Rédacteurs : Johan Nguyen, Henri Truong

Urinary Incontinence

Incontinence urinaire : évaluation 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. Yang 2021

Yang N, Ge X, Ye J, Liu Q, Wu Y, Yan H, Han X. Efficacy of acupuncture for urinary incontinence in middle-aged and elderly women: A systematic review and meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2021;257:138-43. [190854]. doi

Objectives Our aim was to generalize the available evidence and evaluate the effectiveness of acupuncture for urinary incontinence in middle-aged and elderly women.
Methods Six databases including VIP, CNKI, Wan Fang, Web of Science, PubMed and The Cochrane Library were systematically searched to retrieve similar studies updated to December 2019 to gather RCTs regarding the effectiveness of acupuncture for middle-aged and elderly women with urinary incontinence. Two researchers independently performed the whole process of retrieving the studies, extracting the data and assessing the risk of bias of the included studies. The current meta-analysis was performed using RevMan 5.3 software.
Results A total of eight studies with 607 patients were included in the evaluation. The current meta-analysis showed that Compared with rehabilitation exercise or medication, acupuncture intervention significantly improved the clinical effectiveness (OR = 5.52, 95 % CI, 3.13-9.73), reduced the urine leakage in pad test (SMD = -2.67, 95 % CI, -4.05 to -1.29) and decrease the ICIQ-SF score (MD = -3.46, 95 % CI, -3.69 to -3.22). The results indicated that acupuncture intervention can help the patients alleviate the symptoms effectively.
ConclusionBased on this study, acupuncture intervention of stress urinary incontinence in middle-aged and elderly women can improve the clinical effectiveness, reduce the urine leakage in pad test and ICIQ-SF score. More high-quality studies with large sample size are required for further verification.

1.1.2. Zhang 2016 (stress urinary incontinence) ☆☆

Zhang Yan, Xie Jiangping. [A Meta-analysis of treating female stress urinary incontinence by acupuncture]. Clinical Journal of Chinese Medicine. 2016;8(22):16-20. [201954].

Objective To assess clinical efficacy of acupuncture on female stress urinary incontinence.
MethodsRandomized controlled trials on treating female stress urinary incontinence by acupuncture were found in Pubmed, CNKI, Wanfang database and VIP database. According to RCT quality evaluation of modified Jadad scale evaluation criterion, selected literatures were evaluated with Rev Man 5.2 statistics software; and the Meta-analysis was performed. Clinical efficacy and safety of acupuncture on female stress urinary incontinence were assessed.
Results10 papers(785 patients) were included. The results of the Meta-analysis showed that differences of clinical efficacy of acupuncture on female stress urinary incontinence between groups were significant; and acupuncture could reduce VAS score, without significant meaning to improve ICIQ-SF score.
ConclusionAcupuncture on female stress urinary incontinence showed obvious effects, but the result should be verified farther by strict, multi-center and large sample, and high-quality randomized double-blind placebo-controlled trials with enough followed-up time to further validated.

1.1.3. Wang 2014 (stress urinary incontinence) ☆

Wang Lei ,Fu Li - Xin , Zhu Yuan , et al. [Systematic review of domestic literature of therapeutic effect of acupuncture on stress urinary incontinence]. Journal of Clinical Acupuncture and Moxibustion. 2014;30(9):64. [173471].

Objective To evaluate the therapeutic effect of acupuncture in the treatment of stress urinary incontinence in China.
Methods Retrieve related papers from CNKI, WANFANG, vIP database by computer, from conference papers and magazines like “Chinese acupuncture” by hand. The retrieval time ended in November 2013, and two independent eva1uator extracted data from obtained all random and ha1f randomized controlled trials for the treatment of stress urinary incontinence by acupuncture, and assess the methodology. RevMan5. 0 software was used to do Meta ana1ysis and security number analysis and funnel chart ana1ysis publication bias.
ResultsA total of 10 trials involving 669 patients. Meta - analysis showed that the total effective rate in the treatment group was better than that in the control group: acupuncture versus placebo ( OR = 3. 05, 95 % CI [1. 59, 5. 84]), acupuncture versus medicine ( OR = 9. 14, 95% CI[4. 77, 17. 53]), acupuncture versus pelvic muscle exercice ( OR = 4. 00, 95 % CI [ 2. 5 1, 6. 39]). Fail - safe number analysis showed that the evaluation results were stable. Funnel figure graphics were around the basic symmetry, and the publication bias was not big.
Conclusion Acupuncture in the treatment of stress urinary incontinence is effective, and superior to western medicine and pelvic muscle exercise. However, more high - quality randomized double - blind controlled trials are needed to confirm the curative effect of acupuncture in the treatment of stress urinary incontinence.

