quality of life index score （Qualiveen scale）. The efficacy and safety of the two groups of patients were also evaluated. Results After treatment， the FDV， MCC， Q_max， P_detQmax， and the average daily single urine volume of both groups increased. Statistically， the levels in the observation group were higher than those in the control group （all P < 0.05）. Meanwhile， P_ves， RUV， the average daily urine volume， the number of leakage episodes， the NBSS score， and the Qualiveen scale score all decreased. Significantly， the values in the observation group were lower than those in the control group （all P < 0.05）. The total effective rate in the observation group （93.33%） was significantly higher than that in the control group （73.33%）（P < 0.05）. During the entire intervention period， neither group experienced serious adverse events. Conclusions The combination of rTMS and medium-frequency electrotherapy has demonstrated remarkable efficacy in the rehabilitation treatment of patients with PSNB. It plays a positive role in enhancing clinical symptoms， bladder function， and the quality of life. Moreover， it is highly safe， bringing substantial benefits to patients.

Key words: stroke, neurogenic bladder, repetitive transcranial magnetic stimulation, medium-frequency electrotherapy, closed-loop rehabilitation

CLC Number:

R493

Mengyu LI,Ruisi TIAN,Le GAO,Junjiang LIU,Jing WANG,Dexi FANG,Yanxia LI. Efficacy of repetitive transcranial magnetic stimulation combined with medium frequency electrotherapy for post-stroke neurogenic bladder[J]. The Journal of Practical Medicine, 2026, 42(11): 1899-1905.

