Rédacteurs : Johan Nguyen, Henri Truong
Sommaire
Acupuncture and Urinary Incontinence
Acupuncture et Incontinence urinaire
| Articles connexes: - conduites thérapeutiques - pathologies - qigong - acupuncture expérimentale - |
1. Systematic Reviews and Meta-Analysis
| ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture |
| ☆☆ | Evidence for effectiveness of acupuncture |
| ☆ | Limited evidence for effectiveness of acupuncture |
| Ø | No evidence or insufficient evidence |
1.1. Generic Acupuncture
1.1.1. Liu 2024 (older women)
Liu W, Sun X, Gao Y, Sun H, Feng H, Tan H, Chen Q, Peng L, Wu IX. Comparative effectiveness of nonsurgical interventions for urinary incontinence in older women: A systematic review and network meta-analysis. Arch Gerontol Geriatr. 2024 Jan;116:105214. https://doi.org/10.1016/j.archger.2023.105214
| Purpose | To compare the effectiveness of existing nonsurgical interventions to improve or cure urinary incontinence in older women. |
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| Methods | Five English databases (Medline, EMBASE, Web of Science, PsychINFO and the Cochrane Library) were searched from January 1, 2018, until August 27, 2023. Studies published before 2018 were directly extracted from a review published in 2019 on a similar research question. Three Chinese databases (China National Knowledge Infrastructure (CNKI), Wanfang and SinoMed) were searched from January 1, 2000, until August 27, 2023. Randomized controlled trials of nonsurgical interventions for women aged ≥ 60 years with urinary incontinence were considered eligible. The primary outcome was the rate of improvement and cure. Pairwise meta-analysis and network meta-analysis were performed, with the pooled risk ratio (RR) and 95 % confidence interval (CI) being reported. |
| Results | There were 15 intervention categories among the included 32 randomized controlled trials for older women with urinary incontinence. The combination of behavioral therapy with other interventions, including Chinese herbal medicine, electrical stimulation, and acupuncture were effective for both improvement and cure rates. Behavioral therapy plus Chinese herbal medicine was the most effective intervention category for both improvement and cure rates. |
| Conclusion | Behavioral therapy plus Chinese herbal medicine was currently the optimal selection for the management of older women with urinary incontinence. However, the clinicians should carefully consider the effectiveness and quality of evidence because of the limited quality and quantity of the randomized controlled trials included. |
1.1.2. Cui 2023 ☆☆☆
Cui Y, Ma Q, Zhang Y, Wei G, Zhou Z. The Efficacy and Safety of Acupuncture in Treating Stress Urinary Incontinence in Women from a Meta-Analysis of Four Randomized Controlled Trials. Arch Esp Urol. 2023 Feb;76(1):40-49. https://doi.org/10.56434/j.arch.esp.urol.20237601.3. https://pubmed.ncbi.nlm.nih.gov/36914418.
| Purpose | To verify the efficacy and safety of acupuncture in treating stress urinary incontinence (SUI) in women in a single treatment cycle lasting at least 6 weeks. |
|---|---|
| Methods | A preferred reporting items for systematic reviews and meta-analyses (PRISMA) summary was followed correctly. Through the use of EMBASE, Cochrane Library databases, and PubMed (until July 2021), we looked for randomized controlled trials. In addition, the included articles' original references were looked up as well. |
| Results | Totally, we analyzed four studies including 690 patients. Compared with the sham acupuncture group, this analysis verified that acupuncture was critically better result in decreasing mean urine leakage (p = 0.04), 1-hour pad test (p = 0.04), 72-hour incontinence episodes (p < 0.00001), International Consultation on Incontinence Questionnaire-Short Form scores (p = 0.0005) and improving patient self-evaluation (All p < 0.05). However, two groups had no statistical significance in improving pelvic floor muscle strength. In the matter of safety, mainly adverse events, especially with respect to pain, both groups showed no statistical difference. |
| Conclusions | Acupuncture is more beneficial to patients with stress urinary incontinence in women with no critical difference in the incidence of advent events than sham acupuncture. |
1.1.3. Long 2022 ☆
Long Z, Chen H, Yu S, Wang X, Liu Z. Effect of Acupuncture for Mixed Urinary Incontinence in Women: A Systematic Review. Front Public Health. 2022 Mar 18;10:827853. https://doi.org/10.3389/fpubh.2022.827853
| Background | Mixed urinary incontinence increasingly undermines women's quality of life. Previous studies showed some effects of acupuncture for MUI, but no systematic review has been done to evaluate the efficacy and safety of acupuncture for MUI in women. |
|---|---|
| Objective | To systematically review the efficacy and safety of acupuncture for women with MUI. |
| Methods | Ten databases (i.e., PubMed, Web of Science, Embase, ClinicalTrials.gov, the Cochrane Library, CBM, Scoups, CNKI, VIP and WANFANG DATA) were searched up to July 19th, 2021, using tailored search strategies with keywords not limited to “female,” “mixed urinary incontinence,” “acupuncture,” and “randomized controlled trial,” etc. RCTs and quasi-RCTs were included if investigating effect of any type of acupuncture for female patients with MUI. Data were extracted from eligible studies, and risks of bias were assessed according to the Cochrane Handbook from seven aspects using the RevMan 5.4 software. |
| Results | A total of three randomized studies with 591 women were included. The risk of bias among the studies varied, with major concerns on blinding of participants and outcome assessor. Liu's study (497) mainly showed that electroacupuncture's effect on reduction of numbers of incontinence, urgency, nocturia episodes, and amount of urine leakage etc. was not inferior to that of PFMT-Solifenacin group at 12, 24, and 36 weeks. Zhan's study (60) showed that electroacupuncture reduced significantly more amount of urine leakage than Tolterodine at 8 weeks, with no data on incontinence episodes frequency. All 3 studies reported that acupuncture significantly increased the quality of life assessed by ICIQ score. In addition, incidence of acupuncture-related adverse events was rare, while antimuscarinic agents related adverse events were common in two studies. |
| Conclusion | Although acupuncture showed some benefit for women with MUI, more evidences were required to draw a solid conclusion of effectiveness and safety of acupuncture for women with MUI. |
1.1.4. Yang 2021
Yang N, Ge X, Ye J, Liu Q, Wu Y, Yan H, Han X. Efficacy of acupuncture for urinary incontinence in middle-aged and elderly women: A systematic review and meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2021;257:138-43. [190854]. doi
| Objectives | Our aim was to generalize the available evidence and evaluate the effectiveness of acupuncture for urinary incontinence in middle-aged and elderly women. |
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| 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. |
1.1.5. Ma 2021 (stress urinary incontinence) ★
Ma Guanglin, Mai Genghan, Mo Qian, Zhang Weiwei, Ou Liang, Liu Jisheng, Yang Dan. [Meta Analysis of Clinical Randomized Controlled Literature of Acupuncture and Moxibustion in Treating Female SUI]. Journal of Clinical Acupuncture and Moxibustion. 2021;37(6):46. [220717].
