Your browser does not support the NLM PubReader view.

Go to this page to see a list of supporting browsers.

Clinical Practice Guideline for acupuncture in Post-stroke urinary retention

Article information

J Korean Med. 2016;37(1):1-9
Publication date (electronic) : 2016 March 31
doi : https://doi.org/10.13048/jkm.16001
Ji-Won Lee1, Eui-Ju Lee2,, Byung-Cheul Shin3, Myeong-Soo Lee4, Sung-Min Lim5, Chung-Sik Cho6, Sang-Kwan Moon7
1Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
2Dept. of Sasang Constitutional Medicine, School of Korean Medicine, Kyung Hee University Korean Medicine Hospital
3Dept. of Rehabilitation Medicine of Korean Medicine, Korean Medicine Hospital, Yangsan, Pusan National University
4Clinical Research Division, Korean Institute of Oriental Medicine
5Department of Clinical Research on Rehabilitation, Korean National Rehabilitation Research Institute
6Dept. of Internal Medicine, College of Korean Medicine, Daejeon University
7Dept. of Korean Internal Medicine, Kyung Hee University Korean Medicine Hospital
Correspondence to: 이의주(Eui-Ju Lee), 서울 동대문구 경희대로 23 경희의료원 한방병원 사상체질과, Tel: +82-2-958-9232, Fax: +82-2-958-9234, E-mail: drsasang@daum.net
Received 2015 November 19; Revised 2016 March 14; Accepted 2016 March 18.

Abstract

Objectives:

Objectives : This study is aimed to develop a Clinical Practice Guideline (CPG) on acupuncture treatment for the patients with Post-stroke Urinary Retention; PSUR.

Methods:

Experts committee, consisting of stroke or methodology specialists, searched Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and 19 Korean medicine journals. The search terms were selected to screen the randomized controlled trials (RCTs) or systematic reviews for the effectiveness of acupuncture on PSUR compared with placebo or conventional group. Levels of evidence and grades of recommendations were appraised based on Recommendations for Development of Clinical Practice Guideline in Korean Medicine.

Results & Conclusions:

4 RCT were included to build the CPG. There was a strong evidence to support the effectiveness of acupuncture treatment for PSUR. The moderate evidence was presented that over 3 times a week of the acupuncture should be performed over 4 weeks on the acupoints, such as SP6, CV3, CV6, CV4, SP9, BL28, BL23, BL22, KI3 or BL67, for 15–30 minutes. 20–140Hz frequency and 10–20 minutes of treatment is suggested if electro-acupuncture treatment is performed with. It was also suggested that the procedure should begin at the acute stage just after the vital signs of the patients are stabilized. Finally, there was a moderate evidence to support safety of acupuncture treatment for PSUR.

Keywords: Acupuncture; Stroke; Urinary dysfunction; Urinary retention; Clinical practice guideline

Quality of Evidence

Grade of Recommendation

Summary of Randomized Controlled Trials of Acupuncture for Urinary Retention after Stroke

References

1. Meng NH, Lo SF, Chou LW, Yang PY, Chang CH, Chou EC. Incomplete bladder emptying in patients with stroke: Is detrusor external sphincter dyssynergia a potential cause? Archives of physical medicine and rehabilitation 2010;91:1105–1109.
2. Park DS, Choi DY, Lee JD, Kim YS, Nam SS, Lee SH. The acupuncture and moxibustion medicine Seoul: Jipmoondang; 2012. p. 479.
3. Kim TG, Chun MH, Chang MC, Yang S. Outcomes of drug-resistant urinary retention in patients in the early stage of stroke. Annals of rehabilitation medicine 2015;39:262–267.
4. Yu KW, Lin CL, Hung CC, Chou EC, Hsieh YL, Li TM, et al. Effects of electroacupuncture on recent stroke inpatients with incomplete bladder emptying: A preliminary study. Clinical interventions in aging 2012;7:469–474.
5. Curtis LA, Dolan TS, Cespedes RD. Acute urinary retention and urinary incontinence. Emergency medicine clinics of North America 2001;19:591–619.
6. Kim Y, Han T, Jung H, Chun M, Lee J, Kim D, et al. Clinical practice guideline for stroke rehabilitation in korea. Brain and NeuroRehabilitation 2009;2:1–38.
7. Lee M, Lee J, Choi T, Choi J, Jeon J. Preferred reporting items for development of clinical practice guideline in korean medicine Elsevier Korea: YJ Lee; 2015.
8. Lee MS. Preferred reporting items for development of clinicla practice guidline in korean medicine(pride-cpg-km) Daejeon: Korea Institute of Oriental Medicine; 2013. p. 118.
9. Chen S, Chen H, Yu S, LW D. Therapeutic effect of warm acupuncture for treating post-stroke urinary retention. Modern Journal of Integrated Traditional Chinese and Western Medicine 2000;9(6):530–531.
10. Gong Y. Treatment of post-stroke uriary retention with scalp acupuncture and ginger-partioned moxibustion. Zhejiang Jornal of Integrated Traditional Chinese and Western Medicine 2003;13(8):511.
11. Wang Z, Yang B. Clinical observation of effect of electro-acupuncture with physical bladder traning for post-stroke urinary retention. Journal of Mordern Urology 2009;14(2):121–122.
12. Zeng C, Zhou E. Clinical efficacy of electroacupuncture combined with bladder training in the treatment of post-stroke neurogenic bladder. Journal of Shandong University of Traditional Chinese Medicine 2012;36(6):513–515.
13. Park BW, Yoon JM, Moon BS. Review of clinical research on acupuncture treatment of voiding difficulty in stroke patients. J. Int. Korean Med 2015;36:153–164.
14. McGee MJ, Grill WM. Selective co-stimulation of pudendal afferents enhances bladder activation and improves voiding efficiency. Neurourology and urodynamics 2014;33:1272–1278.
15. Liu Y, Liu L, Wang X. Electroacupuncture at points baliao and huiyang (bl35) for post-stroke detrusor overactivity. Neural Regen Res 2013;8:1663–1672. doi: 1610.3969/j.issn.1673-5374.2013.1618.1004.
16. Wang H, Deng D, Huang X. Clinical observation of 43 cases of post-stroke urinary incontinence treated by electro-acupuncture and pelvic floor muscle training. Journal of Qilu Nursing 2011;17(12):12–13.
17. Zhang Q, Cui Q, Song B. 50 cases of post-stroke urinary incontinence treated by electro-acupuncture and pelvic floor muscle exercise. Chinese Journal of Traditional Medical Science and Technology 2012;19(1):83–84.
18. Zhu Z. Clinical observation on 39 cases of urinary incontinence after stroke treated by acupuncture. Chinese journal of practical nervous diseases 2012;15(3):75–76.
19. Chu J, Bao Y, Zou C, Zhao H, Gong Y, Wang C. Clinical observation of electric acupuncture in treatment of non - inhibitory neurogenic bladder. Chinese Archives of Traditional Chinese Medicine 2012;30(10):2293–2294.
20. Feng X, Bai J. Clinical observation of electroacupuncture in the treatment of urinary incontinence after stroke. Guangming Journal of Chinese Medicine 2011;26(2):321–322.
21. Wu HM, Tang JL, Lin XP, Lau JTF, Leung PC, Woo J, et al. Acupuncture for stroke rehabilitation. Cochrane Database of Systematic Reviews 2006;:CD004131.
22. Li L, Zhang H, Meng SQ, Qian HZ. An updated meta-analysis of the efficacy and safety of acupuncture treatment for cerebral infarction. PloS one 2014;9:e114057.
23. Shen PF, Kong L, Ni LW, Guo HL, Yang S, Zhang LL, et al. Acupuncture intervention in ischemic stroke: A randomized controlled prospective study. The American journal of Chinese medicine 2012;40:685–693.
24. Huang F, Liu Y, Yao GX, Zhou FX, Wang XY. Clinical observations on treatment of ischemic stroke with acupuncture at back-shu points. Shanghai J Acupunct Moxibust 2008;10:4–7.
25. Schuler MS, Durdak C, Hol NM, Klink A, Hauer KA, Oster P, et al. Acupuncture treatment of geriatric patients with ischemic stroke: A randomized, double-controlled, single-blind study. Journal of the American Geriatrics Society 2005;53:549–550.

