A Pilot Randomized Placebo Controlled Trial of Electroacupuncture for Women with Pure Stress Urinary Incontinence

Efficacy and safety of acupuncture monotherapy or combined with pelvic floor muscle training for female stress urinary incontinence: a systematic review and meta-analysis

Background

Stress urinary incontinence (SUI) is involuntary urine leakage during effort. Pelvic floor muscle training (PFMT) is a common physical therapy for SUI, but has low adherence and its long-term effectiveness is uncertain. Drug therapy has side-effect problems and surgery has risks. Acupuncture's role in improving SUI is also unclear based on previous studies.

Objectives

This systematic review and meta-analysis evaluated the efficacy and safety of acupuncture individually or combined with PFMT in improving symptoms and women's health-related quality of life of SUI.

Design

A systematic review and meta-analysis were conducted.

Patients

Women with stress urinary incontinence were treated with electroacupuncture (EA) individually or acupuncture combined with PFMT.

Results

In the analysis comparing urinary leakage 1 h and the ICIQ-SF score, electroacupuncture (EA) intervention was significantly associated with improvements in both urine leakage (MD = 4.69, 95% CI 2.83 to 6.55, I2 = 62%) and ICIQ-SF (MD = 2.61, 95% CI 1.64 to 3.58, I2 = 65%). The results were robust for the sensitivity analyses. EA was not associated with an increased incidence of adverse events compared to placebo EA (RR = 1.08, 95% CI 0.50 to 2.35, I2 = 0%). When comparing the group receiving pelvic floor muscle training (PFMT) combined with acupuncture to the PFMT only group, the combination therapy was found to improve urine leakage 1 h (MD = 1.91, 95% CI 0.96 to 2.86, I2 = 80%) and improve ICIQ-SF (MD = 2.63, 95% CI 1.60 to 3.65, I2 = 75%) in patients with SUI, despite significant heterogeneity observed. Subgroup analyses based on urine leakage 1 h revealed that subjects with mild stress urinary incontinence showed improvements (MD = 1.46, 95% CI 0.82 to 2.10, I2 = 58%), as did those with moderate stress urinary incontinence (MD = 4.9, 95% CI 1.72 to 8.08, I2 = 77%). There were significant differences between these subgroups (I2 = 77%, p = 0.04). In the subgroup analysis of intervention types, manual acupuncture showed no significant effect when combined (MD = 1.11, 95% CI -0.61 to 2.83, I2 = 86%).

Conclusion

The findings from this meta-analysis indicate that EA is more effective at improving the clinical symptoms and quality of life in patients with SUI compared to placebo EA, and it does not increase the risk of adverse events. Moreover, the therapeutic effect of SUI treatment with EA combined with pelvic floor muscle training (PFMT) elicits a more positive response than PFMT alone. This suggests that EA, either as a standalone therapy or as an adjunct to PFMT, can offer beneficial outcomes for individuals with stress urinary incontinence, expanding the range of clinical treatment options available.

Systematic Review Registration

The meta-analysis was registered in PROSPERO (CRD42022381409).

Comparison of nonimplantable electrical stimulation in women with urinary incontinence: a systematic review and network meta-analysis of randomized controlled trials

This study examined the effectiveness of various electrical stimulation methods in alleviating symptoms and enhancing the quality of life for women with urinary incontinence. We conducted a systematic search of PubMed, Cochrane Library, PEDro, EMBASE, and ClinicalTrials.gov from inception to August 2024. Randomized controlled trials (RCTs) that meet following criteria were included, urinary continence in women, using various electric stimulation treatments and evaluated outcomes related to symptoms, quality of life. Thirty RCTs were subjected to risk of bias assessment, certainty of evidence, and network meta-analysis. Statistical analysis was performed using a random-effects model, with continuous variables expressed as standardized mean difference (SMD) and 95% confidence interval (CI). Percutaneous tibial stimulation (SMD - 1.86, 95% CI - 2.77 to - 0.96) and intravaginal stimulation (SMD - 0.97, 95% CI - 1.55 to - 0.38) significantly reduced symptom severity. Additionally, percutaneous tibial, intravaginal, transcutaneous tibial, and trans-sacral stimulations improved quality of life. Percutaneous tibial stimulation was the most effective, followed by intravaginal stimulation. Despite moderate to low confidence in the evidence, large-scale RCTs are needed to evaluate long-term benefits of these treatment.

Efficacy of Electroacupuncture in the Treatment of Mild to Moderate Female Stress Urinary Incontinence: Protocol for a Systematic Review and Network Meta-Analysis

BACKGROUND

Stress urinary incontinence (SUI), the most common form of urinary incontinence, is a condition that affects many women. It is characterized by involuntary urine leakage during activities that increase abdominal pressure, such as sneezing, coughing, or physical exertion, according to the International Continence Society. SUI affects patients' quality of life and causes depression and emotional disorders, which negatively influences physical and mental health. The participants in the studies in this review comprised women with mild to moderate SUI, because there are more female patients than male patients, and most patients with severe SUI are treated surgically. Moreover, after retrieval, there were no systematic reviews or network meta-analyses (NMAs) of conservative treatments, such as electroacupuncture (EA), in women with mild to moderate SUI.

OBJECTIVE

This study aims to investigate the efficacy of electroacupuncture among women with mild to moderate SUI using an NMA.

METHODS

Randomized clinical trials related to conservative treatments for SUI will be searched in 5 English and 3 Chinese literature databases: EMBASE, PubMed, Cochrane, Web of Science, ClinicalTrials.gov, Chinese National Knowledge Infrastructure (CNKI), WanFang, and the Chinese BioMedical Literature Database. The search period for these 8 electronic databases will be from 2002 to 2022. The PROSPERO database and the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) database will also be searched. Two reviewers will independently complete the research selection. After screening the studies, 2 other researchers will extract the data, and the quality of the included studies will be evaluated according to the quality standards specified in the Cochrane Collaboration Tool (version 2). The primary outcomes will be the change in urine leakage determined by a 1-hour pad test and International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) scores at baseline and at the conclusion of the follow-up. The secondary outcomes will be 72-hour incontinence episodes, residual bladder volume, effective rate, urodynamic indexes, and other reported measurements. Stata (version 14.0; StataCorp) and Review Manager (RevMan version 5.3; Cochrane) will be implemented for data synthesis and meta-analysis.

