Effectiveness and safety of acupuncture for the treatment of stress urinary incontinence: A systematic review and meta-analysis

Introduction: Stress urinary incontinence (SUI) is an involuntary loss of urine on physical exertion, sneezing, or coughing. Acupuncture, a worldwide accepted traditional and complementary medicine, has been widely used in China to treat SUI. This review aims to evaluate the effectiveness and safety of acupuncture for women with SUI. Methods: The protocol was registered in PROSPERO (CRD42022361059) and this systematic review (SR) was funded by the National Administration of Traditional Chinese Medicine. Databases including China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database, SinoMed, Web of Science, PubMed, The Cochrane Library, and Embase were searched from their inception to October 2023, for relevant randomised controlled trials (RCTs) on the treatment of acupuncture with/without pelvic floor muscle training (PFMT). Study screening and data extraction were carried out independently by two authors. Methodological quality was evaluated using the Cochrane's risk of bias (RoB) tool 2.0. Meta-analysis was performed by RevMan 5.3.5. Results: A total of 31 RCTs with 2885 patients were included in this SR. The results showed that the combination of acupuncture with PFMT had a better effect than PFMT only in decreasing urine leakage (RR = -1.87, 95 % CI [-2.24, -1.49], 13 studies, 956 patients) and Incontinence Questionnaire Short Form (ICI-Q-SF) scores (RR = -2.26, 95 % CI [-2.64, -1.88], 14 studies, 1015 patients) in women with SUI. Acupuncture compared with sham acupuncture demonstrated improvements in urinary leakage (RR = -4.22, 95 % CI [-5.52, -2.93], 5 studies, 286 patients), and ICI-Q-SF scores with MD and 95 % CI of -3.88(-4.59, -3.17), -8.71(-10.85, -6.57), and -3.10(-3.38, -2.82), respectively. Subgroup analyses of manual acupuncture or electroacupuncture and duration of PFMT treatment can appropriately reduce heterogeneity. For the Egger's test of 1-h pad leakage and of ICI-Q-SF scores, suggesting that there was a small possibility of publication bias in this SR (p = 0.1257 and p = 0.8058, respectively). Adverse events appeared in 12 participants in the acupuncture group and 9 in the sham group. (relative risk = 1.33, 95 % CI = [0.56, 3.15], P = 0.70). The quality of RCTs included in this review was generally poor. Conclusion: Acupuncture has potential in the treatment of SUI in women, and no significant adverse events were reported. However, considering issues with the methodological quality of the included studies, the reliability of this review conclusion may be affected to a certain extent.