Stimulated by Ots et al 2024.[1]
The diagram on the left is a segmental EA protocol favoured by MC.
UTI – urinary tract infection
rUTI – recurrent UTI
RCT – randomised controlled trial
DZA – Deutsche Zeitschrift für Akupunktur– key to acronyms
This is the largest RCT of acupuncture for the prevention of rUTI in women to date (n=137). It comes over 20 years after the previous trials, both of which were conducted in Norway.[2,3]
This trial was based in Graz, Austria, and the lead author is a famous, rather senior, medical acupuncturist and former editor in chief of the DZA – Thomas Ots.
In order to qualify for the study, the women must have had 2 UTIs in the previous 6 months, or 3 in the previous 12 months. The UTIs had to be diagnosed by a healthcare provider using dipstick testing and at least one positive urine culture within the previous 12 months.
The trial randomised 137 women to either acupuncture plus cranberry products or cranberry products alone. The latter were provided free to all participants for 6 months. The acupuncture consisted of 12 treatments over 18 weeks and was performed at 1 of 7 different private acupuncture clinics that were participating in the study.
The acupuncture was described as segmental but included ear points and GV20 as well. The authors state that the segments relevant to the urogenital system are T10 to S4. We (BMAS teaching) usually quote T11 to L2 and S2 to S4, since the vast majority of nerve fibres in the ventral primary rami of L3 to S1 head off down the leg.
The protocol included abdominal, back, and lower limb points, as well as the ones mentioned above. Patients were positioned side lying for treatment and the side was alternated at each subsequent session. 3 points in the abdomen were described as being in proximity to KI13 to 15, and 5 points in the low back were described as in proximity to BL24 to 28. Alternate sides were needled at each segment apart from BL24, which was needled bilaterally. The limb points used were ST36 bilaterally, and the upper facing side for BL60, SP6, KI6, KI7. I count 19 needles in total per session.
The primary outcome was the proportion of women without UTIs at 6 months. I assume that by ‘without UTIs at 6 months’ they mean the women who had not had any UTIs during this period. They also counted the numbers of UTIs that occurred throughout the first 6 months, the whole 12 months, and the 6 to 12 months period.
In the acupuncture group, 59% were UTI free at 6 months, and 46% were UTI free in the cranberry alone group. Unfortunately, this was not statistically significant; however, all but one of the secondary outcomes were statistically significant in favour of the acupuncture group. The proportions that were UTI free at 12 months were 47% and 26% respectfully.
So, all three RCTs so far have demonstrated a reduced incidence of UTI, even though they may not all have been positive trials in the technical sense. The results here will strengthen the meta-analytic result of acupuncture against no acupuncture, which is already comfortably positive, albeit based on relatively small numbers as yet.[4]
References
1 Ots T, Gold D, Ziller P, et al. Segmental Acupuncture for Prevention of Recurrent Urinary Tract Infections. A Randomised Clinical Trial. Int Urogynecology J. Published Online First: 25 July 2024. doi: 10.1007/s00192-024-05872-7
2 Aune A, Alraek T, LiHua H, et al. Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women. Scand J Prim Health Care. 1998;16:37–9. doi: 10.1080/028134398750003386
3 Alraek T, Soedal LIF, Fagerheim SU, et al. Acupuncture Treatment in the Prevention of Uncomplicated Recurrent Lower Urinary Tract Infections in Adult Women. Am J Public Health. 2002;92:1609–11. doi: 10.2105/AJPH.92.10.1609
4 Qin X, Coyle M, Yang L, et al. Acupuncture for recurrent urinary tract infection in women: a systematic review and meta‐analysis. BJOG Int J Obstet Gynaecol. 2020;1471-0528.16315. doi: 10.1111/1471-0528.16315
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