Clinical Efficacy and Preliminary Cost-Utility of Low-Frequency Repetitive Transcranial Magnetic Stimulation Versus Sham Stimulation for Neurogenic Overactive Bladder in Stroke Survivors: A Randomized Controlled Trial

Background: Neurogenic overactive bladder (OAB) among survivors is burdensome. Low-frequency repetitive transcranial magnetic stimulation (rTMS) is a promising non-invasive intervention requiring comprehensive evaluation of its clinical and economic impact. Objectives: To evaluate the efficacy, cost-utility, and stroke survivors’ experiences of rTMS for neurogenic OAB. Methods: In this randomized, assessor-blinded, sham-controlled trial, 60 stroke survivors with neurogenic OAB received active rTMS (1200 pulses 80% resting motor threshold [RMT]) or sham (20% RMT) thrice weekly for 4 weeks at contralateral primary motor cortex. The OAB Symptom Score (OABSS), Incontinence Quality of Life (I-QOL), and Brief Resilience Scale (BRS)—were measured at baseline, week 4, and week 8. Repeated measures analysis of covariance evaluated effects. Cost-utility analysis used societal costs and quality-adjusted life years (QALYs). Focus groups involved 12 active-group participants. Results: Active rTMS (n = 30; 60% male; mean age = 62.1 ± 9.5 years) significantly improved OABSS (mean difference [MD] = 1.81 points, 95% confidence interval [CI] [1.42-2.20], P < .001), I-QOL (MD = 17.48 points, 95% CI [14.18-20.79], P < .001), and BRS (MD = 0.25 points, 95% CI [0.09-0.41], P = .002), at weeks 4 and 8 compared to sham (n = 30; 47% male; mean age = 61.7 ± 8.3 years). Active rTMS was associated with lower societal costs (HK$1267.3 vs HK$1839.0) and higher QALYs (0.691 vs 0.571) than sham. Qualitative data indicated excellent tolerability, symptom relief, and acceptability. Conclusions: Low-frequency rTMS is clinically effective, safe, acceptable, and potentially cost-saving for post-stroke neurogenic OAB. Larger trials with active comparators and extended follow-up are warranted. Trial Registration: This trial was registered at http://ClinicalTrials.gov (reference number: NCT05557175) before the recruitment of the first participant.