Wang Hao, Lei Xulu
Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, People's Republic of China.
Department of Preventive Care Center, Beijing Fengtai Hospital of Integrated Chinese and Western Medicine, Beijing, People's Republic of China.
Int J Gen Med. 2023 Mar 28;16:1137-1148. doi: 10.2147/IJGM.S406194. eCollection 2023.
Overactive bladder (OAB) syndrome is one of the most common diseases in urology and affects quality of life. Although the current treatment for OAB is based on oral medications, there are limitations and many patients have difficulty accepting drug-induced adverse effects. This review aimed to analyze the efficacy of acupuncture and its related mechanisms and provide a preliminary therapeutic regimen.
Two authors independently searched PubMed, Embase, and Cochrane Library up to April 2022. They searched related English literature and extracted the data under a standard form based on the search strategy. Clinical trials which included OAB women with the treatment of acupuncture were included. Common acupuncture alone without other pharmacotherapy, external treatments was in the treatment group. The control interventions may include any active treatments, sham placebo, or no establishment of a control group. Outcomes included 3-day or 24-hour voiding diary, overactive bladder symptom score, etc. The Cochrane risk of bias tool was also used to assess the methodological quality of the randomized controlled trials (RCTs).
We analyzed five RCTs and one comparative study on acupuncture for OAB to review and discuss the acupoint location, treatment course, and retention time based on clinical evidence and treatment ideas in traditional Chinese medicine. Additionally, we used the available evidence to reveal and discuss the acupuncture mechanisms for OAB. Acupuncture may regulate bladder function by inhibiting C-fibers, modulating nerve growth factors and reducing spontaneous contractions of the detrusor muscle.
Combined with the available evidence, the combination of local acupoints and distal acupoints should be necessary to consider, especially the lumbosacral acupoints, the small abdomen acupoints and the lower limb acupoints. Among them, acupuncture at SP4, CV4 and KI3 are strongly recommended. The treatment course of acupuncture should be no less than 4 weeks and maintain the frequency of acupuncture no less than once a week. The duration of each session should be no less than 20 minutes. In addition, investigations remain necessary to verify acupuncture's efficacy and precise mechanism for OAB treatment in further exploration.
膀胱过度活动症（OAB）综合征是泌尿外科最常见的疾病之一，会影响生活质量。尽管目前OAB的治疗以口服药物为主，但存在局限性，许多患者难以接受药物引起的不良反应。本综述旨在分析针灸的疗效及其相关机制，并提供初步治疗方案。
两位作者独立检索了截至2022年4月的PubMed、Embase和Cochrane图书馆。他们检索了相关英文文献，并根据检索策略以标准表格形式提取数据。纳入了包括接受针灸治疗的OAB女性的临床试验。仅采用普通针刺且无其他药物治疗、外治法的为治疗组。对照干预措施可能包括任何积极治疗、假安慰剂或不设对照组。结局指标包括3天或24小时排尿日记、膀胱过度活动症状评分等。还使用Cochrane偏倚风险工具评估随机对照试验（RCT）的方法学质量。
我们分析了五项关于针灸治疗OAB的RCT和一项比较研究，以基于中医临床证据和治疗思路，回顾和讨论穴位位置、疗程和留针时间。此外，我们利用现有证据揭示和讨论针灸治疗OAB的机制。针灸可能通过抑制C纤维、调节神经生长因子和减少逼尿肌的自发收缩来调节膀胱功能。
结合现有证据，应考虑局部穴位与远端穴位相结合，尤其是腰骶部穴位、小腹部穴位和下肢穴位。其中，强烈推荐针刺三阴交、关元和气海。针灸疗程应不少于4周，且保持针灸频率不少于每周一次。每次针刺持续时间应不少于20分钟。此外，仍有必要进行研究，以在进一步探索中验证针灸治疗OAB的疗效和确切机制。
