Rédacteurs : Claude Pernice, Johan Nguyen

Urinary Retention after Spinal Cord Injury

Rétention urinaire des traumatismes médullaires : Evaluation de l'acupuncture

1. Systematic Reviews and Meta-Analysis

☆☆☆ Evidence for effectiveness and a specific effect of acupuncture
☆☆ Evidence for effectiveness of acupuncture
Limited evidence for effectiveness of acupuncture
Ø No evidence or insufficient evidence

1.1. Generic acupuncture

1.1.1. Cheng 2018

Cheng Jie, Guo Jia-Bao, Chen Bing-Lin, Zhu Yi. [Acupuncture treatment for urinary retention following spinal cord injury: a Meta-analysis]. Journal of Clinical Rehabilitative Tissue Engineering Research. 2018;12:1962-1968. [201785]. Cheng Jie, Guo Jia-Bao, Chen Bing-Lin, Zhu Yi. [Acupuncture treatment for urinary retention following spinal cord injury: a Meta-analysis]. Modern Rehabilitation. 2018;12:1962-1968. [201786].

Background Acupuncture is a common treatment for urinary retention after spinal cord injury. It has been widely used in the clinical treatment of urinary retention after spinal cord injury due to its small side effects and simple operation. However, there is a lack of evidence-based medicine.
ObjectiveTo examine the effectiveness of acupuncture for urinary retention in patients with spinal cord injury by a systematic review and Meta-analysis of randomized controlled trials(RCTs).
MethodsA computer-based online retrieval of CBM, CNKI, Wan Fang, Cochrane Library, Pub Med, EMBASE, and Web of Science databases was performed. The keywords were “spinal cord injury, neurogenic bladder, acupuncture” in English and Chinese, respectively. RCTs concerning acupuncture or acupuncture combined with conventional therapy were identified and a Meta-analysis was conducted on Rev Man 5.3 software.
ResultsNine RCTs involving 632 participants were included. In terms of urodynamic changes, compared with the control group, acupuncture was more effective in improving the residual urine volume [mean difference(MD)=-144.26, 95% confidence interval(CI)(-252.15,-36.37), P=0.009] and maximum cystometric capacity [MD=35.69, 95%CI(3.15, 68.22), P=0.03]. However, there were no significant differences between two groups for average daily number of urination [MD=-1.66, 95%CI(-3.40, 0.07), P=0.06]. Concerning total effective rate, acupuncture was more effective than control group [RR=1.24, 95%CI(1.11, 1.37), P < 0.0001].
ConclusionsTo conclude, compared with the conventional therapy, acupuncture is more effective in improving residual urine volume, maximum cystometric capacity and total effective rate for urinary retention in patients with spinal cord injury.

1.1.2. Wang 2016 ☆

Wang J, Zhai Y, Wu J, Zhao S, Zhou J, Liu Z.. Acupuncture for Chronic Urinary Retention due to Spinal Cord Injury: A Systematic Review. Evid Based Complement Alternat Med. 2016;9245186. [173852].

Objectives No systematic review has been published on the use of acupuncture for the treatment of chronic urinary retention (CUR) due to spinal cord injury (SCI). The aim of this review was to assess the effectiveness and safety of acupuncture for CUR due to SCI.
Results Three randomized controlled trials (RCTs) including 334 patients with CUR due to SCI were included. Meta-analysis showed that acupuncture plus rehabilitation training was much better than rehabilitation training alone in decreasing postvoid residual (PVR) urine volume (MD -109.44, 95% CI -156.53 to -62.35). Likewise, a combination of acupuncture and aseptic intermittent catheterization was better than aseptic intermittent catheterization alone in improving response rates (RR 1.23, 95% CI 1.10 to 1.38). No severe adverse events were reported.
Conclusions In conclusion, acupuncture as a complementary therapy may have a potential effect in CUR due to SCI in decreasing PVR and improving bladder voiding. Additionally, acupuncture may be safe in treating CUR caused by SCI. However, due to the lack of high quality RCTs, we could not draw any definitive conclusions. More well-designed RCTs are needed to provide strong evidence.

1.2. Special Acupuncture Techniques

1.2.1. Comparison of acupuncture techniques

1.2.1.1. He 2022

He K, Li X, Qiu B, Jin L, Ma R. Comparative Efficacy of Acupuncture-Related Techniques for Urinary Retention After a Spinal Cord Injury: A Bayesian Network Meta-Analysis. Front Neurol. 2022 Feb 7;12:723424. https://doi.org/10.3389/fneur.2021.723424

Background Urinary retention is one of the most frequent complications of spinal cord injuries (SCI) and negatively impacts patient satisfaction and quality of life. Acupuncture as an integral part of traditional Chinese medicine (TCM) has recently drawn widespread attention for its potential in the management of urinary retention. However, there are many different styles of acupuncture-related techniques, and the optimal choice of acupuncture for urinary retention after SCI is still unclear. Hence, this study uses a Bayesian network meta-analysis (NMA) to compare the efficacy of different types of acupuncture therapies using both direct and indirect evidence.
Methods Randomized controlled trials of acupuncture-related techniques for treating urinary retention after SCI were retrieved from the following electronic databases: Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Service System (SinoMed), the Wan-Fang database, and the Chinese Scientific Journals Database (VIP). The retrieval time was from inception to November 2020. Clinical effective rate (CER) was the primary outcome indicator and residual urine volume (RUV) was the secondary outcome indicator. A Bayesian NMA was performed using the Markov chain Monte Carlo method in R software (version 3.6.1) interfacing with JAGS software (version 4.3.0). The node-splitting method was used to identify inconsistencies. In addition, a comparative adjusted funnel plot was used to assess publication bias.
ResultsA total of 26 randomized controlled trials involving 1,652 patients were included. Bayesian NMA showed that electroacupuncture combined with moxibustion ranks first in both CER and RUV. In addition, in terms of cumulative probability, electro-acupuncture combined with moxibustion ranked first in CER. The results of the node splitting method revealed that direct and indirect evidence were consistent (P > 0.05). In addition, publication bias was detected.
Conclusion A Bayesian NMA that combined direct and indirect comparisons showed that electro-acupuncture combined with moxibustion had a better effect on urinary retention due to SCI. However, it still needs a large sample size and high-quality randomized controlled trials to verify this finding.Systematic Review Registration: https://inplasy.com/, identifier: INPLASY2021110005.