EA for SUI 2022

Inspired by Tang et al 2022.[1]

EA – electroacupuncture
SUI – stress urinary incontinence
PFMT – pelvic floor muscle training

key to acronyms

This is not a new topic or a new protocol, but it is quite a large sham controlled trial (n=304), so deserves a mention on this blog.

I have not come across the journal European Urology Focus before, but it has been around since 2015, and currently has an impact factor of 5.996.

This topic was first addressed by a Cochrane review in 2013,[2] but of the 17 studies found by the review team, only one trial with 60 women met the inclusion criteria.

In 2017 we saw a big trial (n=504) published in JAMA on EA for SUI,[3] and it was the first time I had seen a Streitberger-like non-penetrating sham used in a big trial from China. They described it as a ‘blunt-tipped placebo needle’ and noted the use of adhesive pads in both real and sham groups.

This was a positive trial with a modest result in favour of real EA. The current trial used the same protocol, which is described in a previous blog: EA for stress urinary incontinence. In that blog I observe that the effect of 18 sessions of EA over 6 weeks was similar to the effect of 12 weeks of PFMT.

In the current trial EA or sham was added to an 8-week course of PFMT. The EA or sham was applied 3 times per week and the PFMT was performed 3 times a day. The primary outcome was the same as in the JAMA trial – urinary leakage measured by the one-hour urine pad test. The mean reduction in urinary leakage from baseline was 9.8g in the EA group and 5.8g in the sham group. The equivalent figures from the JAMA trial were 9.9g and 2.6g, but in this trial there was no PFMT co-intervention. PFMT alone results in a reduction in leakage of 5.1g after 8 weeks training and 8.9g after 12 weeks training.

I guess the question is: would additional EA improve the results of 12 weeks of PFMT? Performing this EA protocol 3 times a week is logistically challenging, so you would hope that it would do more than reduce urinary leakage by an additional gram. The most recent Cochrane review of PFMT quotes a reduction of 9.7g,[4] but with a very wide confidence intervals and this is only based on 4 trials and a total of 185 women.

Perhaps the pragmatic approach is to push the PFMT for everyone and then add EA for those that are still struggling with SUI after 12 weeks. Talking of PFMT, which we should all be doing apparently, the lead author of the Cochrane review has published a trial comparing group-based training with individualised training (n=362) and found that the effect is similar (more accurately, group-based PFMT is statistically non-inferior).[5]

References

1          Tang K, Su T, Fu L, et al. Effect of Electroacupuncture Added to Pelvic Floor Muscle Training in Women with Stress Urinary Incontinence: A Randomized Clinical Trial. Eur Urol Focus 2022;:S2405-4569(22)00233-4. doi:10.1016/j.euf.2022.10.005

2          Wang Y, Zhishun L, Peng W, et al. Acupuncture for stress urinary incontinence in adults. Cochrane Database Syst Rev 2013;:CD009408. doi:10.1002/14651858.CD009408.pub2

3          Liu Z, Liu Y, Xu H, et al. Effect of Electroacupuncture on Urinary Leakage Among Women With Stress Urinary Incontinence: A Randomized Clinical Trial. JAMA 2017;317:2493–501. doi:10.1001/jama.2017.7220

4          Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2018;10:CD005654. doi:10.1002/14651858.CD005654.pub4

5          Dumoulin C, Morin M, Danieli C, et al. Group-Based vs Individual Pelvic Floor Muscle Training to Treat Urinary Incontinence in Older Women: A Randomized Clinical Trial. JAMA Intern Med 2020;180:1284–93. doi:10.1001/jamainternmed.2020.2993

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Declaration of interests MC