EA for post-RARP UI

Stimulated by Niu et al 2025.[1]

EA – electroacupuncture
RARP – robot-assisted radical prostatectomy
UI – urinary incontinence
UC – urinary continence
IF – impact factor
RCT – randomised controlled trial

– key to acronyms

This week we have another paper from JAMA Network Open (IF 9.7). This time the research group comes from Nanjing rather than Oregan (see Acupuncture for cLBP 2025).

Nanjing literally means southern capital and is about 1000km south of Beijing (northern capital). The journey takes 3.5 to 4.5 hours on China’s high-speed trains and 2 hours to fly. The Yangtze River runs just north of the city, having approached it from the southwest, and then continues east for 400km where it opens into the Yellow Sea just above Shanghai. This is one of China’s busiest waterways, and historically the Yangtze corridor between Nanjing and Shanghai was one of the most strategically important stretches of water in China.

All this talk of waterworks is quite appropriate since this is the first RCT I have seen on EA for reducing urinary incontinence (UI) following radical prostatectomy. Early (within 3 months) UI following RARP is very common, and if all degrees of urinary leakage are included following catheter removal the reported rates are as high as 80% to 90%.

110 patients with early UI (4 to 6 weeks) following standard RARP were randomised to either real EA or a non-penetrating sham. Patients received 3 sessions per week for 6 weeks and the primary outcome was the proportion of patients with UC at 6 weeks. The latter was defined as using 0 or 1 urinary pad per day. Secondary outcomes included the 24-hour urinary leakage in grams by weighing the pads used each day.

The EA protocol was a dorsal segmental protocol involving deep needling into the sacral foramina at S2 to S4 bilaterally, ie BL32 to BL34. BL32 (anode) was connected to BL33 (cathode) on each side and stimulated at 2/15Hz at the maximum tolerated intensity for 30 minutes. Non-penetrating needles were used in the sham group and placed 20mm lateral to the real point locations. Foam pads were used in both groups, and these held the needles in place in the sham group.

The paper describes the angulation and depth of insertion of the needles at each point in some detail, including the angulation to the skin surface as well as to the sagittal plane.

At the end of the 6-week treatment course, 24 out of 55 patients in the EA group and 12 out of 55 in the sham group satisfied the criteria for UC (p=0.02). The median reduction in 24-hour urinary leakage was 320g in the EA group and 200g in the sham group (p<0.001).

So, in the short term, EA clearly improves the rate of UC following RARP; however, this was after 18 sessions, and at the 20-week point there was little difference between the groups, with the EA group achieving UC in 42 out of 55 patients and the sham group reaching 37 out of 55.

This is about a 10% difference, which could be significant in a much larger trial, so this is where the subgroup analyses come in handy, because they clearly show that EA only works better than sham in patients with nerve sparing surgery (either unilateral or bilateral). EA also works better in patients who do not drink alcohol and are not diabetic.

References

1          Niu J, Wang Y, Wang Y, et al. Electroacupuncture in Patients With Early Urinary Incontinence After Radical Prostatectomy: A Randomized Clinical Trial. JAMA Netw Open. 2025;8:e2534491. doi: 10.1001/jamanetworkopen.2025.34491

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Declaration of interests MC