Clinical practice guideline for acupuncture and moxibustion: Female urinary incontinence

Urinary incontinence (UI) is a common problem worldwide.It has a major impact on physical and social activities and interpersonal relationships.UI is common in women,but is under-reported and undertreated.It affects the quality of life of female patients severely.Acupuncture and moxibustion have been proposed as potentially effective interventions for female UI.Hence,for the benefit of acupuncture practitioners around the world,the World Federation of Acupuncture-moxibustion Societies initiated a project to develop a clinical practice guideline (CPG) for the use of acupuncture and moxibustion to treat female UI.This CPG was developed according to the Grading of Recommendations Assessment,Development,and Evaluation (GRADE) methodology,referring to the principles of the World Health Organization Handbook for Guideline Development.During the development of the CPG,the guideline development group (GDG) played an important role.The clinical questions,recommendations and therapeutic protocols were all formulated by GDG using the modified Delphi method.This CPG contains ten recommendations about the use of acupuncture and moxibustion interventions for ten clinical questions,which include nine conditional recommendations for the intervention and one conditional recommendation for either the intervention or the comparison.This CPG also provides one protocol for conventional filiform needle therapy,two therapy protocols for deep needling stimulation on lumbosacral acupoints,and four moxibustion therapy protocols,based on the protocols presented in randomized controlled trials reviewed by the GDG.

Small Extracellular Vesicles Secreted by Peri-urethral Tissues Regulate Fibroblast Function and Contribute to the Pathogenesis of Female Stress Urinary Incontinence

Objective:This study aimed to explore the existence of small extracellular vesicles(sEVs)in peri-urethral tissues and the role of abnormal expression of sEVs in the pathogenesis of female stress urinary incontinence(SUI).Methods:sEVs were extracted from peri-urethral vaginal wall tissues using differential centrifugation and were observed by transmission electron microscopy(TEM).The number of sEVs and their protein contents were compared between SUI and control groups using nanoparticle tracking analysis(NTA)and bicinchoninic acid(BCA)protein assay.Fibroblasts were cultured separately with SUI(SsEVs group)and normal tissue sEVs(NsEVs group).Proliferation and migration of fibroblasts were compared between groups using CCK-8 and wound healing assays,respectively.Expression levels of collagenⅠandⅢwere compared among blank control(BC),NsEVs,and SsEVs groups using real-time PCR.Protein mass spectrometry was used to test the differentially expressed proteins contained in sEVs between groups.Results:sEVs were extracted and found under the electron microscope.There were significantly more sEVs extracted from the SUI group compared to the normal group.Fibroblasts showed increased proliferative and decreased migratory abilities,and expressed more collagen in the SsEVs group compared to the NsEVs and BC groups.Protein spectrum analysis demonstrated several differentially expressed targets,including components of microfibrils,elastin polymer,and anti-inflammatory factors.Conclusion:sEVs were detected in the peri-urethral tissues.SUI tissues expressed more sEVs than control.The abnormal expression of sEVs and their protein contents may contribute to the pathogenesis and progression of SUI.

Clinical value of needleless sling in treatment of female stress urinary incontinence

BACKGROUND Stress urinary incontinence(SUI)is a common disease in women.The emergence of the needle-free sling has led to a new clinical treatment for SUI in women.AIM To explore the clinical value of the needleless sling without acupuncture in the treatment of SUI in women.METHODS From February 2017 to November 2018,according to the order of admission,44 patients(mid-suspension group)were treated by tension-free transobturator urethral suspension,and 44 patients(non-acupuncture group)were treated with a needleless non-acupuncture band.The clinical effects of the two treatments were evaluated.RESULTS There was no significant difference between the two groups in the total clinical effectiveness rate(P=0.374),but intraoperative blood loss and visual analogue scale score at postoperative day 1 were significantly lower in the non-acupuncture suspension group than in the middle urethral suspension group(P=0.396).The incidence of complications in the needle-free sling group was significantly lower than that in the middle urethral suspension group(P=0.025).CONCLUSION The clinical effectiveness of acupuncture-free suspension in treating SUI in female patients is better than that of traditional tension-free transobturator mid-urethral suspension.

艾灸治疗女性尿失禁的系统评价与meta分析

Background:Urinary incontinence(Ul)is a common condition that bothers women's lives,including stress urinary incontinence(SUI),urgency urinary incontinence(UUI)and mixed urinary incontinence(MuI).The current non-surgical treatment of Western medicine includes pelvic floor muscle training(PFMT),medication,electric stimulation,etc.,all of which have varied limitations.For instance,the patients are poor in compliance with PFMT and medication results in frequent adverse effects.Being one of the featured treatments of TCM,moxibustion has several merits including safety,low cost and simple operation.In recent years,the clinical evidences prove increasingly that moxibustion may be effective for women with Ul.However,there is no high-quality systematic review of moxibustion for this disease.Objective:To evaluate the effect and safety of moxibustion on UI(including SUI,UUI and MUI)among women.Methods:From the inception to October 13,2022,the data of the randomized controlled trials(RCTs)of moxibustion on UI among women were collected from CNKI,WanFang Data,VIP,SinoMed,Web of Science,Pubmed,EMBASE and Cochrane Library databases.Two investigators screened the articles independently and extracted the data according to the inclusion and exclusion criteria developed in advance.Using the risk of bias assessment tool of Cochrane Handbook,the included RCTs were evaluated.With RevMan 5.3 software,meta-analysis was performed,and the GRADE tool was adopted to assess evidence certainty of different outcomes.Results:A total of 1176 articles were retrieved and 19 of them with 1397 patients were eligible and included in the review.In experimental groups,moxibustion combined with PFMT was used,while in control groups PFMT was applied alone.And the subjects were all women with SUI.Meta-analysis showed that compared with PFMT alone,moxibustion combined with PFMT reduced the urine leakage volume(1-hour pad test)(MD=-1.95,95%CI[-2.32,-1.57],P<0.001),the frequency of Ul in 24-hour(MD=-0.64,95%CI[-0.88,-0.40],P<0.001)and the score of the short form of International Consultation on Incontinence Questionnaire(ICIQ-SF)of women with SUI(MD=-2.53,95%CI[-3.43,-1.63],P<0.001);and this combined intervention measure did not increase significantly the adverse events(RR=0.82,95%CI[0.15,4.6],P=0.82).GRADE assessment showed that the UI frequency in 24-hour and the incidence of adverse events were rated as low quality,the urine leakage volume of 1-hour pad test and ICIQ-SF score were very low quality.Conclusion:Compared with PFMT alone,the intervention combined with moxibustion greatly reduced the urine leakage volume and UI frequency and improved the quality of life(QoL)among women with SUI with favorable safety.Moxibustion could be effective supplementary therapy on sUI among women.However,due to the high risk of bias of the included trials and low certainty of evidence,more highquality clinical studies are needed to verify the above findings.