| BackgroundThe International Continence Society (ICS) defines chronic urinary retention (CUR) as’a non-painful bladder, which remains palpable or percussable after the patient has passed urine’. Most studies and the UK National Institute for Health and Clinical Excellence guidelines for lower urinary tract symptoms describe CUR as either a post-void residual (PVR)> 300 ml in patients who are able to void, or PVR> 1,000 ml in patients who are unable to void. CUR can be caused by obstructive, neurologic, myogenic or other pathogenesis, such as spinal cord injury (SCI), pelvic nerve injury, peripheral neuropathy and detrusor overdistention injury. SCI is an important non-obstructive pathogeneses of CUR, which can disrupt the reflex circuitry controlling micturition. SCI has high incidence ofprevalence, disability and low incidence of recovery. The annual incidence of prevalence of SCI is 12.1/106～58.7/106. However, to the best of our knowledge, the exact incidence and prevalence of CUR due to SCI are still unclear. This disease has a serious impact on patients’health and their quality of life. Long-term neglect of CUR may lead to chronic urinary tract infections, upper urinary tract damage and renal failure. Therefore, timely diagnosis and treatment are vital.CUR due to SCI can be treated by pelvic floor training, sacral neuromodulation (SNM), intravesical electro stimulation (IVES) and other therapies. All these therapies have some effects. However, IVES provides only short-term efficacy, and the potential complications of SNM include implant infection, pain, and superficial dehiscence. These disadvantages may hamper the expansion of these therapies to some extent. CUR due to SCI can also be relieved using an intermittent or indwelling catheter; although these relief methods have some benefits, catheterization cannot help patients restore their voiding function. Furthermore, long-term catheterization may be associated with complications such as discomfort, urethral injury and urinary tract infection.Acupuncture originates from ancient China and has been used to manage various clinical disorders for thousands of years. Although acupuncture plays an important role in Traditional Chinese Medicine (TCM) and is commonly used for treating CUR due to SCI in mainland China, no systematic review of this treatment for CUR due to SCI exists; hence, the effectiveness and safety of this treatment remain unclear.ObjectiveThis review aimed to assess the effectiveness and safety of acupuncture for CUR due to SCI by systematically analyzed the Randomized controlled trials (RCTs) related to acupuncture for CUR caused by SCI. Besides, this review aimed to provide scientific basis for the future clinical treatment and research. The effectiveness would be assessed by’effective’,’non-effective’and’lack of enough evidence’.MethodsEight databases were searched from their inception:China National Knowledge Infrastructure (CNKI), Wan-Fang Database, Chinese Scientific Journal Database (VIP database), and the Chinese Biomedical Literature Database (CBM), PubMed, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov. RCTs related to acupuncture for CUR caused by SCI in English or Chinese without restrictions on the publication status were included. PVR, response rates and health-related quality of life (HRQL) were analyzed. Adverse events were also investigated. The risk ratio (RR) was applied for dichotomous outcomes and the mean difference (MD) was applied for continuous outcomes. The 95% confidence intervals (CI) were used for these outcomes.ResultsThree RCTs, including 334 patients with CUR caused by SCI were included. All of the trials were evaluated as having high risks of bias. Two trial applied etectroacupuncture, one trial applied manual acupuncture; acupuncture performed were all based on disease diagnosis; patients received acupuncture therapy once a day, and each treatment lasted for 20 or 30 minutes; the treatment duration ranged from two weeks to eight weeks. Zhongji (CV3), Qihai (CV6) and Guanyuan (CV4) were the most frequently used points, and all the acupoints selected were based on disease diagnosis. One trial evaluated PVR, while the other two trials evaluated response rates. Meta-analysis showed that acupuncture plus rehabilitation training was much better than rehabilitation training alone in decreasing PVR (MD-109.44, 95% CI-156.53 to -62.35). Likewise, a combination of acupuncture and aseptic intermittent catheterization was better than aseptic intermittent catheterization alone in improving response rates (RR 1.23,95% CI 1.10 to 1.38).18 clinical trials were included for safety evaluation, and only one trial mentioned adverse events. None of the 18 trials mentioned severe adverse events.ConclusionsBased on the available literatures, acupuncture as a complementary therapy may have a potential effect in CUR caused by SCI in decreasing PVR and improving bladder voiding. Additionally, acupuncture is safe in treating CUR caused by SCI. However, due to the lack of high quality trials, we could not draw any definitive conclusions. More well-designed trials are needed to provide strong evidence for the effectiveness and safety of acupuncture. |
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