1.1.4. Paik 2013

Paik SH, Han SR, Kwon OJ, Ahn Ym, Lee Bc, Ahn Sy. Acupuncture for the treatment of urinary incontinence: a review of randomized controlled trials. Exp Ther Med. 2013;6(3):773-780. 160279.

Objective The aim of this study was to examine the effects of acupuncture on urinary incontinence and to discuss why these acupoints were selected.
Methods Seven databases were searched for any randomized controlled trials (RCTs) that investigated the use of acupuncture or acupressure as a treatment for urinary incontinence, and the Cochrane risk of bias tool was utilized to evaluate the risk of bias in each study. Four RCTs met all the inclusion criteria.
Results The results from the selected RCTs failed to demonstrate any statistically significant improvements in urinary incontinence, although acupuncture or acupressure did exhibit favorable effects on overactive bladder symptoms and quality of life, in comparison with other conventional therapies.
Conclusion There have been limited results supporting acupuncture or acupressure as an effective treatment method for urinary incontinence; therefore, further RCTs are required to confirm the effectiveness of acupuncture or acupressure in the treatment of urinary incontinence.

1.1.5. Wang 2013 (stress urinary incontinence) Ø

Wang Y, Zhishun L, Peng W, Zhao J, Liu B. Acupuncture for stress urinary incontinence in adults. Cochrane Database Syst Rev. 2013. [160667].

BackgroundThe use of acupuncture for stress urinary incontinence is increasing in frequency, especially in Asian area. However, its effectiveness and side effects have not been evaluated.
Objectives To assess the effectiveness and side effects of acupuncture for stress urinary incontinence in adults. Search methods: We searched the Cochrane Incontinence Group Specialised Register (searched 28 January 2013), EMBASE, AMED, Chinese Biomedical Literature Database (CBM), Chinese Acupuncture Trials Register and China National Knowledge Infrastructure (CNKI) (all searched 20 February 2013). In addition, we searched the reference lists of relevant articles and contacted authors and trialists in the field.
Methods Selection criteria: Randomised and quasi-randomised controlled trials of acupuncture interventions without other treatments for the management of stress urinary incontinence for adults. Data collection and analysis: Two review authors independently assessed eligibility, trial quality and extracted data. We meta-analysed data where appropriate.
Main results We identified 17 possibly eligible studies but only one small trial with 60 women met our inclusion criteria. The trial compared acupuncture versus midodrine, a drug for treating hypotension. The risk of bias was high as there was no concealment of randomised allocation, and there was no blinding of assessment of outcome. In addition, it was not possible to blind participants or health providers to the interventions. The statistical methods were not described.More women improved in the acupuncture group (73% with acupuncture versus 33% with midodrine; risk ratio (RR) 2.20, 95% confidence interval (CI) 1.27 to 3.81) but the cure rates were low and not statistically significantly different (13% versus 7%; RR 2.00, 95% CI 0.40 to 10.11). There were adverse events in the drug group only.
Authors' conclusionsThe effect of acupuncture for stress urinary incontinence for adults is uncertain. There is not enough evidence to determine whether acupuncture is more effective than drug treatment.