| Objective | To analyze the common clinical evaluations indicators of acupuncture and moxibustion in the treatment of female stress urinary incontinence (SUI). |
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| Methods | According to the principles of systematic review, the research objects, intervention measures, outcome indicators and design schemes were formulated, and the clinical randomized controlled trials (RCTs) of acupuncture and moxibustion in the treatment of fema1e SUI at home and abroad were searched and the bias risk of the included literature were assessed according to the method recommended by Cochrane Handbook and analyzed with Review Manager5. 3 software. |
| Results | A total of 16 RCTs were included, involving 985 patients. Meta analysis of the outcome index showed that acupuncture treatment was superior to pelvic floor muscle training [tota1 efficiency rate: OR = 6. 04, 95% CI (3. 84, 9. 49, P<0.00001);ICI -Q-SF score: MD=-3.03,95%CI(-4.17,-1.90,P<0.00001);l hour urine padtest: MD= -2.95, 95% CI(-3.86, - 2.04, P<0.00001); 24 hour voiding diary: MD= - 0.97, 95% CI ( -1. 61, - 0. 33, P = 0. 003)], the difference was statistically significant. |
| Conclusion | Acupuncture treatment for fema1e SUI has definite clinical advantages over pelvic floor muscle training. In the view of the low qua1ity of the literature included at present, this result can be further demonstrated by the future RCTs. |
1.1.6. Zhang 2016 (stress urinary incontinence) ☆☆
Zhang Yan, Xie Jiangping. [A Meta-analysis of treating female stress urinary incontinence by acupuncture]. Clinical Journal of Chinese Medicine. 2016;8(22):16-20. [201954].
| Objective | To assess clinical efficacy of acupuncture on female stress urinary incontinence. |
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| Methods | Randomized controlled trials on treating female stress urinary incontinence by acupuncture were found in Pubmed, CNKI, Wanfang database and VIP database. According to RCT quality evaluation of modified Jadad scale evaluation criterion, selected literatures were evaluated with Rev Man 5.2 statistics software; and the Meta-analysis was performed. Clinical efficacy and safety of acupuncture on female stress urinary incontinence were assessed. |
| Results | 10 papers(785 patients) were included. The results of the Meta-analysis showed that differences of clinical efficacy of acupuncture on female stress urinary incontinence between groups were significant; and acupuncture could reduce VAS score, without significant meaning to improve ICIQ-SF score. |
| Conclusion | Acupuncture on female stress urinary incontinence showed obvious effects, but the result should be verified farther by strict, multi-center and large sample, and high-quality randomized double-blind placebo-controlled trials with enough followed-up time to further validated. |
1.1.7. Wang 2014 (stress urinary incontinence) ☆
Wang Lei ,Fu Li - Xin , Zhu Yuan , et al. [Systematic review of domestic literature of therapeutic effect of acupuncture on stress urinary incontinence]. Journal of Clinical Acupuncture and Moxibustion. 2014;30(9):64. [173471].
| Objective | To evaluate the therapeutic effect of acupuncture in the treatment of stress urinary incontinence in China. |
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| Methods | Retrieve related papers from CNKI, WANFANG, vIP database by computer, from conference papers and magazines like “Chinese acupuncture” by hand. The retrieval time ended in November 2013, and two independent eva1uator extracted data from obtained all random and ha1f randomized controlled trials for the treatment of stress urinary incontinence by acupuncture, and assess the methodology. RevMan5. 0 software was used to do Meta ana1ysis and security number analysis and funnel chart ana1ysis publication bias. |
| Results | A total of 10 trials involving 669 patients. Meta - analysis showed that the total effective rate in the treatment group was better than that in the control group: acupuncture versus placebo ( OR = 3. 05, 95 % CI [1. 59, 5. 84]), acupuncture versus medicine ( OR = 9. 14, 95% CI[4. 77, 17. 53]), acupuncture versus pelvic muscle exercice ( OR = 4. 00, 95 % CI [ 2. 5 1, 6. 39]). Fail - safe number analysis showed that the evaluation results were stable. Funnel figure graphics were around the basic symmetry, and the publication bias was not big. |
| Conclusion | Acupuncture in the treatment of stress urinary incontinence is effective, and superior to western medicine and pelvic muscle exercise. However, more high - quality randomized double - blind controlled trials are needed to confirm the curative effect of acupuncture in the treatment of stress urinary incontinence. |
1.1.8. Paik 2013
Paik SH, Han SR, Kwon OJ, Ahn Ym, Lee Bc, Ahn Sy. Acupuncture for the treatment of urinary incontinence: a review of randomized controlled trials. Exp Ther Med. 2013;6(3):773-780. 160279.
| Objective | The aim of this study was to examine the effects of acupuncture on urinary incontinence and to discuss why these acupoints were selected. |
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| Methods | Seven databases were searched for any randomized controlled trials (RCTs) that investigated the use of acupuncture or acupressure as a treatment for urinary incontinence, and the Cochrane risk of bias tool was utilized to evaluate the risk of bias in each study. Four RCTs met all the inclusion criteria. |
| Results | The results from the selected RCTs failed to demonstrate any statistically significant improvements in urinary incontinence, although acupuncture or acupressure did exhibit favorable effects on overactive bladder symptoms and quality of life, in comparison with other conventional therapies. |
| Conclusion | There have been limited results supporting acupuncture or acupressure as an effective treatment method for urinary incontinence; therefore, further RCTs are required to confirm the effectiveness of acupuncture or acupressure in the treatment of urinary incontinence. |
1.1.9. Wang 2013 (stress urinary incontinence) Ø
Wang Y, Zhishun L, Peng W, Zhao J, Liu B. Acupuncture for stress urinary incontinence in adults. Cochrane Database Syst Rev. 2013. [160667].