RESULTS

The results are not yet accessible because this is a protocol for a systematic review and meta-analysis. The protocol was registered on INPLASY on February 22, 2023. By April 6, 2023, we had completed the literature search of the 8 databases and completed the selection and data extraction of the articles.

CONCLUSIONS

The results of this systematic review will demonstrate the efficacy of EA among women with mild to moderate SUI. The results will provide evidence for clinicians and guideline makers to choose suitable treatments for SUI.

TRIAL REGISTRATION

International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) 202320098; https://inplasy.com/inplasy-2023-2-0098/.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55870.

Comparison of acupuncture and moxibustion related non-surgical therapies for women with stress urinary incontinence: A systematic review and network meta-analysis of randomized controlled trials

BACKGROUND

Stress urinary incontinence (SUI) significantly impacts women's health and imposes substantial mental and socio-economic burdens. Acupuncture and moxibustion, either alone or in combination with other non-surgical therapies, are recognized as effective treatments for SUI. This study aimed to assess the efficacy of various treatments for women with SUI using network meta-analysis (NMA).

METHOD

We systematically searched databases up until June 30, 2022, to identify relevant randomized controlled trials (RCTs) focusing on SUI in women. Subsequently, the quality of the included studies was assessed. NMA was performed using STATA 14.0 software.

RESULTS

A total of 31 RCTs involving 2922 participants were included in the analysis. A total of 18 treatment plans were identified. The treatment plan consisting of Moxibustion + PFMT + EB demonstrated the most significant reduction in ICIQ-UI-SF. Due to lack of consistency across studies, a NMA was not performed for the outcomes of effectiveness and the 1 h pad test.

CONCLUSIONS

The combined intervention of Moxibustion + PFMT + EB appears to be the most effective in reducing patients' reported symptoms and improving their quality of life. However, due to the limitations of the included studies, further high-quality RCTs are necessary to reinforce the current evidence.

Clinical practice guideline for acupuncture and moxibustion: Female urinary incontinence

Urinary incontinence (UI) is a common problem worldwide. It has a major impact on physical and social activities and interpersonal relationships. UI is common in women, but is under-reported and under-treated. It affects the quality of life of female patients severely. Acupuncture and moxibustion have been proposed as potentially effective interventions for female UI. Hence, for the benefit of acupuncture practitioners around the world, the World Federation of Acupuncture-moxibustion Societies initiated a project to develop a clinical practice guideline (CPG) for the use of acupuncture and moxibustion to treat female UI. This CPG was developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, referring to the principles of the World Health Organization Handbook for Guideline Development. During the development of the CPG, the guideline development group (GDG) played an important role. The clinical questions, recommendations and therapeutic protocols were all formulated by GDG using the modified Delphi method. This CPG contains ten recommendations about the use of acupuncture and moxibustion interventions for ten clinical questions, which include nine conditional recommendations for the intervention and one conditional recommendation for either the intervention or the comparison. This CPG also provides one protocol for conventional filiform needle therapy, two therapy protocols for deep needling stimulation on lumbosacral acupoints, and four moxibustion therapy protocols, based on the protocols presented in randomized controlled trials reviewed by the GDG. Please cite this article as: Yang C, Wang SZ, Chen S, Du S, Wang GQ, Guo W, Xie XL, Peng BH, Du SH, Zhao JP. Clinical practice guideline for acupuncture and moxibustion: Female urinary incontinence. J Integr Med. 2024; 22(3): 258-269.

Research trends of acupuncture therapy on stress urinary incontinence from 1992 to 2022: A bibliometric analysis

Background

Stress urinary incontinence (SUI), the most prevalent type of urinary incontinence disorder, has aroused increasing attention among societies since it has caused much inconvenience in daily life. In addition to conventional conservative treatments like medication and pelvic floor muscle training, acupuncture is now frequently advised. However, a bibliometric analysis of the trend of SUI therapies is still lacking.

Objectives

This article was carried out using CiteSpace (6.3.1) software to research the use of acupuncture therapy on SUI worldwide over the past 30 years (since the database's inception).

Methods

All related articles included were retrieved from the Web of Science Core Collection. CiteSpace (6.3.1) software was used to analyze the number of publications, countries and institutions, authors and cited authors, and burst keywords to assess the hotspots and trends over the previous three decades. And Microsoft Office Excel 2019 was also used for sorting data and generating tables.

Results

The articles were retrieved on August 31, 2022. A total of 108 records with publication dates ranging from 1992 to 2022 were discovered. The annual number of publications generally increased. In the aspect of publication regions, the USA ranked first in centrality, but China had the largest number of publications. The China Academic of Chinese Medical Sciences, Beijing University of Chinese Medicine, and Shanghai University of Traditional Chinese Medicine were the top 3 institutions, according to the institution map. Liu Z (Liu ZS) was the most productive author, and Chen Y ranked first in the centrality. The article published by Liu Z (Liu ZS) in 2017 was the most cited reference. "Bladder neck suspension", "electrical stimulation" and "acupuncture" were popular therapies mentioned among the top ten hot topics. The keywords "therapy", "postprostatectomy incontinence", "muscle", "cell therapy", and "symptom" ranked in the top five on citation burst. The four frontier topics were "efficacy", "symptom", "cell therapy", and "medical technology".

Conclusion

This study illustrated that the application of acupuncture on SUI had an increasing acceptance worldwide. Recent research has concentrated mainly on acupuncture and electroacupuncture, however, there is still not enough literature on these topics. The valuable information was provided for acupuncture researchers to identify prospects including potential collaborators, cooperation institutions, hot themes, and research frontiers.

Efficacy of pelvic floor physiotherapy intervention for stress urinary incontinence in postmenopausal women: systematic review

INTRODUCTION AND HYPOTHESIS

Our objective was to evaluate the effectiveness of pelvic floor physiotherapy interventions for stress urinary incontinence (SUI) in postmenopausal women.