Article information Continued

Copyright © 2016 The Society of Korean Medicine all rights reserved

Table 1.

Quality of Evidence

수준 내용
I a 잘 수행된 무작위 대조 임상연구의 메타분석 및 체계적 문헌고찰로부터 얻어진 근거
I b 적어도 하나의 무작위 대조 임상연구로부터 얻어진 근거
II a 무작위 없이 적어도 하나의 잘 디자인된 대조군 연구 및 코호트 연구로부터 얻어진 근거
II b 적어도 하나의 잘 디자인된 관찰연구로부터 얻어진 근거
III 역사적 중요 문헌에 게재된 치료법으로 전문가 합의에 의한 근거
IV 연속증례연구 등 그 외의 연구로부터 얻어진 근거
V 전문가의 의견 또는 임상경험 전문가로부터 얻어진 근거

Table 2.

Grade of Recommendation

등급 내용 근거수준
A 매우권고 적어도 한 개 이상의 무작위 대조 임상연구 또는 메타분석에 의한 근거가 있는 경우 매우 권고함 I a, I b
B 권고 무작위 대조 임상연구가 아니라도 잘 수행된 연구디자인에 의한 근거이거나 역사적으로 중요 문헌에 의한 것이면 권고함. II a, II b, III
C 선택적권고 근거 자료가 부족하더라도 전문가 합의가 있을 경우 선택적으로 권고함 IV, V
GPP 임상진료지침 개발그룹의 임상적 경험에 근거하였을 경우 권고함

Table 3.

Summary of Randomized Controlled Trials of Acupuncture for Urinary Retention after Stroke

Author (year) Country Sample Size (Analyzed) Intervention Group Control Group
N (Analyzed) Range of age (Mean±SD) Types of treatment N (Analyzed) Range of age (Mean±SD) Types of treatment
Chen et al. (2000) China 64 (64) 39 (39) 55∼78 (63±NR) WA + PT 25 (25) 46∼72 (61.5±NR) PT
Gong et al. (2003) China 60 (60) 30 (30) 55∼70 (NR) NSR SA + Ginger-salt-indirect moxibustion 30 (30) 55∼70 (NR) NSR Ginger-salt-indirect moxibustion
Wang et al. (2009) China 142 (142) 74 (74) 39∼72 (55.6±8.4) NSR EA + PT 68 (68) 39∼72 (55.6±8.4) NSR PT
Zeng et al. (2012) China 60 (60) 30 (30) 50∼80 (67.66±6.78) EA + PT 30 (30) 50∼80 (69.38±5.38) PT

AT(acupuncture therapy); CT(conventional therapy); EA(electro-acupuncture); FFVB(the first filling volume of bladder); MA(manual acupuncture); MUFR(maximum urine flow rate); MVBC(maximum volume of bladder capacity); NR(not reported); NSR(not separately reported by the group); PT(physical therapy); RUV(residual urine volume); SA(scalp acupuncture); UDT(urodynamic testing); WA(warm therapy)