| Background | The use of acupuncture for stress urinary incontinence is increasing in frequency, especially in Asian area. However, its effectiveness and side effects have not been evaluated. |
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| Objectives | To assess the effectiveness and side effects of acupuncture for stress urinary incontinence in adults. Search methods: We searched the Cochrane Incontinence Group Specialised Register (searched 28 January 2013), EMBASE, AMED, Chinese Biomedical Literature Database (CBM), Chinese Acupuncture Trials Register and China National Knowledge Infrastructure (CNKI) (all searched 20 February 2013). In addition, we searched the reference lists of relevant articles and contacted authors and trialists in the field. |
| Methods | Selection criteria: Randomised and quasi-randomised controlled trials of acupuncture interventions without other treatments for the management of stress urinary incontinence for adults. Data collection and analysis: Two review authors independently assessed eligibility, trial quality and extracted data. We meta-analysed data where appropriate. |
| Main results | We identified 17 possibly eligible studies but only one small trial with 60 women met our inclusion criteria. The trial compared acupuncture versus midodrine, a drug for treating hypotension. The risk of bias was high as there was no concealment of randomised allocation, and there was no blinding of assessment of outcome. In addition, it was not possible to blind participants or health providers to the interventions. The statistical methods were not described.More women improved in the acupuncture group (73% with acupuncture versus 33% with midodrine; risk ratio (RR) 2.20, 95% confidence interval (CI) 1.27 to 3.81) but the cure rates were low and not statistically significantly different (13% versus 7%; RR 2.00, 95% CI 0.40 to 10.11). There were adverse events in the drug group only. |
| Authors' conclusions | The effect of acupuncture for stress urinary incontinence for adults is uncertain. There is not enough evidence to determine whether acupuncture is more effective than drug treatment. |
1.2. Special Clinical Forms
1.2.1. Poststroke Urinary Incontinence
| See ' corresponding item |
1.2.2. Postprostatectomy Incontinence
1.2.2.1. Chen 2023
Chen H, Liu Y, Wu J, Liang F, Liu Z. Acupuncture for postprostatectomy incontinence: a systematic review. BMJ Support Palliat Care. 2023 Oct;13(e1):e10-e19. https://doi.org/10.1136/bmjspcare-2020-002450
| Background | Postprostatectomy incontinence (PPI) is a clinically significant condition that is caused by surgery of prostate. Study showed that electroacupuncture can reduce urine leakage among women with stress urinary incontinence (SUI), but few was known about its efficacy and safety for men with PPI. This study aims to conduct a systematic review to evaluate efficacy and safety of acupuncture for men with PPI compared with other non-surgical treatment. |
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| Methods | Seven databases were searched for all randomised controlled trials (RCTs) on acupuncture for men with PPI up to August 2020. Risks of bias of included studies were assessed using RevMan V.5.3. Narrative analysis was conducted. |
| Results | Seven studies with 830 men with PPI were included in the review. Studies showed that acupuncture can significantly improve score of International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form for men with urgent urinary incontinence (UUI) when compared with medicine (p<0.05). It showed a significant better overall response rate when acupuncture was combined with solifenacin for men with UUI (p<0.05), or with pelvic floor muscle training (PFMT) (p<0.001), or with PFMT and medicine together for men with UUI or SUI (p<0.01), compared with control groups. No adverse event was reported in the studies. However, the quality of evidences was considered low generally. |
| Conclusion | The results showed that acupuncture could be beneficial for men with PPI when applied alone or as an adjunction to other conservative therapies and medicines, however, the quality of evidence was considered low and inconclusive in this review. |
1.3. Special Acupuncture Techniques
1.3.1. Comparison of Acupuncture techniques
1.3.1.1. Kannan 2023
Kannan P, Bello UM. Efficacy of various forms of acupuncture for the treatment of urinary incontinence in women: A systematic review and meta-analysis. Explore (NY). 2023 Jan-Feb;19(1):26-35. https://doi.org/10.1016/j.explore.2022.07.004
| 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. |
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| 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. |
1.3.2. Electroacupuncture
1.3.2.1. Bilgiç 2024
Bilgiç FŞ, Gençtürk N, Arikan B. The effect of electroacupuncture applied to women with stress urinary incontinence on urinary incontinence severity and symptoms: systematic review and meta-analysis of randomized controlled trials. Actas Urol Esp (Engl Ed). 2024 Mar 29:S2173-5786(24)00027-1. English, Spanish. https://doi.org/10.1016/j.acuroe.2024.03.002
| Introduction | Stress Urinary Incontinence is a condition that impairs the quality of life in women and randomized controlled trials of electroacupuncture for stress urinary incontinence have been conducted. |
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| Objective | The aim of this systematic review and meta-analysis was to examine the effect of electroacupuncture on the severity and symptoms of urinary incontinence in women with stress urinary incontinence. |
| Methods | Literature searches were conducted in PubMed, CINAHL, Scopus and Science Citation Index until November 2023. This study was based on the recommendations of the Cochrane guidelines. Data were analyzed using the Review Manager computer program (Version 5.4). The methodological quality of the studies was assessed using the RoB-2 tool. |
| Results | The analysis included 888 women with stress urinary incontinence and three studies. In women with stress urinary incontinence, electroacupuncture intervention improved urinary incontinence severity and quality of life (MD:-2.37, 95% CI:-3.29 to 1.45, Z = 5.07,p < 0. 001), urinary leakage (SMD:-0.79, 95% CI:-1.02 to -0.55, Z = 6.60,p = 0.001) and incontinence episode frequency (SMD:-2.24, 95%CI:-4.17 to -0.32, Z = 2.29,p < 0.02). |
| Conclusion | In women with stress urinary incontinence, electroacupuncture intervention decreased the severity of urinary incontinence and improved the quality of life. Symptoms related to urinary incontinence were found to decrease urinary leakage and incontinence episode frequency. The studies included in the analysis were determined to be low-risk studies in quality assessment. |
1.3.2.2. Cui 2022
Cui Y, Li Q, Wang D, Bao R, Li L, Zhu J, Li J, Li Z, Yin J, Zhou X, Yin H, Sun Z. Does electroacupuncture benefit mixed urinary incontinence? A systematic review and meta-analysis with trial sequential analysis. Int Urogynecol J. 2022 Apr;33(4):751-766. https://doi.org/10.1007/s00192-021-05057-6
| Introduction and hypothesis | Mixed urinary incontinence (MUI) comprises a combination of urgency and stress. The efficacy and safety of electroacupuncture (EA) for the treatment of MUI remain unclear. |
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| Objective | To assess the efficacy and safety of EA in treating MUI. |
| Methods | We searched PubMed, CENTRAL, Embase, Web of Science, four Chinese databases, clinical research registration platforms, grey literature, and the reference lists of the selected studies. Risk of bias and quality were evaluated using the Revman 5.4 and Jadad scores. Meta-analysis was performed using Stata 15.1 software. Trial sequential analysis (TSA) was used to assess the stability of the results. |
| Results | Eight randomized controlled trials comprising 847 patients were included. The meta-analysis results showed that compared with antimuscarinic drugs plus pelvic floor muscle training, EA resulted in significantly less pad weight on the 1-h pad test and statistically significantly lower severity scores on the International Consultation on Incontinence Questionnaire Short Form. The change in the 72-h incontinence episode frequency difference was not statistically significant, and there was no outcome of overall response rate and quality of life in this meta-analysis. Few adverse events occurred in the EA group. The TSA results suggested that the result of change from baseline in the 1-h pad test was stable and the evidence was conclusive. |
| Conclusions | EA could be a potential treatment option for MUI and is relatively safe. Nevertheless, because of the limitations of this study, our conclusions should be interpreted with caution, and further studies are needed to confirm the comprehensive clinical efficacy and placebo effect of EA. |
1.3.2.3. Lai 2020
Lai X, Zhang J, Chen J, Lai C, Huang C. Is electroacupuncture safe and effective for treatment of stress urinary incontinence in women? A systematic review and meta-analysis. J Int Med Res. 2020;48(10). [212794]. doi