Figures/Tables 5

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

References 34

[1]	WANG J， XIAO C， CHENG Z， et al. Analysis and prediction of disease burden of stroke and its subtypes in China from 1990 to 2040［J］. Chin Med J， 2025， 138（19）： 2452-2463. doi：10.1097/cm9.0000000000003725 . doi: 10.1097/cm9.0000000000003725
[2]	SEVILLA TORRES E， SOTO-JUNCO E J， BAIZAN ORIAS S D， et al. Neurogenic voiding dysfunction in spinal cord injury and stroke： Urodynamic evaluation， functional classification， and therapeutic strategies［J］. Cureus， 2025， 17（8）： e89348. doi：10.7759/cureus.89348 . doi: 10.7759/cureus.89348
[3]	魏衍旭，张思鈺，任慧，等. 盆底重复磁刺激联合排尿功能训练治疗脑卒中后非认知功能障碍性神经源性膀胱的临床效果［J］. 中国老年学杂志， 2025， 45（11）： 2659-2662. doi：10.3969/ j.issn.1005-9202.2025.11.024 . doi: 10.3969/ j.issn.1005-9202.2025.11.024
[4]	WANG Y， DONG T， LI X， et al. Research progress on the application of transcranial magnetic stimulation in spinal cord injury rehabilitation： A narrative review［J］. Front Neurol， 2023， 14： 1219590. doi：10.3389/fneur.2023.1219590 . doi: 10.3389/fneur.2023.1219590
[5]	CHEN J， TAN B， CHEN Y， et al. A randomized controlled trial of low-frequency repeated transcranial magnetic stimulation in patients with poststroke neurogenic bladder［J］. Sci Rep， 2024， 14： 18404. doi：10.1038/s41598-024-69345-z . doi: 10.1038/s41598-024-69345-z
[6]	DAIA C， BUMBEA A， BADIU C， et al. Interferential electrical stimulation for improved bladder management following spinal cord injury［J］. Biom Rep， 2019， 11（3）： 115-122. doi：10.3892/br.2019.1227 . doi: 10.3892/br.2019.1227
[7]	JIA J. Exploration on neurobiological mechanisms of the central–peripheral–central closed-loop rehabilitation［J］. Front Cell Neurosci， 2022， 16： 982881. doi：10.3389/fncel.2022.982881 . doi: 10.3389/fncel.2022.982881
[8]	中华人民共和国国家卫生健康委员会. 脑血管病防治指南（2024年版）［J］. 磁共振成像， 2025， 16（1）： 1-8. doi：10.12015/ issn.1674-8034.2025.01.001 . doi: 10.12015/ issn.1674-8034.2025.01.001
[9]	王毅，赵耀瑞. 卒中后神经源性膀胱诊治专家共识［J］. 中国卒中杂志， 2016， 11（12）： 1057-1066.
[10]	孙婉婷，艾丽皮乃·亚森，龚翔，等. 基于运动序列学习探讨高频重复经颅磁刺激对脑卒中患者上肢功能的效果［J］. 中国康复理论与实践， 2025， 31（7）： 812-821. doi：10.3969/j.issn. 1006-9771.2025.07.008 . doi: 10.3969/j.issn. 1006-9771.2025.07.008
[11]	NARDONE R， VERSACE V， SEBASTIANELLI L， et al. Transcranial magnetic stimulation and bladder function： A systematic review［J］. Clin Neurophysiol， 2019， 130（11）： 2032-2037. doi：10.1016/j.clinph.2019.08.020 . doi: 10.1016/j.clinph.2019.08.020
[12]	CARRO D F， SILVEIRA L T Y DA， BARACAT E C， et al. Validity and reliability study of a free mobile app for assessing voiding habits［J］. Int J Med Inform， 2026， 207： 106183. doi：10.1016/j.ijmedinf.2025.106183 . doi: 10.1016/j.ijmedinf.2025.106183
[13]	WELK B， LENHERR S， ELLIOTT S， et al. The Neurogenic Bladder Symptom Score （NBSS）： A secondary assessment of its validity， reliability among people with a spinal cord injury［J］. Spinal Cord， 2018， 56（3）： 259-264. doi：10.1038/s41393-017-0028-0 . doi: 10.1038/s41393-017-0028-0
[14]	BAUER S， GRASSNER L， MAIER D， et al. Early sacral neuromodulation： A promising opportunity or an overload for patients with a recent spinal cord injury？ a cross-sectional study［J］. J Clin Med， 2025， 14（3）： 1031. doi：10.3390/jcm14031031 . doi: 10.3390/jcm14031031
[15]	董艳，刘震钢，刘媛，等. 火针联合膀胱功能训练治疗脊髓损伤所致神经源性膀胱：随机对照试验［J］. 中国针灸， 2024， 44（12）： 1395-1400. doi： 10.13703/j.0255-2930.20240316-k0001 . doi: 10.13703/j.0255-2930.20240316-k0001
[16]	许艳，王凤丽，耿德勤. 高频重复经颅磁刺激联合丁苯酞对缺血性脑卒中患者肢体功能的作用［J］. 实用医学杂志， 2026， 42（4）： 618-625. doi：10.3969/j.issn.1006-5725.2026.04.011 . doi: 10.3969/j.issn.1006-5725.2026.04.011
[17]	AGAPIOU E， PYRGELIS E S， MAVRIDIS I N， et al. Lower urinary tract dysfunction following stroke： From molecular mechanisms to clinical anatomy［J］. J Biol Meth， 2024， 11（4）： e99010024. doi：10.14440/jbm.2024.0022 . doi: 10.14440/jbm.2024.0022
[18]	刘敏琦，高明威，褚晓蕾，等. 不同频率电刺激促进周围神经损伤的恢复［J］. 中国组织工程研究， 2025， 29（14）： 3061-3069. doi：10.12307/2025.620 . doi: 10.12307/2025.620
[19]	袁泽峰，田高源，黄志伟，等. 生物反馈联合磁电刺激对盆底痉挛综合征患者排粪梗阻的改善作用［J］. 实用医学杂志， 2025， 41（15）： 2372-2380. doi：10.3969/j.issn.1006-5725.2025. 15.012 . doi: 10.3969/j.issn.1006-5725.2025. 15.012
