Underactive Bladder:a Preliminary Study On The Clinical Features And Effectiveness Of Electroacupuncture Matched With Propensity Score

Background and Aims:Hypoactivity of Underactive Bladder(UAB)is particularly common in the elderly,but only a minority of patients are concerned.With the aging of the population,the number of people suffering from UAB and related costs will increase significantly,which is bound to increase the social burden.In December 2015,the Second UAB International Conference was held to address the challenges of UAB,leading to increasing international studies.There are few relevant researches in China,and both doctors and patients have insufficient understanding of UAB.However,there is still a lack of targeted drugs and surgical treatment at present.From the perspective of traditional Chinese medicine,the disease is the category of "Longbi",which was often cured with acupuncture in ancient times.In the modern,Baliao acupoints are used to address lower urinary tract symptoms(LUTS)with often effective.The purpose of this study is to understand the clinical features and disease progression of UAB,to investigate the treatment status of UAB and the patients’ attitude towards acupuncture therapy,and to observe the effectiveness of electroacupuncture in patients with UAB.Methods:Study 1:Clinical data of 77 patients with UAB in a single center Jiangsu Hospital of Traditional Chinese Medicine were retrospectively collected.Semi-structured interviews were conducted through telephone or outpatient service.Each interviewee was guided to describe the current LUTS as well as their attitude to treat UAB with acupuncture as detailed as possible.The main factors concerned included:(1)Clinical features of UAB;(2)Current treatment status;(3)Whether or not to choose acupuncture and why.After the interview,the data was analyzed and presented by descriptive statistics.Study 2:163 patients with UAB were divided into observation group and control group according to whether they selected electroacupuncture.The observation group was treated with electroacupuncture for 6 weeks,and there was no intervention for other treatment schemes in the two groups.The primary outcome was the proportion of responders,and the secondary outcomes was the proportions of patients with catheters inserted or removed.Responders were defined as participants with LUTS improved≥50%from baseline and/or recovered of spontaneous urination.A total of 35 pairs of co variate balanced samples were obtained by 1:1 propensity score matching(PSM).The proportion of responders and patients with catheters inserted or removed were compared between the observation group and the control group.Results:1.Clinical features:(1)Symptoms of UAB:The most common symptoms reported by more than half of patients are feeling of incomplete emptying of the bladder(58.4%),nocturia(58.4%)and straining(50.6%).The following are increased daytime frequency(46.8%),slow stream(44.2%),hesitancy(37.7%),urgency(37.7%),unable to urinate(26.0%),thin stream(24.7%),intermittency(22.1%),incontinence(13.0%).(2)Risk factors of UAB:in addition to aging,common risk factors of UAB include diabetes(18.2%),cerebrovascular disease(14.3%),cauda equina nerve injury(14.3%),and pelvic surgery(14.3%).14.3%of the patients have 2 or more risk factors,and 16.9%of the patients didn’t report any risk factors related to UAB.(3)Current treatment status of UAB:59.7%of the patients are not treated for LUTS.31.2%patients received catheterization,including suprapubic catheter(16.9%),indwelling catheter(7.8%),clear intermittent catheterization(6.5%),and the other(9.1%)receive drug therapy.2.Attitudes to acupuncture therapy:(1)Experience of acupuncture:71.4%patients have never received acupuncture treatment,28.6%patients had be treated with acupuncture in the past,of which 5 cases(6.5%)were treated for diseases other than UAB,17 cases(22.1%)had been treated with acupuncture for UAB;(2)Expectations of acupuncture:61.0%of the surveyed patients have a vague attitude.18.2%of UAB patients believe that acupuncture can treat diseases but not UAB.On the contrary,15.6%of the patients think that acupuncture can treat UAB.5.2%of the patients have the view that acupuncture cannot cure any disease;(3)Willingness to acupuncture:55.8%of UAB patients claime that they are willing to try acupuncture treatment,and 44.2%were unwilling to undergo acupuncture treatment.The main reasons are summarized as follows:1)the current lower urinary tract function is still satisfactory and no treatment is needed;2)No acupuncture in the vicinity of residence;3)Lack of confidence in the effect of acupuncture for UAB;4)have become accustomed to the current conditions of the lower urinary tract,unwilling to increase the treatment;5)worry about the high cost of long-term acupuncture treatment;6)Insurmountable fear of acupuncture.3.Effectiveness of electroacupuncture:The covariates including age,genders,UAB types,spontaneous urination or not,uresis modes of the two groups reached equilibrium after PSM(P>0.05),and a total of 35 pairs of UAB patients were successfully matched.In the observation group,51.4%patients responded successfully,including 9 cases(25.7%)who recovered spontaneous urination,and 8 cases(22.9%)who reported 50%reduction in frequency of daytime urination and/or nocturia.In the control group,25.7%of the patients responded successfully as well,including 2 patients(5.7%)who recovered spontaneous urination,and 7 patients(20.0%)whose daytime urination frequency and/or nocturia symptoms improved by more than 50%,with statistical significance between the groups(P<0.05).Compared with the control group,there was 1 case who with catheters inserted for the aggravation of UAB in the observation group(2.9%)and 2 cases in the control group(5.7%).There was no statistical significance in comparison between the two groups(P>0.05).Conclusions:1.The main symptoms of UAB patients are incomplete emptying of the bladder,nocturia and straining,and the common risk factors include diabetes,cerebrovascular disease,cauda equina nerve injury and pelvic surgery.More than half of UAB patients are not treated.2.The vast majority of UAB patients have never been treated with acupuncture.More than half of them have no high or low expectation for acupuncture,and are willing to try acupuncture treatment,while only a few patients believe that acupuncture can not treat any diseases.3.Electroacupuncture has a significant effect on patients with UAB,which can improve lower urinary tract symptoms and urination function without increasing the risk of catheterization.