| 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. |
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| 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. |
1.3.2.4. Zhong 2020 ★
Zhong Y, Song Y, Zeng F, Zhao Y, Black B, Guan Y. Effectiveness of electroacupuncture for female stress urinary incontinence: a systematic review and Meta-analysis. Journal of TCM. 2020;40(5):707-720. [221092]. https://doi.org/10.19852/j.cnki.jtcm.2020.05.001
| Objective | To evaluate the effectiveness of electroacupuncture (EA) for female stress urinary incontinence (SUI). |
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| Methods | We searched 12 databases electronically from inception to November 2018 without language restrictions. We included randomized controlled trials (RCTs) involving women with SUI, but excludd other types of urinary incontinence or studies that were not RCTs. Two independent reviewers extracted study characteristics, with disagreements resolved by consensus. Data were pooled and expressed as mean difference (MD) for continuous outcomes and relative risk (RR) for dichotomous outcomes, with 95% confidence intervals (CI). This study was registered with the International Prospective Register of Systematic Reviews (number CRD42018089734). |
| Results | We found very low to high level evidence that EA improved the effective rate (RR = 2.03, 95%CI: 1.40, 2.95; P = 0.0002) and reduced urine leakage as measured by the 1-hour pad test (MD = 3.33, 95%CI: 0.89, 5.77; P = 0.008), International Consultation on Incontinence Questionnaire Short Form score (MD = 3.14, 95%CI: 2.42, 3.85; P < 0.00001), and 72-hour incontinence episodes (MD = 1.17, 95%CI: 0.56, 1.78; P = 0.0002) compared with sham electroacupuncture (SA), pelvic floor muscle training, and medication. |
| Conclusion | The effectiveness and safety of EA for key outcomes for women with SUI are statistically significantly better than those of SA, but most available evidence is very low or low quality. More well-designed RCTs are needed to confirm these findings. |
1.3.2.5. Park 2017
Park Eo-Jin, Jo Hyun-Jeong, Jo Hee-Guen. [A Review of Research on Electroacupuncture for Female Stress Urinary Incontinence], J Korean Obstet Gynecol. 2017;30(4):149-74. [196145].
| Objectives | The aim of this study is to establish a base for further research by reviewing studies on electroacupuncture (EA) for stress urinary incontinence (SUI). |
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| Methods | Clinical studies concerning the effects of EA for SUI, were obtained from Cochrane Library, PubMed, CNKI, RISS, NDSL, KISS and OASIS. |
| Results | Forty-five studies met the criteria, which included 33 RCTs, 1 pilot RCT, 4 non-randomized Clinical Trials, 6 Case studies and 1 Orthogonal design study with 3638 patients. There was only one article published in Korea. In these study, the most common primary outcome measurement was the pad test. Most of the studies showed the group treated by EA effects compared to the control group. Also, many interventions that combined with EA were found and all complex therapy group had significantly better than control group. 7 studies observed adverse events (AEs), four of which referred to EA related AEs among them. And 4 studies reported no AEs associated with EA. |
| Conclusions | Despite several limitations, various studies to prove limited yet effective EA on SUI provides much significance. Subsequent studies conducted by the complementary systematic review of the studies and well-designed clinical trials using the methodological quality will be needed to more firmly validate the therapeutic effect of EA on SUI. |
2. Overviews of Systematic Reviews
2.1. Shi 2022
Shi H, Zhao L, Cui L, Wang Z, Wang D, Liu P, Si G, Guo D, Liu W. A Critical Overview of Systematic Reviews and Meta-Analyses of Acupuncture for Female Stress Urinary Incontinence. Pain Res Manag. 2022 May 17;2022:5887862. https://doi.org/10.1155/2022/5887862
| Objectives | As a urinary dysfunction disorder, stress urinary incontinence (SUI) is more common in women than in men. Acupuncture, a traditional minimally invasive technique, has potential efficacy in the treatment of SUI. The purpose of this overview is to critically assess the available evidence on acupuncture for the treatment of SUI in women. |
|---|---|
| Methods | Two researchers searched seven databases for systematic reviews (SRs)/meta-analyses (MAs) of randomized controlled trials (RCTs) on acupuncture for SUI. Two researchers assessed the included SRs/MAs using the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic (ROBIS) scale, the list of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. |
| Results | Eight published SRs/Mas were included in our overview. According to the results of the AMSTAR-2 assessment, all SRs/MAs were of very low quality. According to the ROBIS evaluation results, no SR/MA was assessed as low risk of bias. According to the results of the PRISMA checklist assessment, no SR/MA was fully reported on the checklist. According to GRADE, a total of 27 outcomes extracted from the included SRs/MAs were evaluated, and only 1 was rated as high quality. |
| Conclusions | Acupuncture may be an effective and safe complementary treatment for SUI in women. However, further standard and comprehensive SRs/MAs and RCTs are needed to provide an evidence-based medical rationale for this. |
2.2. Kilpatrick 2020
Kilpatrick KA, Paton P, Subbarayan S, Stewart C, Abraha I, Cruz-Jentoft AJ, O'Mahony D, Cherubini A, Soiza RL. Non-pharmacological, non-surgical interventions for urinary incontinence in older persons: A systematic review of systematic reviews. The SENATOR project ONTOP series. Maturitas. 2020;133:42-48. [204791]. DOI
| Background | Urinary incontinence is especially common in older age. Non-pharmacological therapies are particularly desirable in this group. OBJECTIVE: To define optimal evidence-based non-pharmacological, non-surgical therapies for urinary incontinence in older persons. |
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| Methods | A Delphi process determined critical outcome measures of interest. Studies of any non-pharmacological intervention reporting critical outcomes were identified through database searches for relevant systematic reviews in Medline, Embase, CINAHL, PsycInfo and Cochrane up to June 2018. Primary trials with a population mean age ≥65years were identified, from which data were extracted and risk of bias was assessed. Qualitative analysis and meta-analysis, when possible, were undertaken, followed by grading of the evidence using GradePro software. Finally, bullet-point recommendations were formulated for the indications and contraindications for non-pharmacological interventions for urinary incontinence in older persons. |
| Results | Frequency of incontinence was identified as a critically important outcome. In total, 33 systematic reviews were identified with 27 primary trials meeting inclusion criteria. Evaluated therapies included exercise therapy, habit retraining, behavioural therapy, electrical stimulation, transcutaneous tibial nerve stimulation, magnetic stimulation, caffeine reduction and acupuncture. From meta-analysis, group exercise therapy and behavioural therapy in women were beneficial in reducing episodes of incontinence (mean reduction of 1.07 (95 %CI 0.69-1.45) and 0.74 (95 %CI 0.42-1.06) episodes per day respectively, evidence grade 'moderate'). Evidence for other interventions was limited and of insufficient quality. |
| Conclusions | There is sufficient evidence to warrant recommendation of group exercise therapy for stress incontinence and behavioural therapy for urgency, stress or mixed urinary incontinence in older women. Evidence was insufficient to recommend any other non-drug therapy. |
| Acupuncture | 1 study |
3. Clinical Practice Guidelines
| ⊕ positive recommendation (regardless of the level of evidence reported) Ø negative recommendation, (or lack of evidence) |
3.1. Japanese Continence Society, Japanese Urological Association (JCS, JUA, Japan) 2019 ⊕
The Japanese Continence Society, the Japanese Urological Association. . [Clinical Guidelines for Female Lower Urinary Tract Symptoms] . 2nd ed. Tokyo: RichHill Medical Inc; 2019 [in Japanese] . Cited by Okawa Y, Yamashita H, Masuyama S, Fukazawa Y, Wakayama I. Quality assessment of Japanese clinical practice guidelines including recommendations for acupuncture. Integr Med Res. 2022 Sep;11(3):100838. https://doi.org/10.1016/j.imr.2022.100838
| Female Lower Urinary Tract Sympoms. No firm evidence, but recommend. Grade C1 (out of A to D and I). |
3.2. Agency for Healthcare Research and Quality (AHRQ, USA) 2018 ⊕
Balk E, Adam GP, Kimmel H, Rofeberg V, Saeed I, Jeppson P, Trikalinos T. Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update, Comparative Effectiveness Review No. 212. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ publication). 2018. 643p. [196362].