[20]	BROWN J C， PHILIP N S. Pharmaco-transcranial magnetic stimulation： Letting mechanism guide the way［J］. Am J Psychiatry， 2025， 182（3）： 240-242. doi：10.1176/appi.ajp.20241151 . doi: 10.1176/appi.ajp.20241151
[21]	SHARBAFSHAAER M， CIRILLO G， ESPOSITO F， et al. Harnessing brain plasticity： The therapeutic power of repetitive transcranial magnetic stimulation （rTMS） and Theta burst stimulation （TBS） in neurotransmitter modulation， receptor dynamics， and neuroimaging for neurological innovations［J］. Biomedicines， 2024， 12（11）： 2506. doi：10.3390/biomedicines12112506 . doi: 10.3390/biomedicines12112506
[22]	ATAK ÇAKIR P， MUTLUAY F， HANOĞLU L， et al. Effect of transcutaneous posterior tibial nerve stimulation and repetitive transcranial magnetic stimulation on neurogenic overactive bladder symptoms in female patients with multiple sclerosis： The study protocol of a randomized controlled study［J］. Front Neurol， 2022， 13： 1011502. doi：10.3389/fneur.2022.1011502 . doi: 10.3389/fneur.2022.1011502
[23]	XIE H， LI X， WANG Y， et al. Differential functional network remodeling induced by low- and high-frequency rTMS： Evidence from concurrent fNIRS monitoring［J］. IEEE Trans Neural Syst Rehabil Eng， 2025， 33： 3827-3836. doi：10.1109/TNSRE.2025. 3611796 . doi: 10.1109/TNSRE.2025. 3611796
[24]	SINHA S， GAJEWSKI J B， TARCAN T， et al. Is it possible to regenerate the underactive detrusor？ part 2. electrical stimulation therapies， treatment of bladder outlet obstruction， constipation， and pelvic floor disorders-ICI-RS 2024［J］. Neurourol Urodyn， 2025， 44（3）： 585-591. doi：10.1002/nau.25594 . doi: 10.1002/nau.25594
[25]	中国残疾人康复协会康复评定专业委员会，甘肃省残疾人康复学会脊柱脊髓损伤康复专业委员会，甘肃省医学会物理医学与康复分会，等. 神经源性膀胱综合管理临床实践指南（下）［J］. 中华物理医学与康复杂志， 2025， 47（1）： 1-6. doi：10.3760/cma.j.cn421666-20240703-00545-1 . doi: 10.3760/cma.j.cn421666-20240703-00545-1
[26]	HAAKANA P， NÄTKYNMÄKI A， KIRVESKARI E， et al. Effects of auricular vagus nerve stimulation and electrical earlobe stimulation on motor-evoked potential changes induced by paired associative stimulation［J］. Eur J Neuroscience， 2024， 60（8）： 5949-5965. doi：10.1111/ejn.16539 . doi: 10.1111/ejn.16539
[27]	娄晓乐，宋佳苧，韩雪，等. 经颅联合外周双向反馈磁刺激对脊髓损伤后神经源性膀胱患者膀胱及排尿功能的效果［J］. 实用医学杂志， 2025， 41（6）： 859-865. doi：10.3969/j.issn.1006-5725.2025.06.013 . doi: 10.3969/j.issn.1006-5725.2025.06.013
[28]	ALI M U. Repetitive transcranial magnetic stimulation for the treatment of neurogenic overactive bladder in stroke survivors［D］. Hong Kong： The Hong Kong Polytechnic University， 2025. doi:10.1016/j.mehy.2024.111300 doi: 10.1016/j.mehy.2024.111300
[29]	金娟，周钦钦，刘炜，等. 盆底肌电刺激治疗脊髓损伤后神经源性膀胱的随机对照试验的Meta分析［J］. 中华物理医学与康复杂志， 2021， 43（1）： 64-68. doi：10.3760/cma.j.issn.0254-1424.2021.01.018 . doi: 10.3760/cma.j.issn.0254-1424.2021.01.018
[30]	LIU Y， XU G， GENG J. Efficacy of transcutaneous electrical nerve stimulation in the management of neurogenic overactive bladder： A randomized controlled trial［J］. Am J Phys Med Rehabil， 2022， 101（1）： 2-10. doi：10.1097/PHM. 0000000000001836 . doi: 10.1097/PHM. 0000000000001836
[31]	GU J， ZANG J. Clinical efficacy of bladder function training combined with pelvic floor biofeedback electrical stimulation on neurogenic bladder and its impact on urodynamics［J］. Pak J Med Sci， 2024， 41（1）： 251-256. doi：10.12669/pjms.41.1.9655 . doi: 10.12669/pjms.41.1.9655
[32]	ATAK ÇAKIR P， GÜZELBURÇ V， BIRDAY E， et al. Effect of neuromodulation on neurogenic bladder in women with multiple sclerosis： A pilot randomized controlled trial［J］. Neurodegener Dis Manag， 2025， 15（2-3）： 57-64. doi：10.1080/17582024.2025. 2488712 . doi: 10.1080/17582024.2025. 2488712
[33]	黄强，李春宁，解鸿宇，等. “灸刺任脉” 联合膀胱功能训练治疗卒中后神经源性膀胱：随机对照试验［J］. 中国针灸， 2025， 45（10）： 1427-1433. doi：10.13703/j.0255-2930.20250302-0001 . doi: 10.13703/j.0255-2930.20250302-0001
[34]	朱光跃，陈思韵，霍聪聪，等. 外周联合中枢双靶磁刺激促进脑卒中运动功能障碍康复专家共识［J］. 中国康复医学杂志， 2023， 38（7）： 880-884. doi：10.3969/j.issn.1001-1242.2023.07.003 . doi: 10.3969/j.issn.1001-1242.2023.07.003