1.2. Special Clinical Forms

1.2.1. Incontinence urinaire post-AVC

1.3. Special Acupuncture Techniques

1.3.1. Electroacupuncture

1.3.1.1. Lai 2020

Lai X, Zhang J, Chen J, Lai C, Huang C. Is electroacupuncture safe and effective for treatment of stress urinary incontinence in women? A systematic review and meta-analysis. J Int Med Res. 2020;48(10). [212794]. doi

Objective Stress urinary incontinence (SUI) is prevalent worldwide, particularly among elderly women. Although electroacupuncture (EA) has been accepted by many patients and physicians in Asia, its efficacy for SUI has not been evaluated scientifically and systematically. We aimed to conduct a systematic evaluation of the efficacy and safety of EA treatment for women with SUI.
Methods We retrieved publications up to February 2019 from seven databases. Randomized controlled trials for women with SUI treated by EA were included. Therapeutic effect, 1-hour urine leakage and International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) scores were the primary outcomes. The Cochrane Collection's RevMan 5.3 software was used to pool data.
ResultsThe 15 included articles demonstrated that EA for SUI was effective (odds ratio [OR], confidence interval [CI] = 5.64, 4.19-7.59; Ι2 = 22%). ICIQ-SF scores increased (standard mean difference, CI = -0.48, -0.62 to -0.33; Ι2 = 32%) and 1-hour urine leakage decreased (OR, CI = -4.14, -4.96 to -3.33; Ι2 = 78%) in patients undergoing EA compared with those receiving sham EA, physical exercise or medication.
Conclusion EA for women with SUI exhibited significant efficacy and safety for key outcomes.
1.3.1.2. Park 2017

Park Eo-Jin, Jo Hyun-Jeong, Jo Hee-Guen. [A Review of Research on Electroacupuncture for Female Stress Urinary Incontinence], J Korean Obstet Gynecol. 2017;30(4):149-74. [196145].

Objectives The aim of this study is to establish a base for further research by reviewing studies on electroacupuncture (EA) for stress urinary incontinence (SUI).
MethodsClinical studies concerning the effects of EA for SUI, were obtained from Cochrane Library, PubMed, CNKI, RISS, NDSL, KISS and OASIS.
ResultsForty-five studies met the criteria, which included 33 RCTs, 1 pilot RCT, 4 non-randomized Clinical Trials, 6 Case studies and 1 Orthogonal design study with 3638 patients. There was only one article published in Korea. In these study, the most common primary outcome measurement was the pad test. Most of the studies showed the group treated by EA effects compared to the control group. Also, many interventions that combined with EA were found and all complex therapy group had significantly better than control group. 7 studies observed adverse events (AEs), four of which referred to EA related AEs among them. And 4 studies reported no AEs associated with EA.
Conclusions Despite several limitations, various studies to prove limited yet effective EA on SUI provides much significance. Subsequent studies conducted by the complementary systematic review of the studies and well-designed clinical trials using the methodological quality will be needed to more firmly validate the therapeutic effect of EA on SUI.

2. Overviews of Systematic Reviews

2.1. Kilpatrick 2020

Kilpatrick KA, Paton P, Subbarayan S, Stewart C, Abraha I, Cruz-Jentoft AJ, O'Mahony D, Cherubini A, Soiza RL. Non-pharmacological, non-surgical interventions for urinary incontinence in older persons: A systematic review of systematic reviews. The SENATOR project ONTOP series. Maturitas. 2020;133:42-48. [204791]. DOI

Background Urinary incontinence is especially common in older age. Non-pharmacological therapies are particularly desirable in this group. OBJECTIVE: To define optimal evidence-based non-pharmacological, non-surgical therapies for urinary incontinence in older persons.
Methods A Delphi process determined critical outcome measures of interest. Studies of any non-pharmacological intervention reporting critical outcomes were identified through database searches for relevant systematic reviews in Medline, Embase, CINAHL, PsycInfo and Cochrane up to June 2018. Primary trials with a population mean age ≥65years were identified, from which data were extracted and risk of bias was assessed. Qualitative analysis and meta-analysis, when possible, were undertaken, followed by grading of the evidence using GradePro software. Finally, bullet-point recommendations were formulated for the indications and contraindications for non-pharmacological interventions for urinary incontinence in older persons.
Results Frequency of incontinence was identified as a critically important outcome. In total, 33 systematic reviews were identified with 27 primary trials meeting inclusion criteria. Evaluated therapies included exercise therapy, habit retraining, behavioural therapy, electrical stimulation, transcutaneous tibial nerve stimulation, magnetic stimulation, caffeine reduction and acupuncture. From meta-analysis, group exercise therapy and behavioural therapy in women were beneficial in reducing episodes of incontinence (mean reduction of 1.07 (95 %CI 0.69-1.45) and 0.74 (95 %CI 0.42-1.06) episodes per day respectively, evidence grade 'moderate'). Evidence for other interventions was limited and of insufficient quality.
Conclusions There is sufficient evidence to warrant recommendation of group exercise therapy for stress incontinence and behavioural therapy for urgency, stress or mixed urinary incontinence in older women. Evidence was insufficient to recommend any other non-drug therapy.
Acupuncture 1 study