| Neuromodulation: Electroacupuncture, InterStim™, magnetic stimulation, TENS. Stress UI: Neuromodulation is more effective than no treatment for cure, improvement, and satisfaction (risk of biais: low, Consistency: consistent , Precision: precise, Directness: direct; Overall SoE: High). Urgency UI: BTX and neuromodulation more effective than no therapy for cure, improvement, and satisfaction (risk of biais: low, Consistency: consistent , Precision: precise, Directness: direct; Overall SoE: High); (moderate or low SoE for improvement or satisfaction due to sparseness, indirectness, and nonsignificance). Mixed UI: Neuromodulation has sparse evidence of greater UI improvement compared with no treatment. Consistent with overall network meta-analysis (risk of biais: low, Consistency: consistent , Precision: imprecise, Directness: direct; Overall SoE: low), Quality of life: Neuromodulation better than sham interventions (risk of biais: low, Consistency: consistent , Precision: precise, Directness: direct; Overall SoE: low). |
3.3. Belgian Health Care Knowledge Centre (KCE, Belgium) 2018 ⊕
Obyn C, Jespers V, Camberlin C. Optimisation of RIZIV – INAMI lump sums for incontinence. KCE Reports 304. Brussels: Belgian Health Care Knowledge Centre (KCE). 2018:239p. [219395]. https://kce.fgov.be/sites/default/files/atoms/files/KCE_304_Optimisation_lump_sums_incontinence_Report.pd
| First-line treatments consist of conservative treatments, such as lifestyle interventions, pelvic floor muscle training with or without biofeedback, vaginal cone therapy and use of pessaries, sacral neuromuscular electronical stimulation, stimulation of the tibial nerve, scheduled voiding regimens (bladder training, timed voiding, habit training, prompted voiding), and acupuncture. These treatments have relatively high success rates if they are initiated at an early stage of the incontinence symptoms. They have fewer risks and adverse effects compared with pharmacologic or surgical treatments, and are less expensive, making them well-suited for all patients including older women. |
3.4. Agency for Healthcare Research and Quality (AHRQ, USA) 2014 Ø
Shamliyan T, Wyman J, Kane RL. Nonsurgical Treatments for Urinary Incontinence in Adult Women: Diagnosis and Comparative Effectiveness (comparative Effectiveness Review no. 36.). Rockville, MD: Agency for Healthcare Research and Quality, AHRQ publication no. 11. 2014. [202251].. URL
| Evidence was insufficient to conclude improvement in UI after acupuncture. Low evidence suggested possible improvement in quality of life after active acupuncture. |
3.5. American College of Physicians (ACP, USA) 2014 Ø
Qaseem A, Dallas P, Forciea MA, Starkey M, Denberg TD, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(6):429-40. [198260].
| Other Treatments. Evidence was insufficient to determine the effectiveness of behavioral modification programs, a soy-enriched diet, or acupuncture for improving UI in women with mixed UI. |
4. Randomized Controlled Trials
4.1. Sources
- Acudoc2: Base de données du Centre de documentation du GERA. ECR non inclus dans les autres sources.
- Cui 2023/ Cui Y, Ma Q, Zhang Y, Wei G, Zhou Z. The Efficacy and Safety of Acupuncture in Treating Stress Urinary Incontinence in Women from a Meta-Analysis of Four Randomized Controlled Trials. Arch Esp Urol. 2023 Feb;76(1):40-49. https://doi.org/10.56434/j.arch.esp.urol.20237601.3. https://pubmed.ncbi.nlm.nih.gov/36914418.[n=4]
- Long 2022: Long Z, Chen H, Yu S, Wang X, Liu Z. Effect of Acupuncture for Mixed Urinary Incontinence in Women: A Systematic Review. Front Public Health. 2022 Mar 18;10:827853. https://doi.org/10.3389/fpubh.2022.827853 [n=3]
- AHRQ 2018: Balk E, Adam GP, Kimmel H, Rofeberg V, Saeed I, Jeppson P, Trikalinos T. Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update, Comparative Effectiveness Review No. 212. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ publication). 2018. 643p. [196362].
- Park 2017: Park Eo-Jin, Jo Hyun-Jeong, Jo Hee-Guen. [A Review of Research on Electroacupuncture for Female Stress Urinary Incontinence], J Korean Obstet Gynecol. 2017;30(4):149-74. [196145].
- Zhang 2016: Zhang Yan, Xie Jiangping. [A Meta-analysis of treating female stress urinary incontinence by acupuncture]. Clinical Journal of Chinese Medicine. 2016;8(22):16-20. [201954]
- AHRQ 2014: Shamliyan T, Wyman J, Kane RL. Nonsurgical Treatments for Urinary Incontinence in Adult Women: Diagnosis and Comparative Effectiveness (comparative Effectiveness Review no. 36.). Rockville, MD: Agency for Healthcare Research and Quality, AHRQ publication no. 11. 2014. [202251].
- Paik 2013: Paik SH, Han SR, Kwon OJ, Ahn Ym, Lee Bc, Ahn Sy. Acupuncture for the treatment of urinary incontinence: a review of randomized controlled trials. Exp Ther Med. 2013;6(3):773-780. 160279.
