Objective: To determine whether acupuncture is effective as an overactive bladder (OAB) treatment compared with solifenacin and placebo, and to investigate its relation with urine nerve growth factor (NGF) levels. Patients and Methods: The study was conducted with methodological rigor based on the Consolidated Standards of Reporting Trials criteria. 90 female patients with OAB were included and randomly assigned to a solifenacin, acupuncture or placebo group. The medicated group received solifenacin 5 mg/day; the acupuncture and placebo groups were treated twice a week for 4 weeks. Symptom scores, quality of life scores, frequency of micturition and urine NGF levels were used to assess treatment efficiency. Results: The study was completed with 82 patients (n = 30 in the solifenacin group, n = 28 in the acupuncture group and n = 24 in the placebo group). After treatment, comparison of the medical and acupuncture therapy groups with the placebo group showed significant differences between recovery concerning quality of life (p < 0.001 and p < 0.01, respectively) and symptom scores (p < 0.001 and p < 0.001, respectively). The decrease of NGF levels after treatment compared to before treatment was determined in each group (solifenacin, acupuncture, placebo group; p < 0.001, p < 0.001, p = 0.359, respectively). Sufficient symptomatic improvement was not achieved in 8 patients in the acupuncture group. Therefore, comparisons were assessed twice with and without including these patients, and NGF levels in the acupuncture group were higher than at first comparison in which all patients in the acupuncture group were included. Conclusions: In patients with OAB in whom anticholinergic treatment is contraindicated, acupuncture may be considered another treatment option.

Keywords:
Overactive bladder, Solifenacin, Acupuncture, Nerve growth factor
1.
Irwin DE, Milsom I, Hunskaar S, et al: Population based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006;50:1306-1314.
2.
Stewart WF, Van Rooyen JB, Cundiff GW, et al: Prevalence and burden of overactive bladder in the United States. World J Urol 2003;20:327-336.
3.
Coyne KS, Sexton CC, Kopp ZS, et al: The impact of overactive bladder on mental health, work productivity and health-related quality of life in the UK and Sweden: results from EpiLUTS. BJU Int 2011;108:1459-1471.
4.
Abrams P, Cardozo L, Fall M, et al: The standardization of terminology in lower urinary tract function: report from the standardization sub-committee of the International Continence Society. Urology 2003;61:37-49.
5.
Liu HT, Kuo HC: Urinary nerve growth factor levels are increased in patients with bladder outlet obstruction with overactive bladder symptoms and reduced after successful medical treatment. Urology 2008;72:104-108.
6.
Liu HT, Chancellor MB, Kuo HC: Decrease of urinary nerve growth factor levels after antimuscarinic therapy in patients with overactive bladder. BJU Int 2009;103:1668-1672.
7.
Okragly AJ, Haak-Frendscho M: An acid-treatment method for the enhanced detection of GDNF in biological samples. Exp Neurol 1997;145:592-596.
8.
Liu HT, Kuo HC: Urinary nerve growth factor level could be a potential biomarker for diagnosis of overactive bladder. J Urol 2008;179:2270-2274.
9.
World Health Organization Regional Office for the Western Pacific: WHO standard acupuncture point locations in the Western Pacific region. Manila, World Health Organization, 2008.
10.
Drake M, Abrams P: Overactive bladder; in Wein AJ, Kavoussi LR, Partin AW, et al (eds): Campbell-Walsh Urology, ed 10. Baltimore, Saunders, 2011, pp 1947-1957.
11.
Bø K, Berghmans LC: Nonpharmacologic treatments for overactive bladder-pelvic floor exercises. Urology 2000;55(suppl 5A):7-11.
12.
Kegel AH: The nonsurgical treatment of genital relaxation: use of the perineometer as an aid restoring anatomic and functional structure. Ann West Med Surg 1948;2:213-216.
13.
Lindstrom S, Fall M, Carlsson CA, et al: The neurophysiological basis of bladder inhibition in response to intravaginal electrical stimulation. J Urol 1983;129:405-410.
14.
Walsh IK, Johnston RS, Keane PF: Transcutaneous sacral neurostimulation for irritative voiding dysfunction. Eur Urol 1999;35:192-196.
15.
Philp TJ, Shah PJ, Worth PH: Acupuncture in the treatment of bladder overactivity. Br J Urol 1988;61:490-493.
16.
Thüroff J, Abrams P, Andersson KE, et al: Guidelines on Urinary Incontinence. European Association of Urology, 2009.
17.
NIH Consensus Conference. Acupuncture. JAMA 1998;280:1518-1524.
18.
Blanchet KD: Acupuncture: gaining acceptance in urology: proves effective for a number of chronic conditions. BJU Int 2012;109:ii-iv.
19.
Sunay D, Sunay M, Aydoğmuş Y, et al: Acupuncture versus paroxetine for the treatment of premature ejaculation: a randomized, placebo-controlled clinical trial. Eur Urol 2011;59:765-771.
20.
Emmons SL, Otto L: Acupuncture for overactive bladder: a randomized controlled trial. Obstet Gynecol 2005;106:138-143.
21.
Streitberger K, Kleinhenz J: Introducing a placebo needle into acupuncture research. Lancet 1998;352:364-365.
22.
Steers WD: Pathophysiology of overactive bladder and urge urinary incontinence. Rev Urol 2002;4(suppl 4):S7-S18.
23.
Chung YC, Fraser MO, Yu Y, et al: The role of bladder afferent pathways in bladder hyperactivity induced by the intravesical administration of nerve growth factor. J Urol 2001;165:975-979.
24.
Zvara P, Vizzard MA: Exogenous overexpression of nerve growth factor in the urinary bladder produces bladder overactivity and altered micturition circuitry in the lumbosacral spinal cord. BMC Physiol 2007;7:9. Available from http://www.biomedcentral.com/1472-6793/7/9.
25.
Lowe EM, Anand P, Terenghi G, et al: Increased nerve growth factor levels in the urinary bladder of women with idiopathic sensory urgency and interstitial cystitis. Br J Urol 1997;79:572-577.
26.
Liu HT, Chancellor MB, Kuo HC: Urinary nerve growth factor levels are elevated in patients with detrusor overactivity and decreased in responders to detrusor botulinum toxin-A injection. Eur Urol 2009;56:700-706.
27.
Okragly AJ, Niles AL, Saban R, et al: Elevated tryptase, nerve growth factor, neurotrophin-3 and glial cell line-derived neurotrophic factor levels in the urine of interstitial cystitis and bladder cancer patients. J Urol 1999;161:438-441.
28.
Lamb K, Gebhart GF, Bielefeldt K: Increased nerve growth factor expression triggers bladder overactivity. J Pain 2004;5:150-156.
29.
Kim JC, Park EY: Nerve growth factor and prostaglandins in the urine of female patients with overactive bladder. J Urol 2006;175:1773-1776.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.