3. Clinical Practice Guidelines

⊕ positive recommendation (regardless of the level of evidence reported)
Ø negative recommendation, (or lack of evidence)

3.1. Agency for Healthcare Research and Quality (AHRQ, USA) 2018 ⊕

Balk E, Adam GP, Kimmel H, Rofeberg V, Saeed I, Jeppson P, Trikalinos T. Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update, Comparative Effectiveness Review No. 212. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ publication). 2018. 643p. [196362].

Neuromodulation: Electroacupuncture, InterStim™, magnetic stimulation, TENS.
Stress UI: Neuromodulation is more effective than no treatment for cure, improvement, and satisfaction (risk of biais: low, Consistency: consistent , Precision: precise, Directness: direct; Overall SoE: High).
Urgency UI: BTX and neuromodulation more effective than no therapy for cure, improvement, and satisfaction (risk of biais: low, Consistency: consistent , Precision: precise, Directness: direct; Overall SoE: High); (moderate or low SoE for improvement or satisfaction due to sparseness, indirectness, and nonsignificance).
Mixed UI: Neuromodulation has sparse evidence of greater UI improvement compared with no treatment. Consistent with overall network meta-analysis (risk of biais: low, Consistency: consistent , Precision: imprecise, Directness: direct; Overall SoE: low),
Quality of life: Neuromodulation better than sham interventions (risk of biais: low, Consistency: consistent , Precision: precise, Directness: direct; Overall SoE: low).

3.2. Agency for Healthcare Research and Quality (AHRQ, USA) 2014 Ø

Shamliyan T, Wyman J, Kane RL. Nonsurgical Treatments for Urinary Incontinence in Adult Women: Diagnosis and Comparative Effectiveness (comparative Effectiveness Review no. 36.). Rockville, MD: Agency for Healthcare Research and Quality, AHRQ publication no. 11. 2014. [202251].. URL

Evidence was insufficient to conclude improvement in UI after acupuncture. Low evidence suggested possible improvement in quality of life after active acupuncture.

3.3. American College of Physicians (ACP, USA) 2014 Ø

Qaseem A, Dallas P, Forciea MA, Starkey M, Denberg TD, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(6):429-40. [198260].

Other Treatments. Evidence was insufficient to determine the effectiveness of behavioral modification programs, a soy-enriched diet, or acupuncture for improving UI in women with mixed UI.