- Wang 2014: Wang Lei ,Fu Li - Xin , Zhu Yuan , et al. [Systematic review of domestic literature of therapeutic effect of acupuncture on stress urinary incontinence]. Journal of Clinical Acupuncture and Moxibustion. 2014;30(9):64. [173471].
- Wang 2013: Wang Y, Zhishun L, Peng W, Zhao J, Liu B. Acupuncture for stress urinary incontinence in adults. Cochrane Database Syst Rev. 2013. [160667].
4.2. List
| Reference | Control | Sources | |
|---|---|---|---|
| 2019 | Liu B, Liu Y, Qin Z, Zhou K, Xu H, He L, Li N, Su T, Sun J, Yue Z, Zang Z, Zhang W, Zhao J, Zhou Z, Liu L, Wu D, Wu J, Zhou J, Pang R, Wang Y, Liu J, Yu J, Liu Z. Electroacupuncture Versus Pelvic Floor Muscle Training Plus Solifenacin for Women With Mixed Urinary Incontinence: A Randomized Noninferiority Trial. Mayo Clin Proc. 2019;94(1):54-65. [198021] - Sun Y, Liu Y, Liu S, Wang W, Liu Z. Electroacupuncture for women with urgency-predominant mixed urinary incontinence: secondary analysis of a randomized noninferiority trial. World J Urol. 2019. [202621]. - Wang W, Liu Y, Su T, Sun Y, Liu Z. 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. Int J Clin Pract. 2019.e13435. [202734]. | Long 2022 | |
| Wang LL, Ren ZX, Zhu JY, Zhang HL, Wu YR. [Efficacy of electroacupuncture combined with penetrating moxibustion for postpartum stress urinary incontinence]. Chinese Acupuncture and Moxibustion. 2019;39(6):599-603. [201207]. | Acudoc2 | ||
| 2017 | Chen Zhuo-wei, Wang Dun-jian, Yuan Ai-qin. [Therapeutic Observation of Acupuncture at Jiaji (EX-B 2) Points plus Pelvic Floor Muscle Exercises for Postpartum Stress Urinary Incontinence] Shanghai Journal of Acupuncture and Moxibustion. 2017;36(3):308-311. [178046]. | Acudoc2 | |
| Hou Wen-Guang, Ming Shu-Ren, Tang Kang-Min, Shen Rui, Chen Yue-Lai. [Preventive and Therapeutic Effects of Electroacupuncture in Treating Mild-moderate Female Stress Urinary Incontinence]. Shanghai Journal of Acupuncture and Moxibustion. 2017;36(8): 956-959. [112431]. | Park 2017 | ||
| Lin Ling. [20 cases of female stress incontinence treated by moxibustion Yongquan combined with electroacupuncture]. Fujian Journal of TCM. 2017;48(3):66. [203288]. | Park 2017 | ||
| Liu Z, Liu Y, Xu H, He L, Chen Y, Fu L, Li N, Lu Y, Su T, Sun J. Effect of Electroacupuncture on Urinary Leakage Among Women With Stress Urinary Incontinence: A Randomized Clinical Trial. JAMA. 2017;317(24):2493-250. [195729 Wang W, Liu Y, Sun S, Liu B, Su T, Zhou J, Liu Z. Electroacupuncture for postmenopausal women with stress urinary incontinence: secondary analysis of a randomized controlled trial. World J Uro. 2019;37(7):1421-1427. [202731]. - Jiao R, Liu Y, Liu B, Liu Z. Risk factors related to acupuncture response in postmenopausal women with stress urinary incontinence: Secondary analysis of a randomized controlled trial. Medicine (Baltimore). 2019;98(16). [197324] - Wang W, Liu Y, Su T, Sun Y, Liu Z. 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. Int J Clin Pract. 2019.e13435. [202734]. | Sham | Cui 2023, AHRQ 2018, Park 2017 | |
| Wang Qiong, Xue Yu-ting, Tang Jian, Cao Zheng-liang, Zhang Wei. [RCTs of Electro-acupuncture in the Treatment of Moderate or Severe Female Mixed Urinary Incontinence]. Journal of Clinical Acupuncture and Moxibustion. 2017;33(10): 27-30. [100814]. | Acudoc2 | ||
| Yu Chunxiao, Zhang Donglei, Chen Chaoming. [Treatment of Female Stress Urinary Incontinence by Electroacupuncture Combined with Pelvic Floor Muscle Training: A Clinical Observation of 38 Cases]. Jiangsu Journal of TCM. 2017;6:51-3. [202603]. | Park 2017 | ||
| 2016 | Chen Y, He E, Tian H, Zhao J. [Impact of electroacupuncture on the life quality in patients of female mixed urinary incontinence]. Chinese Acupuncture and Moxibustion. 2016;36(3):256-8. [191798]. | Acudoc2 | |
| Cui Xiu-Min, Zhao Jie-Jing, He Xiang-Cheng, Wen Chun-guang. [Acupuncture and Aconite Moxibustion in the Treatment of Senile Female Urinary Incontinence]. Journal of Clinical Acupuncture and Moxibustion. 2016;32(5):11-14. [184308]. | Acudoc2, Exclu AHRQ 2018 ( No primary data or no usable results ) | ||
| He E, Chen Y, Tian H, Zhao J. [Effective observation of electroacupuncture with different courses for female stress urinary incontinence]. Chinese Acupuncture and Moxibustion. 2016;36(4):351-4. [186693]. | Park 2017 | ||
| Hong Ling-Jun, Zhao Jin. [Clinical observation of electro-acupuncture on pudendal nerve stimulation therapy in stress urinary incontinence patients]. China Journal of TCM and Pharmacy. 2016;31(7):2857-6. [202749]. | Park 2017 | ||
| Liu Xiang-rong, Zang Zhi-wei, Li Xiao-ling, Ma Jing-hua. [Efficacy Observation of Electro-acupuncturing at Zhongliao( BL33)and Huiyang( BL3S) on Female Stress Urinary Incontinence]. Chinese Journal of Basic Medicine in TCM. 2016;22(7):955. [193956]. | Park 2017 | ||
| Solberg M, Alræk T, Mdala I, Klovning A. A pilot study on the use of acupuncture or pelvic floor muscle training for mixed urinary incontinence. Acupuncture in Medicine. 2016;34(1):7-13. [188201]. | Long 2022, AHRQ 2018, | ||
| Tang Kang-min, Shen Rui, Jiang Fan, Wang Qian, Xie Xu-bin, Chen Yue-lai. [Therapeutic Evaluation of Acupuncture for Female Stress Urinary Incontinence]. Shanghai Journal of Acupuncture and Moxibustion. 2016;35(12):1439-144. [191555]. | Park 2017 | ||
| Tao L, Lu J, Leng W. [Orthogonal Design Study on the Best Indications of Electric Acupuncture for Female Stress Urinary Incontinence]. Journal of TCM (Zhongyi Zazhi). 2016;57(10):843-6. [202619]. | Park 2017 | ||
