Acupuncture for neurogenic bladder after spinal cord injury: A systematic review and meta-analysis

IntroductionThe objective of this study is to evaluate the efficacy and safety of acupuncture for neurogenic bladder after spinal cord injury (SCI).MethodsData up to September 2012 were from 7 databases. Randomized-controlled clinical trials (RCTs) on acupuncture for neurogenic bladder after SCI were included.ResultsEight RCTs with 529 patients were identified. One RCT reported significant effects of electroacupuncture (EA) adjuvant therapy for improving residual urine volume slip ratio compared with drug therapy plus intermittent catheterization program (ICP), (P < 0.05); one reported improving of time of achieving balanced voiding compared with ICP plus physical therapy (PT) (P < 0.05 or P < 0.01); one reported improving of bladder capacity and residual urine volume compared with ICP plus PT (P < 0.01). Two RCTs showed no significant effects of EA mono-therapy for total efficacy rate compared with drug therapy plus PT or plus PT and ICP (RR 1.26, 95% CI 0.95-1.68, P = 0.11). Three RCTs showed significant effects of EA adjuvant therapy for total efficacy rate compared with ICP alone or ICP plus PT or drug therapy plus PT (RR 1.50, 95% CI 1.25-1.79, P < 0.01). The methodological quality was generally poor. No trial reported adverse effects.ConclusionsDue to the poor methodological quality of the studies and the small number of trials included in the meta-analysis, the current evidence is insufficient to support the efficacy of acupuncture for neurogenic bladder after SCI. Acupuncture appeared to be well tolerated, but no evidence is available to assess the safety. Further large, rigorous designed trials are needed.