Acupuncture for children with primary nocturnal enuresis: a systematic review and meta-analysis

Zhou B1, Shi P1, Pang R1

Research Type

Clinical

Abstract Category

Paediatrics

Abstract 426
Paediatric Lower Urinary Tract Symptoms and Urinary Incontinence
Scientific Podium Short Oral Session 19
Thursday 5th September 2019
15:15 - 15:22
Hall H2
Conservative Treatment Pediatrics Rehabilitation
1.Guang An Men Hospital, China Academy of Chinese Medical Sciences
Presenter
B

BingYing Zhou

Links

Abstract

Hypothesis / aims of study
This study aims to systematically review the efficacy and safety of acupuncture on primary nocturnal enuresis in children.
Study design, materials and methods
We performed a comprehensive search of medical literature, including Cochrane Library, MEDLINE, EMBASE, Chinese Biomedical Literature Database, trials registries, with no restrictions on the language of publication or publication status. The date of the latest search of all databases was February 22, 2019. In this systematic review, we only included randomized controlled trials (RCTs). Inclusion criteria were children with primary nocturnal enuresis, and age 5 to 21 years. Trials of children with secondary nocturnal enuresis were excluded. The intervention we focused on in this review was acupuncture and the controls included conventional drug, sham acupuncture, and Chinese herbal therapy.  The primary outcome was complete response rate and the secondary outcomes included number of nocturnal enuresis, and the adverse events. After two reviewers screened the studies, extracted data from including studies, and rated the quality of evidence independently, we performed meta-analysis using software of Revman version 5.3 and interpreted data according to the Cochrane Handbook for Systematic Reviews of Interventions.
Results
A total of 10 studies with 953 randomized participants (441 in acupuncture group and 412 in control group) were included. The results of meta-analysis showed that, compared with the control group, the acupuncture group had statistically significant higher complete response rate [OR=2.41, 95%CI (1.41, 4.93),P=0.002], so did the statistical significance when compared with conventional drug group [OR=2.46, 95%CI (1.69, 3.60),P<0.00001], sham acupuncture group [OR=9.14, 95%CI (2.46, 33.92),P=0.0009], and herbal therapy group [OR=1.78, 95%CI (1.13, 2.79),P=0.01] respectively. Moreover, although acupuncture did not reduce the average number of nocturnal enuresis in comparison with control intervention [MD=-0.93, 95%CI (-1.95, 0.09),P=0.07], a significant decrease was found when compared to the sham acupuncture [MD=-1.49, 95%CI (-2.26, -0.72),P=0.0002]. In terms of adverse events, there was no significant difference between acupuncture group and control group [OR=0.62, 95%CI (0.04, 8.72),P=0.72].
Interpretation of results
Nocturnal enuresis is a common disorder in children and has a significant negative effect on emotional state, self-esteem, as well as the social development of a child. The current treatment of nocturnal enuresis includes behavior intervention, alarm therapy, and pharmacotherapy. However, these therapeutic options cannot meet the needs of children and their parents due to limited effectiveness, inconvenience, and troublesome adverse events. 
Acupuncture, as an important component of traditional Chinese medicine, has gained the acceptance in management of various urological diseases worldwide. The result of our current systematic review shows that acupuncture has a better efficacy and similar adverse events in managing nocturnal enuresis in children compared with other intervention. Through literature search, we have also identified three published systematic reviews assessing the efficacy and safety of acupuncture for children with nocturnal enuresis [1-3]. Differing from our finding, two reviews [1, 2] demonstrated a similar effectiveness between acupuncture and conventional drug. The potential reason for the inconsistency may result from the fact that our review included more recent trials. Furthermore, these two reviews included observational studies besides RCTs, which might contribute to the difference in findings. Another systematic review [3] presented the similar findings with ours. However, that review included the studies using acupoint injection as an intervention. The result form these studies may not present the accurate effect of acupuncture because acupoint injection provides an additional chemical stimulation beside the physical stimulation result from acupuncture.
Concluding message
The current evidence shows that acupuncture has a better effect in management of primary nocturnal enuresis in children, and a similar risk of adverse events, when compared to conventional drug, sham acupuncture, and herbal therapy respectively.  However, further study is still needed since the findings of this review were limited by the limitations of included studies.
Figure 1 Forest plot for primary outcome
References
  1. W. F. Bower, et al., Acupuncture for nocturnal enuresis in children: a systematic review and exploration of rationale. Neurourol Urodyn, 2005. 24(3): p. 267-72.
  2. F. Saettini, et al., Acupuncture for the treatment of pediatric nocturnal enuresis: A systematic review and a meta-analysis of randomized and non-randomized studies. European J Integ Med, 2016. 8: p. 89-97.
  3. Z. T. Lv, et al., Efficacy of Acupuncture in Children with Nocturnal Enuresis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evid Based Complement Alternat Med, 2015. 2015: p. 320701.
Disclosures
Funding This work was funded by Beijing Municipal Science & Technology Commission No. Z161100000516156 Clinical Trial No Subjects None