Acupuncture for Women with Overactive Bladder: Perspective of Traditional Chinese Medicine and Related Mechanism

Figures & data

Table 1 PubMed Search Strategy

No.	Searching Item
#1	Acupuncture[Title/Abstract]
#2	Acupuncture treatment[Title/Abstract]
#3	Electroacupuncture[Title/Abstract]
#4	Acupuncture therapy[Title/Abstract]
#5	Warm needling[Title/Abstract]
#6	Laser acupuncture[Title/Abstract]
#7	Or/#1-#6
#8	Overactive bladder[Title/Abstract]
#9	Overactive bladder syndrome[Title/Abstract]
#10	Bladder overactive[Title/Abstract]
#11	Overactive detrusor[Title/Abstract]
#12	Bladder instability[Title/Abstract]
#13	Urinary bladder[Title/Abstract]
#14	Or/#8-#13
#15	Clinical trial[Publication Type]
#16	Trial[Publication Type]
#17	Clinical study[Publication Type]
#18	Controlled study[Publication Type]
#19	Randomized [Publication Type]
#20	Placebo[Publication Type]
#21	Or/#16-#21
#22	#4 and #14 and #21

Figure 1 Flow chart of the study search.

Table 2 Risk of Bias for Included Randomized Controlled Trials

Reference	Sequence Generation	Allocation Concealment	Blinding of Participants and Personnel	Blinding of Assessment	Incomplete Outcome	Selective Outcome Report	Other Source of Bias
Hargreaves 2021^Citation15	Low	Low	High	High	High	Unclear	Unclear
Chang 2020^Citation16	Low	Unclear	Low	Unclear	Low	Low	Unclear
Aydoğmuş 2014^Citation17	Low	Unclear	Low	Unclear	High	Unclear	Unclear
Yuan 2015^Citation18	Low	Low	High	Low	High	Low	Low
Emmons 2005^Citation19	Low	Low	Low	Low	Low	Unclear	Low

Table 3 Summary of the Included Studies

References	Sample	Characteristics	Treatment	Acupoints	Outcomes	Conclusion
Hargreaves 2021^Citation15	16	54.5±16.23 years 8.4 voids/day;3.16 leakage episodes per day;1.39 episodes of nocturia	Standard care (individually tailored advice regarding bladder health, pelvic floor exercises and lifestyle adjustment) plus acupuncture, 30 min, 6 sessions for 8 weeks	CV3 (Zhongji), CV4 (Guanyuan), CV5 (Shimen), ST25 (Tianshu), SP6 (Sanyinjiao), SP9 (Yinlingquan), KI3 (Taixi), KI7 (Fuliu)	Voids per day 8.4±1.57 vs 7.87±2.84 in week 8 and 8.80±2.40 in week 14; leakage episodes per day 3.16±3.20 vs 2.70±2.95 in week 8 and 2.53 ±3.00 in week 14; nocturia 1.39±1.36 vs 1.39±1.36 in week 8 and 1.13±1.15 in week 14; ICIQ‐SF score 11.00±4.73 vs 9.4±5.2 in week 8 and 10.2±5.1 in week 14	The majority of participants found the protocol acceptable and completed all aspects of the study. Acupuncture treatment appeared to be safe and well-tolerated and feasible.
Chang 2020^Citation16	15	56.4±14.3 years 10 wet OAB and 5 dry OAB	Subjects in the verum laser acupuncture group received a total energy of 6 joule at each acupoint with frequency prescribed, 611Hz~1102Hz, 9 sessions for 3 weeks	KI3 (Taixi), SP6 (Sanyinjiao), CV4 (Guanyuan), CV6 (Qihai), BL33 (Zhongliao), BL34 (Xialiao), GV20 (Baihui)	OABBS 8.7±1.8 vs 4.7±2.4 in week 1 and 3.4±1.9 in week 2 and 3.1±1.6 in week 3 (p<0.01); UDI-6 6.0±2.5 vs 3.5±1.9 in week 1 and 2.3±1.8 in week 2 and 2.4±1.6 in week 3 (p<0.05); IIQ-7 9.9 ± 5.7 vs 4.2±2.3 in week 1 and 4.2±3.2 in week 2 and 3.0±2.5 in week 3 (p<0.05)	Laser acupuncture can alleviate OAB symptoms and improve quality of life and could be an effective therapy for women with OAB.
Aydoğmuş 2014^Citation17	28	38±12.9 years all OAB dry	Acupuncture, 20 min, 8 session for 4 weeks	LI4 (Hegu), GV22 (Xinhui), SP6 (Sanyinjiao), ST36 (Zusanli), LR3 (Taichong), GV29 (Yintang), CV4 (Guanyuan), KI3 (Taixi), KI5 (Shuiquan)	NFG,0.92pg/mL (range 0.70–2.45) vs 0.07 (range 0.01–2.82); symptom scores 21 (range 14–21) vs 5 (range 2–20); quality of life scores 2.0 (1–3) vs 2.0 (range 0–3), all the results had been significantly improved after treatment (p<0.01)	In patients with OAB in whom anticholinergic treatment is contraindicated, acupuncture may be considered another treatment option.
Yuan 2015^Citation18	118	57.5±12.1 years 2.2 incontinence episodes/day	Acupuncture, 20 min, 4 sessions for 4 weeks	SP6 (Sanyinjiao), SP9 (Yinlingquan), KI3 (Taixi), CV4 (Guanyuan)	At week 4, the number of urgency episodes per 24 h in the intervention group decreased by 3.1 (−47.7%), urgency incontinence episodes by 1 (−45.5%), daytime frequency by 4.2 (−30.0%), nocturia episodes by 1.5 (−37.5%) and the volume voided per micturition increased by 68 mL (40.0%), while in the control group, the number of urgency episodes per 24 h decreased by 3.5 (−50%), urgency incontinence episodes by 1.2 (−48%), daytime frequency by 4.3 (−32.6%), nocturia episodes by 1.3 (−36.1%) and the volume voided per micturition increased by 70 mL (43.2%).	Acupuncture is safe with significant improvements in patient assessment of overactive bladder symptoms and may be considered a clinically alternative treatment for overactive bladder in female adult.
Emmons 2005^Citation19	38	53±13 years 30.4 voids/3 days; 16.2 urge episodes/3 days	Acupuncture, 20 min, 4 sessions for 4 weeks	SP6 (Sanyinjiao), BL39 (Weiyang), BL28 (Pangguangshu), CV4 (Guanyuan)	A 59% reduction in number of incontinent episodes; a 14% reduction in urinary frequency (p=0.013); a 30% reduction in the proportion of voids associated with urgency (p=0.016), and a 13% increase in both maximum voided volume and maximum cystometric capacity (p=0.01); an 54% reduction in the urinary distress inventory and incontinence impact questionnaire scores (p<0.01)	Women who received 4 weekly bladder specific acupuncture treatments had significant improvements in bladder capacity, urgency, frequency, and quality of-life scores as compared with women who received placebo acupuncture treatments.
Chang 1988^Citation20	26	35±17 years symptom duration 9 months->10 years	Acupuncture, 20 min, 1 session	SP6 (Sanyinjiao)	Acupuncture improved maximum cystometric capacity (p<0.01) and decreased peak urinary flow rate (p<0.02).	Acupuncture could be used as a simple and effective method to treat female patients with frequency, urgency and dysuria.

