Neuromodulatory effects of repetitive transcranial magnetic stimulation on post-stroke urinary retention: insights from neuroelectrophysiological assessment.

BACKGROUND: Post-stroke urinary retention is common and clinically relevant. Repetitive transcranial magnetic stimulation (rTMS) may modulate supraspinal micturition circuits, but evidence in retention is limited. METHODS: We retrospectively studied 103 patients with post-stroke urinary retention: 52 received 4 weeks of contralesional M1 low-frequency rTMS plus rehabilitation, and 51 rehabilitation alone. Outcomes included post-void residual volume (PVR) and neurophysiological measures, while the urinary function score was analyzed as an exploratory symptom measure. RESULTS: Most baseline characteristics were similar between groups. Compared with controls, the rTMS group showed greater reductions in PVR (- 30 vs. - 10 ml at week 2; -64 vs. - 17 ml at week 4, p < 0.001), exploratory improvements in urinary function scores (- 6.1 vs. - 2.1, p < 0.001), shorter reflex latency (- 14.4 vs. - 5.0 ms, p < 0.001), and higher EMG amplitude (+ 23.4 vs. + 2.5 µV, p < 0.001). CONCLUSIONS: In this retrospective cohort, low-frequency rTMS was associated with improved bladder emptying and neurophysiological changes in post-stroke urinary retention.