METHODS

Searches were performed in MEDLINE/PubMed, PEDro, Cochrane Library Registry and LILACS databases until October 2021. Only randomized controlled trials (RCTs) which had physiotherapy interventions as primary outcome were included. There were no restrictions on the year of publication or language. Qualitative methodology was evaluated using the PEDro scale.

RESULTS

After applying inclusion/exclusion criteria and quality control, 6 randomized controlled trials were included in this systematic review. Methodological quality of trials varied from 5 to 8 (out of 10 possible points in PEDro scale score). Sample consisted of 715 subjects; mean age was between 51.6 and 66.3 years; SUI severity scale ranged from small to severe. Interventions were pelvic floor muscle training (PFMT); vaginal cone (VC); biofeedback (BF); electrical muscle stimulation (EMS); radiofrequency (RF) and electroacupuncture (EA). Pelvic floor physiotherapy was effective in all studies, however, meta-analysis was considered irrelevant due to the heterogeneity of the reported interventions.

CONCLUSION

There is not a literature consensus about the most effective pelvic floor physiotherapy intervention applied to stress urinary incontinence in postmenopausal women. It seems appropriate to state that further randomized controlled clinical trials should be done, due to the limited number of studies and heterogeneity of physiotherapeutic interventions applied to date.

TRIAL REGISTRATION

This systematic review is registered in PROSPERO in the trial registration CRD42021255062.

Efficacy and safety of acupuncture on sleep quality for post-stroke insomnia: a systematic review and meta-analysis

Background

Stroke is the second leading cause of death worldwide, and improving sleep quality in post-stroke insomnia is beneficial to the recovery of stroke. Acupuncture is widely used for the treatment of post-stroke insomnia in China. Therefore, this systematic review and meta-analysis were performed to explore the efficacy and safety of acupuncture for post-stroke insomnia.

Methods

Eight databases were searched from their inception to 12 September 2022. Two reviewers independently performed the study screening and data extraction. The outcomes include Pittsburgh Sleep Quality Index (PSQI), objective sleep data measured by polysomnography (PSG), long-term efficacy and adverse events. The quality of the trials was assessed by the Cochrane risk of bias tool 2.0. The RevMan 5.4 and Stata 15.1 were used for data synthesis.

Results

Among 3,233 participants from 41 studies were included. Pooled results indicated that acupuncture was superior to control group (CG) in improving PSQI total score (standardized mean difference (SMD) = -1.03, 95% confidence interval (CI): -1.32, -0.74, P < 0.00001), increasing sleep efficiency (SMD = 0.65, 95% CI: 0.37 to 0.92) and total sleep time (SMD = 0.54, 95% CI: 0.22 to 0.86). The favorable results in improving PSQI total score (SMD = 0.65, 95% CI: 0.37 to 0.92), reduced sleep latency (SMD = 1.84, 95% CI: 0.31 to 3.38) and increased total sleep time (SMD = -0.73, 95% CI: -1.15 to -0.31) were also observed in comparisons of acupuncture plus CG vs. CG. As of long-term efficacy and safety, the effects of acupuncture were long-term and robustness, however, due to limited safety information, reliable safety conclusions cannot be drawn. Subgroup analysis showed that acupuncture plus CG was superior to CG for post-infarction patients, but the efficacy of acupuncture alone compared to non-BZDs or other hypnotics needs further research. The GRADE assessment demonstrated that the level of evidence was mostly low or very low given the flaws in the study design and considerable heterogeneity among the included studies.

Conclusion

Acupuncture could improve sleep quality, has long-term efficacy and without serious adverse events. However, the findings should be treated with caution owing to the existence of methodological quality issues. More studies with rigorous designs are warranted for validation and explored the safety of acupuncture.

How about the RCTs' quality of acupuncture treatment for female urinary incontinence in recent 20 years? A report quality assessment

PURPOSE

To evaluate the quality of randomized controlled trials (RCTs) of acupuncture on female urinary incontinence (UI).

METHODS

We searched for related RCTs of acupuncture on female UI from seven databases (PubMed, Embase, Cochrane library, Web of Science, Medline, ClinicalKey, and Clinical trials). We applied CONSORT (2010 year) and STRICTA criteria to evaluate the relevant factors of included RCTs. Two trained researchers scored independently, and concordance was assessed by Cohen's к-statistic. The median and interquartile range summarized the CONSORT and STRICTA scores of the included studies. In addition, two independent sample t tests were used to assess the differences in the study quality between the 2000-2010 and the 2011-2022 years.

RESULTS

A total of 25 RCTs were finally included, and the scores were consistent between different assessors. The average CONSORT score was 10.50 (IQR 9.0-15.0) (total score was 25.0). Overall, the studies generally included scientific background (24/25, 96%), inclusion and exclusion criteria (24/25, 96%), outcome indicators (24/25, 96%), randomization methods (21/25, 84%), generalizability (19/25, 76%), and financial support (15/25, 60%). Most lacked sample size calculation (5/25, 20%), type of randomization (5/25, 20%), blinding (6/25, 24%), case screening period and follow-up (4/25, 16%), and study registration (6/25, 24%), etc. The average STRICTA score was 3.380 (IQR 3.02-3.95) (total score was 6.0). There had a lack of education on treatment methods for patients (3/25, 12%) and the qualification of acupuncturists (6/25, 24%).

CONCLUSION

The overall quality of RCTs on acupuncture treatment of female UI was suboptimal. It is still necessary to improve the research methods, especially the application of random methods, blinding, the interpretation of treatment, and the identification qualification of acupuncturists.

Efficacy of various forms of acupuncture for the treatment of urinary incontinence in women: A systematic review and meta-analysis

BACKGROUND AND PURPOSE

Evidence regarding the efficacy of various forms of acupuncture for the treatment of urinary incontinence (UI) in women is outdated and inconclusive. This review aims to determine the efficacy of different forms of acupuncture for the treatment of UI in women.

METHODS

Multiple databases were searched from inception to June 2020. Randomized controlled trials that compared various forms of acupuncture to control were included.