| Wang S, Lv J, Feng X, Wang G, Lv T. Efficacy of Electrical Pudendal Nerve Stimulation in Treating Female Stress Incontinence. Urology. 2016;91:64-9. [202174]. | Park 2017 | ||
| Wang Wei, Jiang Yi-ming, Wang Rong, Xiao Jin-long. [Observations on the Therapeutic Effect of Electroacupuncture on Mild and Moderate Female Stress Incontinence]. Shanghai Journal of Acupuncture and Moxibustion. 2016;35(1): 47-49. [191488]. | Park 2017 | ||
| Xu H, Liu B, Wu J, et al. A Pilot Randomized Placebo Controlled Trial of Electroacupuncture for Women with Pure Stress Urinary Incontinence. PLoS One. 2016;11(3):e0150821. [202640] | Sham | Cui 2023, AHRQ 2018, Park 2017 | |
| 2015 | Chen Yuan-Xiao, Ma Rui-Jie. [Clinical Observation of Electroacupuncture at Huiyang (BL35) and Zhongliao (BL33) plus Scalp Acupuncture for Female Stress Urinary Incontinence]. Shanghai Journal of Acupuncture and Moxibustion. 2015;34(12):1159. [187521]. | Park 2017, Zhang 2016 | |
| Cui Yan. [Observation on the effect of electroacupuncture combined with Jinkui Shenqi Pills on female stress urinary incontinence]. Guangxi Journal of TCM. 2015;38(1):43-4. [195724]. | Park 2017, Zhang 2016 | ||
| Hong Ling-Jun, Zhao Jin, Zheng Guo-Hong. [Clinical Study on Electro - acupuncture for the Treatment of Mixed Urinary Incontinence] Journal of Clinical Acupuncture and Moxibustion. 2015;31(11):1. [187705]. | Acudoc2 | ||
| Lian A, Zhang W, Wang S. [Mild and moderate female stress urinary incontinence treated with transcutaneous acupoint electrical stimulation: a randomized controlled trial]. Chinese Acupuncture and Moxibustion. 2015;35(4):327-9. [182656]. | Acudoc2 AHRQ 2018 | ||
| Liu Jie, Yang Shaoqin, Shi Ying. [Curative effect observation of needle warming moxibustion Ba Liao point combined with pelvic floor muscle exercise in the treatment of female stress urinary incontinence], Chinese Community Doctors. 2015;31(8):83-4. [168695]. | Zhang 2016 | ||
| Rong Qun, Zhong Shan. [The Quality of Life Effects Acupuncture Treatment for the Female Pelvic Floor Dysfunction]. Chinese Journal of Ethnomedicine and Ethnopharmacy. 2015;24(21):92-3. [183859]. | Zhang 2016 | ||
| Wen Qi. [Electroacupuncture combined with Chinese moxibustion and functional training in treatment of female stress urinary incontinence]. Acta Medicinae Sinica. 2015;28(1):44-6. [201937]. | Park 2017 | ||
| Zheng Hui-min, Xu Shi-fen, Yin Ping, Tang Kang-min, Chen Yue-lai. [Observation on Short-term and Long-term Therapeutic Effects of Electro-acupuncture on Mild and Moderate Stress Urinary Incontinence], World Journal of Integrated Traditional and Western Medicine. 2015;10(2):191-3. [194938]. | Park 2017, Zhang 2016 | ||
| 2014 | Bao Jian. [Clinical Efficacy and Mechanism of Electroacupuncture Pudendal Nerve Stimulation in the Treatment of Female Stress Urinary Incontinence]. China Foreign Medical Treatment. 2014;33:4-5. [201866]. | Park 2017 | |
| Chen Shen - Xu, Zhang Fu - Ging, Wang Si - You. [Clinical observation of electrical pudendal nerve stimulation for female stress urinary incontinence]. Journal of Clinical Acupuncture and Moxibustion. 2014;30(3):5. [170061]. | Acudoc2 | ||
| Shi Xiao-lan, Yang Shuai, Wang Yuan-hui, Zhang Guo-qing. [Clinical research of modified acupuncture for the treatment of female stress urinary incontinence perimenopausal]. Shanghai Journal of TCM. 2014;48(10):67-8;73. [201865]. | Park 2017 | ||
| Ting-Ting, Wang Si-Ou. [Comparative study of the efficacies of different operators-performed electroacupuncture pudendal nerve stimulation in treating female stress incontinence]. Shanghai Journal of Acupuncture and Moxibustion. 2014;33(3):231. [184587]. | Park 2017 | ||
| Xu Guojie, Zhao Zuo, Huang Dianzuo, Wang Ling, Jiang Lifang. [Clinical Observation of 20 cases on Deep Electroacupuncture at Baliao Point Combined with Pelvic Floor Muscle Training for Female Stress Urinary Incontinence]. Zhejiang Journal of TCM. 2014;49(8):605-6. [201859]. | Park 2017 | ||
| Xu Guojie , Xiao Shaoqing , Yao Gang. [Clinical Observation on Deep Electroacupuncture at Baliao Point for Stress Urinary Incontinence]. Modern Diagnosis and Treatment. 2014;24:5551-2. [201897]. | Park 2017 | ||
| Xu Huan-fang, Du Ruo-sang, Mo Qian, Liu Zhi-shun. [A phase 1 clinical study on the efficacy of electroacupuncture for female patients with mild to moderate stress incontinence], China Journal of TCM and Pharmacy. 2014;29(12):3755-8. [201873].;. | Park 2017 | ||
| Zhan J, Wang X, Fei L. Clinical observation on electroacupuncture treatment of mixed urinary incontinence. Health Bull MedSection. (2014) 19:176–7. | Long 2022 | ||
| Zhao Yongzhi. [Clinical Observations on Female Stress Urinary Incontinence Patients with Acupuncture and Traditional Chinese Medicine], Journal of Liaoning University of TCM. 2014;16(5):209-11. [188429]. | Park 2017, Zhang 2016 | ||
| 2013 | Carmona MVO, Molleja ÁMG, Ríos IL, et al. Neuroestimulación percutánea del nervio tibial posterior frente a neuroestimulación de B 6 (Sanyinjiao) en incontinencia urinaria de urgencia. Revista Internacional de Acupuntura. 2013;7(4):124-30. [202675]. | AHRQ 2018 | |
| Mo Qian, Liu Zhi-shun, Ma Xiao-jing. [Efficacy observation of electro-acupuncture on female stress urinary incontinence]. Beijing Journal of TCM. 2013;23(6):434-6. [201858]. | Park 2017 | ||
