Systematic review and meta-analysis of electrical stimulation for quality of life in women with urinary incontinence

Electrical stimulation is increasingly applied as a non-invasive intervention for managing urinary incontinence in women, aiming to improve both urinary symptoms and quality of life. The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of electrical stimulation on quality of life and relevant clinical outcomes in women with urinary incontinence, and to explore sources of heterogeneity through subgroup and meta-regression analyses. This review was conducted according to PRISMA 2020. Six electronic databases were searched for randomized controlled trials evaluating electrical stimulation interventions for women with urinary incontinence published between 1995 and 2025. Fourteen randomized controlled trials met the inclusion criteria. A random-effects model was used to synthesize effect sizes (Hedges' g). Heterogeneity was assessed using Cochran's Q and I². Subgroup and meta-regression analyses were conducted to explore potential moderators. Publication bias was evaluated using funnel plots, Egger's and Begg's tests, and the trim-and-fill method. Additionally, a network meta-analysis was conducted to facilitate indirect comparisons among intervention types. The pooled effect size for quality of life was not statistically significant (Hedges' g = -0.29, 95% CI -0.72 to 0.14, p = .182), with high heterogeneity (I² = 91.1%). Subgroup analyses revealed significant effects in studies using the I-QoL, ICIQ, and Wagner's QoL tool, participants with urgency urinary incontinence, in smaller sample sizes, and in interventions involving fewer sessions or continuous stimulation. Meta-regression confirmed that outcome tool, sample size, urinary incontinence type, and study quality were significant moderators. In the network meta-analysis, which included ES, ES + PFMT, PFMT, biofeedback, and control, no statistically significant differences in quality of life were observed among the interventions, and no inconsistency was detected between direct and indirect comparisons. For secondary outcomes, electrical stimulation significantly improved symptom severity, micturition frequency, nocturia, and urinary incontinence episodes, but not pad test results or pelvic floor muscle strength. Electrical stimulation appears to have limited overall effects on improving quality of life and symptoms in patients with urinary incontinence. However, it may be effective under specific conditions, when adjusted for the subtype of urinary incontinence, the method of electrical stimulation application, and the quality of life measures used.