4. Randomized Controlled Trials

4.1. Sources

  1. Acudoc2: Base de données du Centre de documentation du GERA. ECR non inclus dans les autres sources.
  2. AHRQ 2018: Balk E, Adam GP, Kimmel H, Rofeberg V, Saeed I, Jeppson P, Trikalinos T. Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update, Comparative Effectiveness Review No. 212. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ publication). 2018. 643p. [196362].
  3. Park 2017: Park Eo-Jin, Jo Hyun-Jeong, Jo Hee-Guen. [A Review of Research on Electroacupuncture for Female Stress Urinary Incontinence], J Korean Obstet Gynecol. 2017;30(4):149-74. [196145].
  4. Zhang 2016: Zhang Yan, Xie Jiangping. [A Meta-analysis of treating female stress urinary incontinence by acupuncture]. Clinical Journal of Chinese Medicine. 2016;8(22):16-20. [201954]
  5. AHRQ 2014: Shamliyan T, Wyman J, Kane RL. Nonsurgical Treatments for Urinary Incontinence in Adult Women: Diagnosis and Comparative Effectiveness (comparative Effectiveness Review no. 36.). Rockville, MD: Agency for Healthcare Research and Quality, AHRQ publication no. 11. 2014. [202251].
  6. Paik 2013: Paik SH, Han SR, Kwon OJ, Ahn Ym, Lee Bc, Ahn Sy. Acupuncture for the treatment of urinary incontinence: a review of randomized controlled trials. Exp Ther Med. 2013;6(3):773-780. 160279.
  7. Wang 2014: Wang Lei ,Fu Li - Xin , Zhu Yuan , et al. [Systematic review of domestic literature of therapeutic effect of acupuncture on stress urinary incontinence]. Journal of Clinical Acupuncture and Moxibustion. 2014;30(9):64. [173471].
  8. Wang 2013: Wang Y, Zhishun L, Peng W, Zhao J, Liu B. Acupuncture for stress urinary incontinence in adults. Cochrane Database Syst Rev. 2013. [160667].

