Effect Of Acupuncture On Overactive Bladder In Females-A Case Series Study

Background:Overactive bladder(OAB)is a symptom syndrome defined as the presence of urinary urgency,usually accompanied by increased frequency and nycturia with or without urge urinary incontinence in the absence of urinary tract infection or other obvious pathology.OAB is a highly prevalent disorder affecting 16.5%of adult women in population-based studies,a prevalence similar to other major chronic conditions,with an increasing economical global coast every year.Pharmaceutical remedies remain suboptimal therapies due to a high incidence of side effects,relatively modest efficacy,poor patient compliance and high long-term costs.Overactive bladder affects patient health related Quality of Life(QOL)to a great extent,but often is a problem unrecognized and under-managed.Non-pharmaceutical therapy for OAB has gradually aroused more attention due to its satisfied effect,such as neuromodulation in western medicine and acupuncture in traditional Chinese medicine(TCM).Neuromodulation refers to some techniques which has effect to modulate bladder function and facilitate storage.As a commonly used neuromodulation method,sacral nerve stimulation(SNS)shows satisfied effect of inhibition of bladder,so it has been used as an evidence-based clinical treatment for OAB.However,SNS technique is not very accessible and may cause more invasive injury for the patient.Therefore,an easily applicable and less invasive technique,percutaneous tibial nerve stimulation(PTNS)was developed.PTNS is developed from acupuncture used in TCM,similar to electroacupuncture(EA)at Sanyinjiao(SP6)and was first described in the early 1980s.Although PTNS is minimally invasive and not costly,it is time consuming.Therefore,in western medicine,new techniques with implants are being explored and show initially promising results.Acupuncture has been used for the treatment of OAB with advantages of safe,effective,easily applicable and cost-effectiveness,particularly in China,but evidence is limited.Recently,a high quality randomized clinical trial showed that among women with stress urinary incontinence,treatment with EA involving the lumbosacral region,compared with sham EA,resulted in less urine leakage.Animal experimental study also showed that EA at SP6 had the inhibitory effect for OAB.However,clinical evidence for needling SP6 as the main point for OAB is limited,since needling SP6 is more accessible.Moreover,acupuncture treatment is a complex and individualized intervention including aspects of needling,specific non-needling components drove by acupuncture theory,and generic components not unique to acupuncture treatment.In addition,acupuncture treatment should be performed on the basis of the patient condition and TCM theory,such as syndrome differentiation.Therefore,there is a need to conduct some real-world researches to estimate the effectiveness and safety of acupuncture for OAB in real world settings.Objectives:The aim of this study is to observe the effect of acupuncture for the treatment of symptoms of overactive bladder,so as to find a safe,effective and easily applicable method for OAB.Methods:Design and Setting:A serial case report was designed and performed at the(Gabinet Diagnosi Girona),Spain,between January 4,2018 and June,2018.Patients:A number of about 12 cases were recruited from the gynecology outpatient department of diagnosis and treatment,observing the criteria of inclusion and exclusion,and,after information and consent,the patients accepted to be treated at minimum with 4 sessions.Interventions:A group of points including Sanyinjiao(SP6),Guanyuan(CV4),Zusanli(ST36),Baihui(GV20),Shenting(GV24),Hegu(LI4),and Taichong(LR3)were used as the main points with even method to induce proper needling sensation.Other acupuncture points were modified according to the TCM syndromes.Cupping or lamp-heating methods were also used at lumbosacral region and abdominal region based on the patient condition.Outcome measurements:Primary outcomes were the total number of voiding episodes and number of urge episodes.Overactive bladder syndrome score(OABSS)developed by Homma.The OABSS consists of four questions regarding OAB symptoms;day-time frequency,nycturia,urgency,and urgent urinary incontinence(UUI).The sum of the four scores runs between 0 and 15.Secondary outcomes were the number of nocturnal awakenings related to OAB over 24 h,maximum bladder capacity(when registered)and ultrasound evaluation of signs of OAB.The incontinence ICIQ-SF questionnaires as well as 3-day voiding diaries,in the cases with urine incontinence.Also,were considered the number of pads used over 24 h,Quality of Life Scales(QOL)questionnaires,adverse events and participant withdrawal.Results:In 10 of our 12 cases series was appreciated an improvement in the primary outcome measure,that was the reduction in the total amount of voiding episodes,and in the number of urge episodes.The overactive bladder symptom score(OABSS)changed in all of them(time frame;at baseline,and after end of the treatment period).The change was in direction to a subjective improvement in OAB symptoms.We also observed in 3 of the 4 cases with UUI,a decrease in the number of pads used over 24 h,and a reduction in number of nocturnal awakenings related to OAB over 24 h.Bladder capacity(mL)and ultrasound evaluation of signs of OAB,only improved in two cases.In the rest the differences were no significant.We have only 4 cases with UUI,where the short version of the incontinence ICIQ-SF questionnaires as well as 3-day voiding diaries were recorded at baseline and at the end of the treatment showing improvement.Subject global response assessments have been evaluated with Quality of Life Scales(QOL)questionnaires before and after the treatment and the impact in all of them has been positive.Adverse events were only minor pain in two patients when needling and one patient had subcutaneous bruises which disappeared without any medical attention.One patient drop-out the treatment because of plaquetopenia revealed once started the treatrment.Conclusions:This cases series study of females with overactive bladder preliminarily showed that acupuncture treatment has been,safe,effective and easy to apply for overactive bladder in females.TCM through a holistic and integrated point of view,from syndrome differential diagnosis allows us to treat overactive bladder as a symptom part of a whole syndrome.Despite the limitations,this cases series study suggests a benefit in treating more points apart than Sanyinjiao(SP6),and that may improve the success of other techniques that are now in use as electrostimulation PTNS.We observed alleviation of symptoms such as frequency,nycturia,urgency and quality of life,so the case series study can provide some clinical evidence of the effect of acupuncture on OAB in females.