RESULTS

Ten trials were included in this review. The pooled analysis demonstrated that an increased proportion of women with stress UI (SUI) reported fewer UI episodes (1.73 [95% CI 1.46, 2.04]; p < 0.00001) in the electroacupuncture group than in the sham group. The meta-analysis also revealed a significantly increased number of women who reported the complete cure of SUI in the electroacupuncture combined with pelvic floor muscle training group than in the medication group (RR 2.67 [95% CI 1.51, 4.71]; p = 0.0007). Body and laser acupuncture caused significant decreases in the number of urge accidents (-2.70 [95% CI -4.86, -0.54]; p = 0.01) and the occurrence of urgency symptoms (-3.60[95% CI -5.34, -1.86]; p < 0.0001), compared with sham acupuncture.

CONCLUSIONS

Based on the findings of this review, electroacupuncture may be able to improve SUI in women in clinical settings. This review also identified evidence supporting the use of body, electro,- and laser acupuncture for the treatment of urge UI; however, these results were obtained from single studies, and further research remains necessary to confirm the effects of these interventions on the treatment of urge UI in women.

Effect of Electroacupuncture Added to Pelvic Floor Muscle Training in Women with Stress Urinary Incontinence: A Randomized Clinical Trial

BACKGROUND

Pelvic floor muscle training (PFMT) is a first-line conservative therapy for stress urinary incontinence (SUI). Electroacupuncture (EA) has been used to treat SUI recently.

OBJECTIVE

To compare the effectiveness of PFMT + EA versus PFMT + sham EA for SUI in women.

DESIGN, SETTING, AND PARTICIPANTS

A prospective, multicenter, randomized, controlled clinical trial was conducted at four hospitals in China involving 304 women with SUI from May 20, 2014 to November 21, 2017. Data were analyzed from April 20 to December 21, 2018.

INTERVENTION

Participants were randomized to receive 8 wk of PFMT+ EA (n = 154) or PFMT + sham EA (n = 150).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

The primary outcome was the change in the amount of urine leakage measured on a 1-hr pad test. Student's t test, the χ² test, and the Wilcoxon rank-sum test were used for data analysis.

RESULTS AND LIMITATIONS

Among the 304 participants randomized, 286 completed the study. The mean age was 57.6 yr (standard deviation [SD] 8.9) for the PFMT + sham EA group and 57.2 yr (SD 9.1) for the PFMT + EA group. The mean urine leakage at baseline was 13.6 g for the PFMT + sham EA group and 13.9 g for the PFMT + EA group. After the 8-wk intervention, the PFMT + EA group had a greater decrease in mean urine leakage (-9.8 g) than the PFMT + sham EA group (-5.8 g) with a mean difference of 4.0 g (95% confidence interval [CI] 0.8-7.2). Significantly more patients experienced a ≥50% reduction in urine leakage and the mean number of incontinence episodes in 24 h in the PFMT + EA group than in the PFMT + sham EA group (26.3%, 95%CI 15.8-36.8%). The PFMT + EA group experienced better improvement in participant-reported SUI severity at 6 wk (p < 0.001) and 8 wk (p < 0.001) and self-evaluated therapeutic effects at 2-32 wk (p < 0.001) after the intervention. Lack of measurement of the amount of urine leakage during follow-up is a limitation.

CONCLUSIONS

In this randomized clinical trial, 8-wk combined treatment with PFMT + EA led to a greater improvement in SUI symptoms and better outcomes than with PFMT + sham EA.

PATIENT SUMMARY

We evaluated the effectiveness and safety of pelvic floor muscle training combined with electroacupuncture for stress urinary incontinence in women, Our results show that this is a promising therapeutic approach for the treatment of stress urinary incontinence.

Acupuncture for treating overactive bladder in adults

BACKGROUND

Overactive bladder is a common, long-term symptom complex, which includes frequency of micturition, urgency with or without associated incontinence and nocturia. Around 11% of the population have symptoms, with this figure increasing with age. Symptoms can be linked to social anxiety and adaptive behavioural change. The cost of treating overactive bladder is considerable, with current treatments varying in effectiveness and being associated with side effects. Acupuncture has been suggested as an alternative treatment.

OBJECTIVES

To assess the effects of acupuncture for treating overactive bladder in adults, and to summarise the principal findings of relevant economic evaluations.

SEARCH METHODS

We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (including In-Process, Epub Ahead of Print, Daily), ClinicalTrials.gov and WHO ICTRP (searched 14 May 2022). We also searched the Allied and Complementary Medicine database (AMED) and bibliographic databases where knowledge of the Chinese language was necessary: China National Knowledge Infrastructure (CNKI); Chinese Science and Technology Periodical Database (VIP) and WANFANG (China Online Journals), as well as the reference lists of relevant articles.  SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi-RCTs and cross-over RCTs assessing the effects of acupuncture for treating overactive bladder in adults.

DATA COLLECTION AND ANALYSIS

Four review authors formed pairs to assess study eligibility and extract data. Both pairs used Covidence software to perform screening and data extraction. We assessed risk of bias using Cochrane's risk of bias tool and assessed heterogeneity using the Chi2 testand I2 statistic generated within the meta-analyses. We used a fixed-effect model within the meta-analyses unless there was a moderate or high level of heterogeneity, where we employed a random-effects model. We used the GRADE approach to assess the certainty of evidence.