4.2. List

2019 Liu B, Liu Y, Qin Z, Zhou K, Xu H, He L, Li N, Su T, Sun J, Yue Z, Zang Z, Zhang W, Zhao J, Zhou Z, Liu L, Wu D, Wu J, Zhou J, Pang R, Wang Y, Liu J, Yu J, Liu Z. Electroacupuncture Versus Pelvic Floor Muscle Training Plus Solifenacin for Women With Mixed Urinary Incontinence: A Randomized Noninferiority Trial. Mayo Clin Proc. 2019;94(1):54-65. [198021]
- Sun Y, Liu Y, Liu S, Wang W, Liu Z. Electroacupuncture for women with urgency-predominant mixed urinary incontinence: secondary analysis of a randomized noninferiority trial. World J Urol. 2019. [202621].
- Wang W, Liu Y, Su T, Sun Y, Liu Z. Comparing the effect of electroacupuncture treatment on obese and non-obese women with stress urinary incontinence or stress-predominant mixed urinary incontinence: A secondary analysis of two randomised controlled trials. Int J Clin Pract. 2019.e13435. [202734].
Acudoc2
Wang LL, Ren ZX, Zhu JY, Zhang HL, Wu YR. [Efficacy of electroacupuncture combined with penetrating moxibustion for postpartum stress urinary incontinence]. Chinese Acupuncture and Moxibustion. 2019;39(6):599-603. [201207]. Acudoc2
2017 Chen Zhuo-wei, Wang Dun-jian, Yuan Ai-qin. [Therapeutic Observation of Acupuncture at Jiaji (EX-B 2) Points plus Pelvic Floor Muscle Exercises for Postpartum Stress Urinary Incontinence] Shanghai Journal of Acupuncture and Moxibustion. 2017;36(3):308-311. [178046]. Acudoc2
Hou Wen-Guang, Ming Shu-Ren, Tang Kang-Min, Shen Rui, Chen Yue-Lai. [Preventive and Therapeutic Effects of Electroacupuncture in Treating Mild-moderate Female Stress Urinary Incontinence]. Shanghai Journal of Acupuncture and Moxibustion. 2017;36(8): 956-959. [112431]. Park 2017
Lin Ling. [20 cases of female stress incontinence treated by moxibustion Yongquan combined with electroacupuncture]. Fujian Journal of TCM. 2017;48(3):66. [203288]. Park 2017
Liu Z, Liu Y, Xu H, He L, Chen Y, Fu L, Li N, Lu Y, Su T, Sun J. Effect of Electroacupuncture on Urinary Leakage Among Women With Stress Urinary Incontinence: A Randomized Clinical Trial. JAMA. 2017;317(24):2493-250. [195729
Wang W, Liu Y, Sun S, Liu B, Su T, Zhou J, Liu Z. Electroacupuncture for postmenopausal women with stress urinary incontinence: secondary analysis of a randomized controlled trial. World J Uro. 2019;37(7):1421-1427. [202731].
- Jiao R, Liu Y, Liu B, Liu Z. Risk factors related to acupuncture response in postmenopausal women with stress urinary incontinence: Secondary analysis of a randomized controlled trial. Medicine (Baltimore). 2019;98(16). [197324]
- Wang W, Liu Y, Su T, Sun Y, Liu Z. Comparing the effect of electroacupuncture treatment on obese and non-obese women with stress urinary incontinence or stress-predominant mixed urinary incontinence: A secondary analysis of two randomised controlled trials. Int J Clin Pract. 2019.e13435. [202734].
AHRQ 2018, Park 2017
Wang Qiong, Xue Yu-ting, Tang Jian, Cao Zheng-liang, Zhang Wei. [RCTs of Electro-acupuncture in the Treatment of Moderate or Severe Female Mixed Urinary Incontinence]. Journal of Clinical Acupuncture and Moxibustion. 2017;33(10): 27-30. [100814]. Acudoc2
Yu Chunxiao, Zhang Donglei, Chen Chaoming. [Treatment of Female Stress Urinary Incontinence by Electroacupuncture Combined with Pelvic Floor Muscle Training: A Clinical Observation of 38 Cases]. Jiangsu Journal of TCM. 2017;6:51-3. [202603]. Park 2017
2016 Chen Y, He E, Tian H, Zhao J. [Impact of electroacupuncture on the life quality in patients of female mixed urinary incontinence]. Chinese Acupuncture and Moxibustion. 2016;36(3):256-8. [191798]. Acudoc2
Cui Xiu-Min, Zhao Jie-Jing, He Xiang-Cheng, Wen Chun-guang. [Acupuncture and Aconite Moxibustion in the Treatment of Senile Female Urinary Incontinence]. Journal of Clinical Acupuncture and Moxibustion. 2016;32(5):11-14. [184308]. Acudoc2, Exclu AHRQ 2018 ( No primary data or no usable results )
He E, Chen Y, Tian H, Zhao J. [Effective observation of electroacupuncture with different courses for female stress urinary incontinence]. Chinese Acupuncture and Moxibustion. 2016;36(4):351-4. [186693]. Park 2017
