PURPOSE: Urinary incontinence (UI) is a prevalent clinical manifestation in spinal cord injury (SCI) patients, occurring in approximately 70% of these individuals. This systematic review aims to comprehensively evaluate the research evidence on electroacupuncture (EA) for UI after SCI, assess its clinical efficacy and safety, and provide a reference for clinical practice. METHOD: Eight databases were searched for randomized controlled trials (RCTs) published from inception to May 20th, 2025. RCTs comparing EA (with or without conventional rehabilitation, CR) to CR alone for managing UI after SCI were included. Data were analyzed using R version 3.6.3. In accordance with PRISMA-2020 guidelines, two reviewers independently extracted data and assessed the risk of bias using the Cochrane risk of bias tool (ROB 2.0). The certainty of the evidence was graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) according to GRADE handbook. RESULTS: A total of 15 studies were included, comprising 1,394 patients with UI after SCI. The meta-analysis indicated that, compared to the CR group, the EA group showed a significant improvement in 24h incontinence frequency (MD -1.42, 95% CI -1.88 to -0.96, p < 0.01), maximum urine output in 24h (MD 18.98, 95% CI 9.27 to 28.69, p < 0.01), and single urination volume in 24h (MD 30.76, 95% CI 21.45 to 40.08, p < 0.01). Regarding the Urodynamic outcome indices, the EA group displayed significant improvement in residual urine volume (MD -20.06, 95% CI -28.73 to -11.38, p < 0.01), bladder volume (MD 38.86, 95% CI 19.98 to 57.75, p < 0.01), maximum urine flow rate (Qmax) (MD 2.68, 95% CI 1.66 to 3.70, p < 0.01), detrusor pressure (PdetQmax) (MD -6.77, 95% CI -9.54 to -4.00, p < 0.01), and bladder compliance (BC) (MD 1.41, 95% CI 0.88 to 1.93, p < 0.01). Trial Sequential Analysis (TSA) confirmed the superior treatment outcomes of EA compared to CR. The reported adverse events related to acupuncture were minimal and less severe. CONCLUSION: EA exhibits considerable potential to enhance self-control of bladder function in patients with UI following SCI. However, this study has certain limitations, and higher quality randomized controlled trials are necessary to confirm these findings. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD42024594516.

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