MAIN RESULTS

We included 15 studies involving 1395 participants in this review (14 RCTs and one quasi-RCT). All included studies raised some concerns regarding risk of bias. Blinding of participants to treatment group was only achieved in 20% of studies, we considered blinding of outcome assessors and allocation concealment to be low risk in only 25% of the studies, and random sequence generation to be either unclear or high risk in more than 50% of the studies. Acupuncture versus no treatment One study compared acupuncture to no treatment. The evidence is very uncertain regarding the effect of acupuncture compared to no treatment in curing or improving overactive bladder symptoms and on the number of minor adverse events (both very low-certainty evidence). The study report explicitly stated that no major adverse events occurred. The study did not report on the presence or absence of urinary urgency, episodes of urinary incontinence, daytime urinary frequency or episodes of nocturia. Acupuncture versus sham acupuncture Five studies compared acupuncture with sham acupuncture. The evidence is very uncertain about the effect of acupuncture on curing or improving overactive bladder symptoms compared to sham acupuncture (standardised mean difference (SMD) -0.36, 95% confidence interval (CI) -1.03 to 0.31; 3 studies; 151 participants; I2 = 65%; very low-certainty evidence). All five studies explicitly stated that there were no major adverse events observed during the study. Moderate-certainty evidence suggests that acupuncture probably makes no difference to the incidence of minor adverse events compared to sham acupuncture (risk ratio (RR) 1.28, 95% CI 0.30 to 5.36; 4 studies; 222 participants; I² = 0%). Only one small study reported data for the presence or absence of urgency and for episodes of nocturia. The evidence is of very low certainty for both of these outcomes and in both cases the lower confidence interval is implausible. Moderate-certainty evidence suggests there is probably little or no difference in episodes of urinary incontinence between acupuncture and sham acupuncture (mean difference (MD) 0.55, 95% CI -1.51 to 2.60; 2 studies; 121 participants; I2 = 57%). Two studies recorded data regarding daytime urinary frequency but we could not combine them in a meta-analysis due to differences in methodologies (very low-certainty evidence). Acupuncture versus medication Eleven studies compared acupuncture with medication. Low-certainty evidence suggests that acupuncture may slightly increase how many people's overactive bladder symptoms are cured or improved compared to medication (RR 1.25, 95% CI 1.10 to 1.43; 5 studies; 258 participants; I2 = 19%). Low-certainty evidence suggests that acupuncture may reduce the incidence of minor adverse events when compared to medication (RR 0.34, 95% CI 0.26 to 0.45; 8 studies; 1004 participants; I² = 51%). The evidence is uncertain regarding the effect of acupuncture on the presence or absence of urinary urgency (MD -0.40, 95% CI -0.56 to -0.24; 2 studies; 80 participants; I2 = 0%; very low-certainty evidence) and episodes of urinary incontinence (MD -0.33, 95% CI -2.75 to 2.09; 1 study; 20 participants; very low-certainty evidence) compared to medication. Low-certainty evidence suggests there may be little to no effect of acupuncture compared to medication in terms of daytime urinary frequency (MD 0.73, 95% CI -0.39 to 1.85; 4 studies; 360 participants; I2 = 28%). Acupuncture may slightly reduce the number of nocturia episodes compared to medication (MD -0.50, 95% CI -0.65 to -0.36; 2 studies; 80 participants; I2 = 0%, low-certainty evidence). There were no incidences of major adverse events in any of the included studies. However, major adverse events are rare in acupuncture trials and the numbers included in this review may be insufficient to detect these events.

AUTHORS' CONCLUSIONS

The evidence is very uncertain about the effect acupuncture has on cure or improvement of overactive bladder symptoms compared to no treatment. It is uncertain if there is any difference between acupuncture and sham acupuncture in cure or improvement of overactive bladder symptoms. This review provides low-certainty evidence that acupuncture may result in a slight increase in cure or improvement of overactive bladder symptoms when compared with medication and may reduce the incidence of minor adverse events. These conclusions must remain tentative until the completion of larger, higher-quality studies that use relevant, comparable outcomes. Timing and frequency of treatment, point selection, application and long-term follow-up are other areas relevant for research.

Efficacy and safety of electrical stimulation for stress urinary incontinence in women: a systematic review and meta-analysis

INTRODUCTION AND HYPOTHESIS

This systematic review and meta-analysis was aimed at investigating the safety and short- and long-term efficacy of electrical stimulation (ES) in women with stress urinary incontinence (SUI).

METHODS

PubMed, Embase, and the Cochrane database were searched for randomized controlled trials (RCTs) conducted up to 2020. Studies comparing ES with sham ES or no intervention were included. Standardized mean differences (SMDs), weighted mean differences (WMDs), relative risks (RR), and 95% confidence intervals (CIs) were calculated.

RESULTS

This study included 9 RCTs, involving a total of 982 patients, of whom 520 received ES. Our results showed that in the short term (< 3 months), compared with sham ES or no intervention, ES significantly improved incontinence-specific quality of life (IQOL) (p = 0.003; SMD = 0.90 [95% CI, 0.30 to 1.50]; I2 = 88%) and reduced urine leakage (p < 0.00001; WMD = -6.15 [95% CI, -8.29 to -4.01]; I2 = 0%) but did not significantly reduce the frequency of incontinence episodes (p = 0.34; WMD = -0.98 [95% CI, -2.99 to 1.04]; I2 = 85%). In the long term (3-7.5 months), ES significantly improved IQOL (p = 0.0009; SMD = 1.14 [95% CI, 0.47 to 1.81]; I2 = 91%) and reduced the frequency of incontinence episodes (p = 0.0009; WMD = -2.45 [95% CI, -3.90 to -1.01]; I2 = 79%) but did not significantly reduce urine leakage (p = 0.27; WMD = -9.21 [95% CI, -25.57 to 7.14]; I2 = 71%). There was no significant difference in adverse events between ES and sham ES or no intervention (p = 0.36; RR = 1.34 [95% CI, 0.72 to 2.50]; I2 = 0%). A test for subgroup differences showed that electroacupuncture (EA) improved long-term IQOL to a greater extent than vaginal ES (VES), whereas there was no significant difference in efficacy between EA and VES in short- or long-term reduction of urine leakage, frequency of incontinence episodes, or short-term IQOL improvement.

CONCLUSIONS

ES may improve short- and long-term IQOL for women with SUI, but it appears to provide only short-term reduction in urine leakage and long-term reduction in frequency of incontinence episodes. However, we cannot draw any conclusion on the safety between ES and sham ES or no intervention because of the rarity of adverse events. It is still uncertain whether EA is comparable or superior to VES owing to an insufficient number of studies and patients. The conclusions should be considered carefully because of the limited quality and quantity of the RCTs included. Further rigorous RCTs with adequate sample sizes and long follow-up are necessary to fully validate our findings.