Hong Ling-Jun, Zhao Jin. [Clinical observation of electro-acupuncture on pudendal nerve stimulation therapy in stress urinary incontinence patients]. China Journal of TCM and Pharmacy. 2016;31(7):2857-6. [202749]. Park 2017
Liu Xiang-rong, Zang Zhi-wei, Li Xiao-ling, Ma Jing-hua. [Efficacy Observation of Electro-acupuncturing at Zhongliao( BL33)and Huiyang( BL3S) on Female Stress Urinary Incontinence]. Chinese Journal of Basic Medicine in TCM. 2016;22(7):955. [193956]. Park 2017
Solberg M, Alræk T, Mdala I, Klovning A. A pilot study on the use of acupuncture or pelvic floor muscle training for mixed urinary incontinence. Acupuncture in Medicine. 2016;34(1):7-13. [188201]. AHRQ 2018,
Tang Kang-min, Shen Rui, Jiang Fan, Wang Qian, Xie Xu-bin, Chen Yue-lai. [Therapeutic Evaluation of Acupuncture for Female Stress Urinary Incontinence]. Shanghai Journal of Acupuncture and Moxibustion. 2016;35(12):1439-144. [191555]. Park 2017
Tao L, Lu J, Leng W. [Orthogonal Design Study on the Best Indications of Electric Acupuncture for Female Stress Urinary Incontinence]. Journal of TCM (Zhongyi Zazhi). 2016;57(10):843-6. [202619]. Park 2017
Wang S, Lv J, Feng X, Wang G, Lv T. Efficacy of Electrical Pudendal Nerve Stimulation in Treating Female Stress Incontinence. Urology. 2016;91:64-9. [202174]. Park 2017
Wang Wei, Jiang Yi-ming, Wang Rong, Xiao Jin-long. [Observations on the Therapeutic Effect of Electroacupuncture on Mild and Moderate Female Stress Incontinence]. Shanghai Journal of Acupuncture and Moxibustion. 2016;35(1): 47-49. [191488]. Park 2017
Xu H, Liu B, Wu J, et al. A Pilot Randomized Placebo Controlled Trial of Electroacupuncture for Women with Pure Stress Urinary Incontinence. PLoS One. 2016;11(3):e0150821. [202640] AHRQ 2018, Park 2017
2015 Chen Yuan-Xiao, Ma Rui-Jie. [Clinical Observation of Electroacupuncture at Huiyang (BL35) and Zhongliao (BL33) plus Scalp Acupuncture for Female Stress Urinary Incontinence]. Shanghai Journal of Acupuncture and Moxibustion. 2015;34(12):1159. [187521]. Park 2017, Zhang 2016
Cui Yan. [Observation on the effect of electroacupuncture combined with Jinkui Shenqi Pills on female stress urinary incontinence]. Guangxi Journal of TCM. 2015;38(1):43-4. [195724]. Park 2017, Zhang 2016
Hong Ling-Jun, Zhao Jin, Zheng Guo-Hong. [Clinical Study on Electro - acupuncture for the Treatment of Mixed Urinary Incontinence] Journal of Clinical Acupuncture and Moxibustion. 2015;31(11):1. [187705]. Acudoc2
Lian A, Zhang W, Wang S. [Mild and moderate female stress urinary incontinence treated with transcutaneous acupoint electrical stimulation: a randomized controlled trial]. Chinese Acupuncture and Moxibustion. 2015;35(4):327-9. [182656]. Acudoc2 AHRQ 2018
Liu Jie, Yang Shaoqin, Shi Ying. [Curative effect observation of needle warming moxibustion Ba Liao point combined with pelvic floor muscle exercise in the treatment of female stress urinary incontinence], Chinese Community Doctors. 2015;31(8):83-4. [168695]. Zhang 2016
Rong Qun, Zhong Shan. [The Quality of Life Effects Acupuncture Treatment for the Female Pelvic Floor Dysfunction]. Chinese Journal of Ethnomedicine and Ethnopharmacy. 2015;24(21):92-3. [183859]. Zhang 2016
Wen Qi. [Electroacupuncture combined with Chinese moxibustion and functional training in treatment of female stress urinary incontinence]. Acta Medicinae Sinica. 2015;28(1):44-6. [201937]. Park 2017
Zheng Hui-min, Xu Shi-fen, Yin Ping, Tang Kang-min, Chen Yue-lai. [Observation on Short-term and Long-term Therapeutic Effects of Electro-acupuncture on Mild and Moderate Stress Urinary Incontinence], World Journal of Integrated Traditional and Western Medicine. 2015;10(2):191-3. [194938]. Park 2017, Zhang 2016
2014 Bao Jian. [Clinical Efficacy and Mechanism of Electroacupuncture Pudendal Nerve Stimulation in the Treatment of Female Stress Urinary Incontinence]. China Foreign Medical Treatment. 2014;33:4-5. [201866]. Park 2017
Chen Shen - Xu, Zhang Fu - Ging, Wang Si - You. [Clinical observation of electrical pudendal nerve stimulation for female stress urinary incontinence]. Journal of Clinical Acupuncture and Moxibustion. 2014;30(3):5. [170061]. Acudoc2