| Lin Zhao, Si-You Wang. Treatment frequency and long-term efficacy observation on electric pudendal nerve stimulation for stress urinary incontinence. Journal of Acupuncture and Tuina Science. 2013;11(3):177-180. [161197]. | Acudoc2 | ||
| Peng Yingke, Zhao Li. [Clinical Research of Combined Acupuncture and Medicine Treatment in the Treatment of Female Stress Urinary Incontinence]. China Journal of Chinese Medicine. 2013;1:142-3. [202604]. | Zhang 2016, Wang 2014 | ||
| Ye Xiaomeng, Gao Shiqing, Gong Jing et al. [Comparative study on the efficacy of electroacupuncture and acupoint embedding for treatment of stress urinary incontinence], China Medical Engineering. 2013;2:73-3. [202610]. | Park 2017, Wang 2014 | ||
| Zhao Lin, Wang Si-You. [Observations on the therapeutic effect on female stress incontinence of electroacupuncture pudendal nerve stimulation under biofeedback monitoring]. Shanghai Journal of Acupuncture and Moxibustion. 2013;32(5):372. [177716]. | Park 2017 | ||
| 2011 | Chang KK, Wong TK, Wong TH, Leung AW, Chung JW. Effect of acupressure in treating urodynamic stress incontinence: a randomized controlled trial. Am J Chin Med. 2011;39(6):1139-59. [202746]. | Sham | Cui 2023, Paik 2013 |
| He Zhaoxia, Li Xin. [Electroacupuncture for female mild to moderate stress urinary incontinence], Xinjiang Journal of TCM. 2011;1:19-21. [202711]. | Park 2017, Wang 2014 | ||
| Lin Dongmei, Gao Tiemin, Li Jinghui. 30 cases of female stress urinary incontinence treated by warm acupuncture treatment. 2012;21(3):47-8. Journal of External Therapy of TCM. 2012;21(3):47-8. [201360]. | Park 2017 | ||
| Wang Bin, Tang Huayong, Wang Weigang, et al. [Therapeutic effect of abdominal acupuncture on elderly women with stress incontinence]. Liaoning Journal of TCM. 2011;11:2244-5. [202494]. | Wang 2014 | ||
| 2010 | Chen Libin. [35 Cases of Female Urinary Incontinence by Stress Treated by Moxibustion on Salt and Electro - acupuncture], Journal of External Therapy of TCM. 2010;20(6):36-7. [143716]. | Park 2017 | |
| 2009 | Engberg S, Cohen S, Sereika SM. the efficacy of acupuncture in treating urge and mixed incontinence in women: a pilot study. J Wound Ostomy Continence Nurs. 2009;36(6):661-70. [155235]. | AHRQ 2018, Paik 2013 | |
| Liang Yuanlan, Lu Liqiong, Liang Jiantao, Xie Xiaolan. [Effect of Acupuncture and Moxibustion Treatment on Stress Urinary Incontinence], Journal of Nursing Science. 2009;13:49-50. [201891]. | Wang 2014 | ||
| Tang CL, Dai DC, Zhu WF, Jin YY, Mei LF, Zhao GF. [Observation on therapeutic effect of dog-day acupuncture and moxibustion combined with pelvic floor muscle exercises for treatment of female stress urinary incontinence]. Chinese Acupuncture and Moxibustion. 2009;29(11):879-83. [154646]. | Zhang 2016, Wang 2014 | ||
| 2008 | Kim JH, Nam D, Park MK, Lee ES, Kim SH. Randomized control trial of hand acupuncture for female stress urinary incontinence. Acupunct Electrother Res. 2008;33:179-192. [130708]. | Sham | Cui 2023, AHRQ 2014 |
| Le Xu-Hua, Wu Hong-Jun, Wang Rui-Hua. [Clinical study of the treatment of female stress incontinence by combined electroacupuncture and pelvic floor muscle exercises]. Shanghai Journal of Acupuncture and Moxibustion. 2008;27(10):18. [151132]. | Park 2017, Zhang 2016, Wang 2014 | ||
| Yue J, Deng H, Zheng F. [Clinical Observations on Electroacupuncture Warming Moxibustion for Female Stress Urinary Incontinence]. Shandong Journal of TCM. 2008;27(10):688-9. [203422]. | Park 2017 | ||
| 2007 | Bi W. [Clinical study on electroacupuncture treatment of female stress incontinence]. Chinese Archives of TCM 2007;25(6): 1284–5. 2007;25(6):1284-5. [202633]. | Park 2017, Zhang 2016, Wang 2014 | |
| Shi Jinhuan. [Clinical study of electroacupuncture for stress urinary incontinence]. Harbin: Heilongjiang University of Traditional Chinese Medicine [Dissertation]. 2007. [202678]. | Wang 2014 | ||
| 2005 | Emmons SL, Otto L. Acupuncture for overactive bladder: a randomized controlled trial. Obstet Gynecol. 2005;106(1):138-43. [140342]. | AHRQ 2014, Paik 2013 | |
| Xiong X et al. [Clinical Study of the Treatment of Stress Incontinence by Combined Electroacupuncture and Pelvic Floor Muscle Exercises]. Chinese Journal of Physical Medicine and Rehabilitation. 2005;22(7):432-3. [143375]. | Park 2017 | ||
| 2004 | Yang Peng-Fei. [Therapeutic effect of warming acupuncture-moxibustion plus.tdp radiation on stress urinary incontinence]. Chinese Acupuncture and Moxibustion. 2004;24(7):459. [131843]. | Acudoc2 | |
| Yang T, Zhou Q, Zhai K. [Clinical Study on Electroacupuncture Treatment of Female Stress Incontinence]. Journal of Sichuan TCM. 2004;22(6):90-1. [204043]. | Park 2017 | ||
| Zhang Cai-Zhen, Lu Yan-Qing. [Clinical observation on acupoint thread-embedding therapy plus functional exercise for treatment of stress urinary incontinence]. Chinese Acupuncture and Moxibustion. 2004;24(7):457. [131842]. | Acudoc2 | ||
| 2001 | Liu Zhishun, Liu Baoyan, Yang Tao, Et Al. [Clinical Study On Electroacupuncture Treatment Of Senile Imperative Urinary Incontinence]. Chinese Acupuncture and Moxibustion. 2001;21(10):579. [107458]. | Acudoc2 | |
| 1998 | Liu Zhishun et al. [Analysis of the curative effect of electro-acupuncture at ciliao and huiyang points to treat senile urinary incontinence]. Shanghai Journal of Acupuncture and Moxibustion. 1998;17(3):14. [68598]. | Acudoc2 | |
| 1994 | Kelleher CJ et al. Acupuncture and the treatment of irritative bladder symptoms. Acupuncture in Medicine. 1994;12(1):9-12. [58154]. | Paik 2013 |