Sacral Acupuncture for Lower Urinary Tract Symptoms: A Systematic Review of Randomized Controlled Trials

Lower urinary tract symptoms (LUTS) associated with storage, voiding, and post-micturition reduce quality of life and cause mental health problems. In traditional medicine, Baliao points have been empirically used to treat urinary system diseases. In this review, randomized controlled trials (RCTs) using sacral acupuncture on Baliao points with sham treatment, other remedies, or other acupoints were retrieved from 8 electronic databases up to June 2021. Sixteen RCTs met the inclusion criteria. The quality of the included studies was assessed using a risk-of-bias (ROB) tool. Most of the evaluation indicators used in the included RCTs showed that sacral acupuncture had a significant therapeutic effect compared with the sham control intervention groups, and other remedies. However, all studies using acupoints (other than the Baliao points) as a control intervention had a “high” ROB and only reported secondary processed information, making it difficult to evaluate the efficacy of sacral acupuncture treatment for LUTS. No serious adverse effects were reported for sacral acupuncture, and only a low number of minor side effects were observed. These results suggest that sacral acupuncture could be considered as an alternative to existing treatments, with the added benefit of low cost. Large-scale, long-term RCTs are required in the future.

Effect of electroacupuncture on the degradation of collagen in pelvic floor supporting tissue of stress urinary incontinence rats

INTRODUCTION AND HYPOTHESIS

To examine the changes induced by electroacupuncture in stress urinary incontinence (SUI) rats, including the urodynamics and collagen degradation-related cytokine molecular biological expression changes, and to explore the effect and mechanism of EA treatment in SUI.

METHODS

Female SPF Sprague-Dawley rats were randomly assigned to five groups (n = 10): sham, model, electroacupuncture control, electroacupuncture, and blocker. The leak point pressure (LPP) and maximum bladder capacity (MBC) were measured for each group of rats, and collagen I, collagen III, matrix metalloproteinases (MMPs), and tissue inhibitor of metalloproteinase (TIMPs) in the anterior vaginal wall of rats in each group were determined by reverse transcription-polymerase chain reaction and western blotting. The data were analyzed by one-way analysis of variance or Kruskal-Wallis test.

RESULTS

Electroacupuncture Shenshu (BL23) and Huiyang (BL35) increased the LPP and MBC in SUI rats (P < 0.05). Electroacupuncture treatment significantly increased the protein expression of collagen I and collagen III in the anterior vaginal wall of SUI rats (P < 0.05) and significantly reduced the protein expression of MMP1, MMP2, and MMP9 (P < 0.05).

CONCLUSIONS

Electroacupuncture stimulation can alleviate the signs of SUI, and its mechanism is related to the degradation of collagen in the anterior vaginal wall.

Application of estrogen for the treatment of stress urinary incontinence in mice

BACKGROUND

Stress urinary incontinence (SUI) is a pervasive health tissue among women, which seriously affects the quality of life. The etiology of SUI is complex and diverse in women, with past studies having demonstrated that estrogen deficiency plays an important role in pelvic floor muscle atrophy and urethral degeneration. We comprehensively investigated the effects of estrogen in the treatment of SUI in female mice at cellular and animal levels.

METHODS

L929 fibroblasts mechanical injury model was established by four-point bending device, and SUI mouse model was established by vaginal dilation method commonly used to simulate labor injury. After estrogen treatment, the expressions of Collagen I, Collagen III, Elastin, TIMP-1, TIMP-2, MMP-2, and MMP-9 were detected, the leak point pressure (LPP) and abdominal leak point pressure (ALPP) of mice in each group were detected, and both the effect of estrogen on extracellular matrix remodeling of mouse urethra and anterior vaginal wall was observed from the histological level.

RESULTS

The results revealed that an appropriate amount of estrogen can promote the expression of Collagen I, Collagen III, Elastin, TIMP-1, and TIMP-2, decrease the expression of MMP-2 and MMP-9, and maintain the dynamic balance of MMPs/TIMPs at both cellular and animal levels. Meanwhile, we determined that estrogen can increase the LPP and ALPP values of SUI mice. The collagen fibers' content in the mice treated with estrogen was significantly greater than in the control group mice.

CONCLUSIONS

The estrogen may alleviate the symptoms of SUI by reconstituting ECM, thus laying a solid foundation for further exploration of estrogen therapy.

Efficacy of acupuncture for urinary incontinence in middle-aged and elderly women: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

Our aim was to generalize the available evidence and evaluate the effectiveness of acupuncture for urinary incontinence in middle-aged and elderly women.

METHODS

Six databases including VIP, CNKI, Wan Fang, Web of Science, PubMed and The Cochrane Library were systematically searched to retrieve similar studies updated to December 2019 to gather RCTs regarding the effectiveness of acupuncture for middle-aged and elderly women with urinary incontinence. Two researchers independently performed the whole process of retrieving the studies, extracting the data and assessing the risk of bias of the included studies. The current meta-analysis was performed using RevMan 5.3 software.

RESULTS

A total of eight studies with 607 patients were included in the evaluation. The current meta-analysis showed that Compared with rehabilitation exercise or medication, acupuncture intervention significantly improved the clinical effectiveness (OR = 5.52, 95 % CI, 3.13-9.73), reduced the urine leakage in pad test (SMD = -2.67, 95 % CI, -4.05 to -1.29) and decrease the ICIQ-SF score (MD = -3.46, 95 % CI, -3.69 to -3.22). The results indicated that acupuncture intervention can help the patients alleviate the symptoms effectively.

CONCLUSION

Based on this study, acupuncture intervention of stress urinary incontinence in middle-aged and elderly women can improve the clinical effectiveness, reduce the urine leakage in pad test and ICIQ-SF score. More high-quality studies with large sample size are required for further verification.

Is electroacupuncture safe and effective for treatment of stress urinary incontinence in women? A systematic review and meta-analysis

OBJECTIVE

Stress urinary incontinence (SUI) is prevalent worldwide, particularly among elderly women. Although electroacupuncture (EA) has been accepted by many patients and physicians in Asia, its efficacy for SUI has not been evaluated scientifically and systematically. We aimed to conduct a systematic evaluation of the efficacy and safety of EA treatment for women with SUI.