Shi Xiao-lan, Yang Shuai, Wang Yuan-hui, Zhang Guo-qing. [Clinical research of modified acupuncture for the treatment of female stress urinary incontinence perimenopausal]. Shanghai Journal of TCM. 2014;48(10):67-8;73. [201865]. Park 2017
Ting-Ting, Wang Si-Ou. [Comparative study of the efficacies of different operators-performed electroacupuncture pudendal nerve stimulation in treating female stress incontinence]. Shanghai Journal of Acupuncture and Moxibustion. 2014;33(3):231. [184587]. Park 2017
Xu Guojie, Zhao Zuo, Huang Dianzuo, Wang Ling, Jiang Lifang. [Clinical Observation of 20 cases on Deep Electroacupuncture at Baliao Point Combined with Pelvic Floor Muscle Training for Female Stress Urinary Incontinence]. Zhejiang Journal of TCM. 2014;49(8):605-6. [201859]. Park 2017
Xu Guojie , Xiao Shaoqing , Yao Gang. [Clinical Observation on Deep Electroacupuncture at Baliao Point for Stress Urinary Incontinence]. Modern Diagnosis and Treatment. 2014;24:5551-2. [201897]. Park 2017
Xu Huan-fang, Du Ruo-sang, Mo Qian, Liu Zhi-shun. [A phase 1 clinical study on the efficacy of electroacupuncture for female patients with mild to moderate stress incontinence], China Journal of TCM and Pharmacy. 2014;29(12):3755-8. [201873].;. Park 2017
Zhao Yongzhi. [Clinical Observations on Female Stress Urinary Incontinence Patients with Acupuncture and Traditional Chinese Medicine], Journal of Liaoning University of TCM. 2014;16(5):209-11. [188429]. Park 2017, Zhang 2016
2013 Carmona MVO, Molleja ÁMG, Ríos IL, et al. Neuroestimulación percutánea del nervio tibial posterior frente a neuroestimulación de B 6 (Sanyinjiao) en incontinencia urinaria de urgencia. Revista Internacional de Acupuntura. 2013;7(4):124-30. [202675]. AHRQ 2018
Mo Qian, Liu Zhi-shun, Ma Xiao-jing. [Efficacy observation of electro-acupuncture on female stress urinary incontinence]. Beijing Journal of TCM. 2013;23(6):434-6. [201858]. Park 2017
Lin Zhao, Si-You Wang. Treatment frequency and long-term efficacy observation on electric pudendal nerve stimulation for stress urinary incontinence. Journal of Acupuncture and Tuina Science. 2013;11(3):177-180. [161197]. Acudoc2
Peng Yingke, Zhao Li. [Clinical Research of Combined Acupuncture and Medicine Treatment in the Treatment of Female Stress Urinary Incontinence]. China Journal of Chinese Medicine. 2013;1:142-3. [202604]. Zhang 2016, Wang 2014
Ye Xiaomeng, Gao Shiqing, Gong Jing et al. [Comparative study on the efficacy of electroacupuncture and acupoint embedding for treatment of stress urinary incontinence], China Medical Engineering. 2013;2:73-3. [202610]. Park 2017, Wang 2014
Zhao Lin, Wang Si-You. [Observations on the therapeutic effect on female stress incontinence of electroacupuncture pudendal nerve stimulation under biofeedback monitoring]. Shanghai Journal of Acupuncture and Moxibustion. 2013;32(5):372. [177716]. Park 2017
2011 Chang KK, Wong TK, Wong TH, Leung AW, Chung JW. Effect of acupressure in treating urodynamic stress incontinence: a randomized controlled trial. Am J Chin Med. 2011;39(6):1139-59. [202746]. Paik 2013
He Zhaoxia, Li Xin. [Electroacupuncture for female mild to moderate stress urinary incontinence], Xinjiang Journal of TCM. 2011;1:19-21. [202711]. Park 2017, Wang 2014
Lin Dongmei, Gao Tiemin, Li Jinghui. 30 cases of female stress urinary incontinence treated by warm acupuncture treatment. 2012;21(3):47-8. Journal of External Therapy of TCM. 2012;21(3):47-8. [201360]. Park 2017
Wang Bin, Tang Huayong, Wang Weigang, et al. [Therapeutic effect of abdominal acupuncture on elderly women with stress incontinence]. Liaoning Journal of TCM. 2011;11:2244-5. [202494]. Wang 2014
2010 Chen Libin. [35 Cases of Female Urinary Incontinence by Stress Treated by Moxibustion on Salt and Electro - acupuncture], Journal of External Therapy of TCM. 2010;20(6):36-7. [143716]. Park 2017
2009 Engberg S, Cohen S, Sereika SM. the efficacy of acupuncture in treating urge and mixed incontinence in women: a pilot study. J Wound Ostomy Continence Nurs. 2009;36(6):661-70. [155235]. AHRQ 2018, Paik 2013
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