Abbreviations: OABSS, the overactive bladder symptom score; IIQ-7, incontinence impact questionnaire; UDI-6, urogenital distress inventory short form; NGF, nerve growth factor.

Figure 2 The location and distribution of the acupoints.

Notes: The green, black, blue, red, yellow, and gray circles represent the acupoints selected by Hargreaves et al, Chang et al (2020), Aydoğmuş et al, Yuan et al, Emmons et al and Chang et al (1988), respectively (Created with BioRender.com.).

Hargreaves E, Harding C, Clarkson C. Acupuncture in addition to standard conservative treatment for overactive bladder; a feasibility trial for a randomized controlled study. Neurourol Urodyn. 2021;40(7):1770–1779. doi:10.1002/nau.24741

 PubMed Web of Science ®Google Scholar

Chang Y-W, Lo T-S, Chang H-N, Shiao Y-H, Yeh Y-C. Laser Acupuncture Alleviates Symptoms and Improves Quality of Life in Women with Overactive Bladder: a Double-Blind, Pilot Randomized Controlled Trial. Evid Based Complement Alternat Med. 2020;2020:1705964. doi:10.1155/2020/1705964

 PubMed Web of Science ®Google Scholar

Aydogmus Y, Sunay M, Arslan H, Aydın A, Adiloğlu AK, Şahin H. Acupuncture versus solifenacin for treatment of overactive bladder and its correlation with urine nerve growth factor levels: a randomized, placebo-controlled clinical trial. Urol Int. 2014;93(4):437–443. doi:10.1159/000358202

 PubMed Web of Science ®Google Scholar

Yuan Z, He C, Yan S, Huang D, Wang H, Tang W. Acupuncture for overactive bladder in female adult: a randomized controlled trial. World J Urol. 2015;33(9):1303–1308. doi:10.1007/s00345-014-1440-0

 PubMed Web of Science ®Google Scholar

Emmons SL, Otto L. Acupuncture for overactive bladder: a randomized controlled trial. Obstet Gynecol. 2005;106(1):138–143. doi:10.1097/01.AOG.0000163258.57895.ec

 PubMed Web of Science ®Google Scholar

Chang PL. Urodynamic Studies in Acupuncture for Women with Frequency, Urgency and Dysuria. J Urol. 1988;140(3):563–566. doi:10.1016/S0022-5347(17)41719-8

 PubMed Web of Science ®Google Scholar

Data Sharing Statement

Data supporting this article are all in this article.