METHODS

We retrieved publications up to February 2019 from seven databases. Randomized controlled trials for women with SUI treated by EA were included. Therapeutic effect, 1-hour urine leakage and International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) scores were the primary outcomes. The Cochrane Collection's RevMan 5.3 software was used to pool data.

RESULTS

The 15 included articles demonstrated that EA for SUI was effective (odds ratio [OR], confidence interval [CI] = 5.64, 4.19-7.59; Ι2 = 22%). ICIQ-SF scores increased (standard mean difference, CI = -0.48, -0.62 to -0.33; Ι2 = 32%) and 1-hour urine leakage decreased (OR, CI = -4.14, -4.96 to -3.33; Ι2 = 78%) in patients undergoing EA compared with those receiving sham EA, physical exercise or medication.

CONCLUSION

EA for women with SUI exhibited significant efficacy and safety for key outcomes.

Comparing the effect of electroacupuncture treatment on obese and non-obese women with stress urinary incontinence or stress-predominant mixed urinary incontinence: A secondary analysis of two randomised controlled trials

OBJECTIVE

To explore whether obesity patients with a body mass index (BMI) of ≥25 kg/m2 who suffer from stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (S-MUI) show less improvement in urinary incontinence (UI) symptoms after electroacupuncture (EA) treatment compared with non-obese counterparts.

METHODS

This study was a secondary analysis of existing data. About 252 SUI patients and 250 S-MUI patients treated with the same EA regimen were assigned to one of the two groups: the obesity group for BMI ≥25 kg/m2 and the non-obesity group for BMI <25 kg/ m2 . The primary outcome was the proportion of treatment responders, defined as patients exhibiting a ≥50% reduction in 72-hours incontinence episode frequency, as measured by a 72-hours bladder diary at week 6 compared with baseline.

RESULTS

Of the 1004 randomised women, 129 obese women (86 SUI and 43 S-MUI) and 255 non-obese women (166 SUI and 89 S-MUI) treated with EA were included in a secondary analysis. The primary outcome was that 58.3% (74/127) of patients in the obesity group and 60.7% (150/247) of patients in the non-obesity group (difference 0.55%; 95% confidence interval, -10.01 to 11.11; P = .919) responded to treatment.

CONCLUSION

This study suggests that EA treatment may safely improve UI symptoms in both obese and non-obese patients, regardless of BMI category. Additionally, obesity status may not affect the efficacy of EA treatment on SUI or S-MUI among Chinese women.

Adverse Events Associated with Nonsurgical Treatments for Urinary Incontinence in Women: a Systematic Review

BACKGROUND

Urinary incontinence (UI) is a common malady in women. Numerous nonsurgical treatments are available, each associated with risk of adverse events (AEs).

METHODS

We systematically reviewed nonsurgical interventions for urgency, stress, or mixed UI in women, focusing on AEs. We searched MEDLINE®, Cochrane Central Trials Registry, Cochrane Database of Systematic Reviews, and Embase® through December 4, 2017. We included comparative studies and single-group studies with at least 50 women. Abstracts were screened independently in duplicate. One researcher extracted study characteristics and results with verification by another independent researcher. When at least four studies of a given intervention reported the same AE, we conducted random effects model meta-analyses of proportions. We also assessed the strength of evidence.

RESULTS

There is low strength of evidence that AEs are rare with behavioral therapies and neuromodulation, and that periurethral bulking agents may result in erosion and increase the risk of voiding dysfunction. High strength of evidence finds that anticholinergics and alpha agonists are associated with high rates of dry mouth and constitutional effects such as fatigue and gastrointestinal complaints. Onabotulinum toxin A (BTX) is also associated with increased risk of urinary tract infections (UTIs) and voiding dysfunction (moderate strength of evidence).

DISCUSSION

Behavioral therapies and neuromodulation have low risk of AEs. Anticholinergics and alpha agonists have high rates of dry mouth and constitutional effects. BTX is associated with UTIs and voiding dysfunction. Periurethral bulking agents are associated with erosion and voiding dysfunction. These AEs should be considered when selecting appropriate UI treatment options. AE reporting is inconsistent and AE rates across studies tended to vary widely. Trials should report AEs more consistently.

Effects of electroacupuncture on bladder and bowel function in patients with transverse myelitis: a prospective observational study

Objective

To preliminarily explore the effect of electroacupuncture (EA) on bladder and bowel dysfunction in patients with transverse myelitis.

Methods

Sixteen participants were treated with EA at bilateral BL32, BL33, and BL35 once a day, five times a week for the first 4 weeks, and once every other day, three times a week for the following 4 weeks. Patients were then followed up for 6 months. Bladder and bowel function, and the safety of EA, were assessed.

Results

After 8 weeks of treatment, five (5/16, 31%) patients resumed normal voiding, three (6/16, 38%) regained partially normal voiding, and five (5/16, 31%) had no change. After treatment, the residual urine volume decreased by 100 mL (IQR 53–393 mL; P<0.05) in nine patients with bladder voiding dysfunction; in 11 patients with urinary incontinence, the number of weekly urinary incontinence episodes, 24-hour urinary episodes, and nocturia episodes per night diminished by 14 (95% CI 5 to 22), 5 (95% CI 1 to 9), and 4 (95% CI 0 to 7) episodes, respectively (all P<0.05). After 8 weeks of treatment in eight patients with faecal retention, four (4/8, 50%) resumed normal bowel movements, three (3/8, 38%) regained partially normal bowel movements, and one (1/8, 13%) had no change.

Conclusions

EA might be a promising alternative for the management of bladder and bowel dysfunction in patients with transverse myelitis. Randomised controlled trials are needed to confirm the effectiveness and safety of EA for this condition.

