Acupuncture for stress urinary incontinence in adults

Stress urinary incontinence is a common disease among older people, especially women. The symptoms are leakage of urine when the person coughs, laughs or exercises. It affects social, psychological, physical and financial aspects of life. Acupuncture is used widely in Asian countries for this condition and frequency of use is increasing worldwide. From the viewpoint of traditional Chinese medicine, acupuncture could improve the symptoms of stress urinary incontinence by reinforcing qi (the vital substance constituting human body) and promoting recovery of the bladder's function. This review included only one small trial with 60 women. There was not enough evidence to assess the effects of acupuncture for stress urinary incontinence compared with drug treatment, and high-quality randomised controlled trials are needed.

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.

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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.

Objectives: 

To assess the effectiveness and side effects of acupuncture for stress urinary incontinence in adults.

Search strategy: 

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.

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.

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