评价指标	观察组（n = 30）	对照组（n = 30）	t/χ²值	P值
性别			0.287	0.592
男	20（66.67）	18（60.00）
女	10（33.33）	12（40.00）
年龄（x ± s）/岁	63.03 ± 11.30	65.60 ± 8.69	-0.986	0.328
病程（x ± s）/月	2.70 ± 1.75	3.47 ± 1.31	-1.927	0.059
NB分型
尿失禁	8（26.67）	11（36.67）	0.693	0.405
尿潴留	22（73.33）	19（63.33）	0.693	0.405
卒中类型
脑梗死	14（46.67）	17（56.67）	0.601	0.438
脑出血	16（53.33）	13（43.33）	0.601	0.438
卒中部位
左侧	9（30.00）	13（43.33）	1.148	0.284
右侧	21（70.00）	17（56.67）	1.148	0.284

组别	FDV/mL		MCC/mL		P_ves/cmH₂O
组别	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组（n = 30）	220.00 ± 34.22	273.00 ± 36.53^*	270.87 ± 39.95	328.43 ± 38.70^*	41.24 ± 5.80	34.71 ± 4.36^*
对照组（n = 30）	226.37 ± 37.02	251.97 ± 31.09^*	270.70 ± 46.63	304.20 ± 44.51^*	41.87 ± 4.89	38.25 ± 4.20*
t值	-0.692	2.402	0.015	2.250	-0.457	-3.198
P值	0.492	0.020	0.988	0.028	0.649	0.002
组别	Q_max/（mL/s）		P_{det Qmax}/cmH₂O		RUV/mL
组别	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组（n = 30）	8.54 ± 2.61	16.77 ± 2.57^*	16.51 ± 2.53	28.91 ± 3.42^*	172.03 ± 34.77	111.07 ± 25.74^*
对照组（n = 30）	8.80 ± 2.13	14.08 ± 2.84^*	16.27 ± 1.45	23.54 ± 3.28^*	174.97 ± 40.63	134.10 ± 26.83^*
t值	-0.422	3.827	0.457	6.212	-0.300	-3.394
P值	0.674	< 0.001	0.649	< 0.001	0.765	< 0.001

组别	日均排尿次数/次		日均漏尿次数/次		日均单次排尿量/mL
组别	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组（n = 30）	11.67 ± 2.50	7.01 ± 1.64^*	9.07 ± 2.44	4.78 ± 1.16^*	66.13 ± 5.66	178.92 ± 18.72^*
对照组（n = 30）	11.33 ± 3.11	9.19 ± 1.44^*	9.00 ± 2.78	6.68 ± 1.42^*	66.74 ± 4.47	140.46 ± 12.65^*
t值	0.472	-5.463	0.099	-5.675	-0.464	9.327
P值	0.639	< 0.001	0.922	< 0.001	0.644	< 0.001

组别	NBSS		Qualiveen
组别	治疗前	治疗后	治疗前	治疗后
观察组（n = 30）	48.70 ± 4.19	34.67 ± 3.85^*	63.80 ± 7.33	44.00 ± 4.91^*
对照组（n = 30）	49.47 ± 4.47	39.40 ± 3.35^*	63.73 ± 5.80	47.90 ± 5.29^*
t值	-0.686	-5.078	0.039	-2.960
P值	0.496	< 0.001	0.969	0.004

组别	痊愈	显效	有效	无效	总有效率
观察组（n = 30）	11（36.67）	13（43.33）	4（13.33）	2（6.67）	93.33^*
对照组（n = 30）	5（16.67）	10（33.33）	7（23.33）	8（26.66）	73.33

Efficacy of repetitive transcranial magnetic stimulation combined with medium frequency electrotherapy for post-stroke neurogenic bladder