A retrospective study of neuromuscular electrical stimulation for treating women with post-stroke incontinence

This retrospective study evaluated the effect of using neuromuscular electrical stimulation (NMES) for the treatment of post-stroke urinary incontinence (PSUI) among female population in China.A total of 163 eligible patients with PSUI were included in this study. Of these, 103 patients were assigned to a treatment group, and 60 subjects were assigned to a control group. All patients in both groups received bladder training. In addition, patients in the treatment group also received NMES. All patients were treated for a total of 8 weeks. The outcome measurements included the amount of urine leakage, urinary symptoms and quality of life. The urinary symptoms were measured by the Bristol Female Urinary Symptoms Questionnaire (BFUSQ) score, and the quality of life was assessed by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score. In addition, adverse events were also documented in this study.After 4-week treatment, patients who received NMES did not exert better outcomes in the amount of urine leakage, urinary symptoms, measured by BFUSQ scale, and the quality of life, assessed by ICIQ-SF scale. However, after 8-week treatment, patients in the treatment group showed greater effect in reducing the amount of urine leakage (P < .01), enhancing urinary symptoms, as measured by BFUSQ scale (P < .01), and improving the quality of life, as assessed by ICIQ-SF scale (P < .01), compared with patients in the control group. In addition, no adverse event was recorded during the period of 8-week treatment in this study.The results of this study indicated that NMES may benefit for patients with PSUI after 8-week treatment. Future studies should focus on warranting the results of this study.

Effects of Moxibustion on the Levels of Insulin-Like Growth Factor 1: A Pilot Study

Moxibustion (艾灸) is a traditional Chinese medicine therapy performed using Artemisia argyii. Zusanli (足三里, ST36) is an acupoint in the stomach meridian, long associated in ancient Chinese medical practices with the extension of life span when moxibustion is applied to it. The aim of this study was to investigate changes in insulin-like growth factor 1 (IGF-1) levels after application of moxibustion to ST36. Four healthy men and women participated in this 28-day trial and were randomly divided into 2 groups. Group A received moxibustion treatment from days 1 to 14, while group B received moxibustion treatment from days 15 to 28. Blood samples were taken 5 times during this study to measure serum IGF-1 (s-IGF-1) levels. The s-IGF-1 levels increased in both groups after 7 and 14 d of moxibustion therapy (group A: 11.02% [7 d] and 29.65% [14 d]; group B: 169.12% [7 d] and 274.85% [14 d]). After moxibustion therapy had been completed (day 14), s-IGF-1 levels continued to increase in group A (increases on day 21 and day 28 were 53.19% and 61.45%, respectively). There were no adverse events in either group. The s-IGF-1 levels were significantly raised in both groups after 7 and 14 d of moxibustion therapy. Moreover, once therapy had been completed, s-IGF-1 levels continued to increase in group A up to 14 d after the treatment.

Electroacupuncture for women with stress urinary incontinence: Protocol for a systematic review and meta-analysis

BACKGROUND

Stress urinary incontinence (SUI) is a widespread complaint in the adult women. Electroacupuncture has been widely applied in the treatment of SUI. But its efficacy has not been evaluated scientifically and systematically. Therefore, we provide a protocol of systematic evaluation to assess the effectiveness and safety of electroacupuncture treatment on women with SUI.

METHODS

The retrieved databases include 3 English literature databases, namely PubMed, Embase, and Cochrane Library, and 3 Chinese literature databases, namely Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and Wanfang Database. The randomized controlled trials (RCTs) of the electroacupuncture treatment on women with SUI will be searched in the above-mentioned databases from the time when the respective databases were established to December 2017. The change from baseline in the amount of urine leakage measured by the 1-hour pad test will be accepted as the primary outcomes. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a meta-analysis is allowed.

RESULTS

This study will provide a high-quality synthesis to assess the effectiveness and safety of electroacupuncture treatment on women with SUI.

CONCLUSION

The conclusion of our systematic review will provide evidence to judge whether electroacupuncture is an effective intervention for women with SUI.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD42017070947.

Effect of Electroacupuncture on Urinary Leakage Among Women With Stress Urinary Incontinence: A Randomized Clinical Trial

Importance

Electroacupuncture involving the lumbosacral region may be effective for women with stress urinary incontinence (SUI), but evidence is limited.

Objective

To assess the effect of electroacupuncture vs sham electroacupuncture for women with SUI.

Design, Setting, and Participants

Multicenter, randomized clinical trial conducted at 12 hospitals in China and enrolling 504 women with SUI between October 2013 and May 2015, with data collection completed in December 2015.

Interventions

Participants were randomly assigned (1:1) to receive 18 sessions (over 6 weeks) of electroacupuncture involving the lumbosacral region (n = 252) or sham electroacupuncture (n = 252) with no skin penetration on sham acupoints.

Main Outcomes and Measures

The primary outcome was change from baseline to week 6 in the amount of urine leakage, measured by the 1-hour pad test. Secondary outcomes included mean 72-hour urinary incontinence episodes measured by a 72-hour bladder diary (72-hour incontinence episodes).

Results

Among the 504 randomized participants (mean [SD] age, 55.3 [8.4] years), 482 completed the study. Mean urine leakage at baseline was 18.4 g for the electroacupuncture group and 19.1 g for the sham electroacupuncture group. Mean 72-hour incontinence episodes were 7.9 for the electroacupuncture group and 7.7 for the sham electroacupuncture group. At week 6, the electroacupuncture group had greater decrease in mean urine leakage (-9.9 g) than the sham electroacupuncture group (-2.6 g) with a mean difference of 7.4 g (95% CI, 4.8 to 10.0; P < .001). During some time periods, the change in the mean 72-hour incontinence episodes from baseline was greater with electroacupuncture than sham electroacupuncture with between-group differences of 1.0 episode in weeks 1 to 6 (95% CI, 0.2-1.7; P = .01), 2.0 episodes in weeks 15 to 18 (95% CI, 1.3-2.7; P < .001), and 2.1 episodes in weeks 27 to 30 (95% CI, 1.3-2.8; P < .001). The incidence of treatment-related adverse events was 1.6% in the electroacupuncture group and 2.0% in the sham electroacupuncture group, and all events were classified as mild.

Conclusions and Relevance

Among women with stress urinary incontinence, treatment with electroacupuncture involving the lumbosacral region, compared with sham electroacupuncture, resulted in less urine leakage after 6 weeks. Further research is needed to understand long-term efficacy and the mechanism of action of this intervention.

Trial Registration

clinicaltrials.gov Identifier: NCT01784172.