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 34

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	Ranran DU,Yuegu WANG,Ying CHEN,Kunyu ZHANG. Comparative of the diagnostic efficiency of VAN and NIHSS in emergency recognition of anterior and posterior circulation acute macrovascular occlusive ischemic stroke [J]. The Journal of Practical Medicine, 2026, 42(7): 1257-1264.
[2]	Guixiong CHEN,Xin LIU,Fanqiang LI,Danxian CAI,Zhengtao ZHENG,Xiaopeng GAN,Wei LIU,Kangling WANG. A randomized controlled study on shock wave therapy for triceps surae spasm in different positions [J]. The Journal of Practical Medicine, 2026, 42(5): 838-845.
[3]	Yan XU,Fengli WANG,Deqin GENG. The influence of high-frequency repetitive transcranial magnetic stimulation combined with butylphthalide on the limb function in patients with ischemic stroke [J]. The Journal of Practical Medicine, 2026, 42(4): 618-625.
[4]	Jianhua JIAO,Ruixue MA,Honghong GU,Xing WU,Xiuli CAO. Evaluation value of sCD163， SHR， pro-ADM， PTX3 combined with score of chest CT on the condition and prognosis of elderly patients with stroke-related pneumonia [J]. The Journal of Practical Medicine, 2026, 42(3): 447-454.
[5]	Xulong ZHANG,Jianrong MI,Jing LI,Lili YUAN,Xiangwei MENG,Xiaoyan FAN. Wake-promoting effect of Xingnao Kaiqiao acupuncture combined with repetitive transcranial magnetic stimulation on patients in a persistent vegetative state [J]. The Journal of Practical Medicine, 2026, 42(3): 511-516.
[6]	Wei TAO,Shifeng LIANG,Zhinong SHI,Zhen LI,Lunshan WANG. Effects of acupuncture on immune homeostasis and functional recovery in ischemic stroke rehabilitation patients [J]. The Journal of Practical Medicine, 2026, 42(2): 255-265.
[7]	Chonghe WANG,Chenrui LI,Yuntao YANG,Jianan CHEN. Research progress on the pathogenesis of post-stroke depression and acupuncture treatment based on the reward circuit [J]. The Journal of Practical Medicine, 2026, 42(10): 1779-1786.
[8]	Peijia CHEN,Peiyun FENG,Ying JIANG,Rong WU,Houwei WEI,Zhenglin WEI,Wenghao HUANG,Liming LU,Yanqing LU. Study on the brain network effects of stroke patients treated with Tongdu Tiaoshen acupuncture method based on the fMRI [J]. The Journal of Practical Medicine, 2026, 42(10): 1811-1821.
[9]	Qiaochu LU,Qianqian SUN,Yi ZHU,Shengliang CHEN,Honghong FENG,Yixiang HUANG. The associations between disease course， functional status and rehabilitation hospitalization costs in patients with stroke [J]. The Journal of Practical Medicine, 2026, 42(10): 1881-1888.
[10]	Panpan GAO,Qian ZHANG,Tinghui LIU,Jie. SUN. Application of ipsilateral high⁃frequency rTMS combined with biofeedback⁃based air swallowing training in patients with post⁃stroke dysphagia [J]. The Journal of Practical Medicine, 2025, 41(8): 1105-1110.
[11]	Bing YU,Mengxia CHEN,Mengdi WANG,Xiaorong HUANG,Lingjuan. ZHANG. Relationship between recurrence risk perception and health behavior in stroke patients： The chain⁃mediated role of self⁃efficacy and e⁃health literacy [J]. The Journal of Practical Medicine, 2025, 41(4): 600-606.
[12]	Xiang GAO,Beibei MA,Wanru BAO. The relationship between demoralization syndrome and death anxiety in stroke patients undergoing neuroendovascular procedures based on latent profile analysis [J]. The Journal of Practical Medicine, 2025, 41(22): 3609-3617.
[13]	Huiling CAO,Jie ZHANG,Xiaofei ZHU,Shining QIAN,Yunfeng. CHEN. Study on the mechanism of tetramethylpyrazine pretreatment umbilical cord mesenchymal stem cell transplantation in the treatment of ischemic stroke [J]. The Journal of Practical Medicine, 2025, 41(2): 178-185.
[14]	Yonglin HU,Yongping HUA,Ying MA,Anmin LU,Yuhua XIAO,Xinjian SONG,Su. LIU. Therapeutic effects of robot⁃assisted training combined with neural mobilization on upper limb functions in stroke patients [J]. The Journal of Practical Medicine, 2025, 41(2): 225-231.
[15]	Haiyi XIE,Xuying LIU,Xiaoxiao MA,Junyun DING,Zhenhong. WANG. Effect of inspired oxygen concentration on perioperative cerebrovascular function in stroke patients [J]. The Journal of Practical Medicine, 2025, 41(19): 3008-3015.