Catheter-related bladder discomfort (CRBD) is characterized by urinary frequency, urgency, and discomfort in the suprapubic region related to indwelling catheter (1). CRBD is one of the most upsetting post-operative complications because it can not only prolong hospital stay, but also extremely weaken patients’ quality of life. The management of CRBD remains challenge although a number of treatments are available. Our study aims to investigate the effectiveness of acupuncture in preventing and managing CRBD after transurethral surgery.

A total of 60 patients underwent transurethral surgery due to Benign Prostate Obstruction (BPO) or Bladder Neck Obstruction (BNO) were recruited and allocated into acupuncture group or sham-acupuncture group randomly in a 1:1 ratio. Patients in acupuncture group received the acupuncture treatment while the counterparts in sham-acupuncture group received the sham-acupuncture from the day before surgery to the third day after surgery. In terms of acupuncture intervention, the needles were inserted at CV3 (Zhongji), CV4 (Guanyuan), bilateral SP9 (Yinlingquan), bilateral SP6 (Sanyinjiao)，bilateral ST 36 (Zusanli) and bilateral LR3 (Taichong) with a depth of 25–30 mm. Following insertion, the needles were retained for 20 minutes. Regarding sham-acupuncture procedure, the same needles with acupuncture group were used with a superficial insertion at 20 mm outward to each acupoint. Primary outcome is the prevalence of moderate to severe CRBD in the first, second and third 24 hours after surgery. Secondary outcomes include the frequency and severity of CRBD, the types and doses of additional medication used in management of CRBD in the first, second and third 24 hours after surgery. Furthermore, the Patient Perception of Bladder Condition (PPBC), Visual Analogue Scale (VAS), and International Prostate Symptom Score-Quality of Life scores (IPSS-QoL) were assessed at 24, 48, and 72 hours after the surgery. In addition, the adverse events were also recorded in detail. This study was approved by the Ethics committee of our hospital, and written informed consent was obtained from each subject. Data analysis was based on the intention to treat (ITT) principle. Continuous variables were expressed as the mean ± standard deviation or median (interquartile range) while categorical variables were expressed as percentage and frequency. Difference between two groups was compared by two sample t-test, Mann-Whitney U test or Chi-square test when appropriate. All reported P-values were two-sided, and P<0.05 was considered statistically significant.

All 60 patients completed the final assessment. There were 19 male and 11 females in acupuncture group whereas 23 male and 7 females in sham-acupuncture group. Patients’ age was 59.7±17 and 56.4 ± 12 in acupuncture and sham-acupuncture group respectively. 
As shown in Table 1, acupuncture group had a significantly lower prevalence of CRBD in the first and second 24 hours after surgery than sham-acupuncture group (P＜0.05), but not in the third 24 hours after surgery (P＞0.05). Besides, acupuncture group had also a significantly lower prevalence of moderate to severe CRBD in the first 24 hours after surgery compared to sham-acupuncture group (P＜0.05), but not in the second and third 24 hours after surgery (P＞0.05) . By contrast, no significant difference was detected in the number of patients receiving additional medication between two groups (P＞0.05). Additionally, acupuncture group presented a significantly lower PPBC score in the first 24 hours after surgery, as well as VAS scores in the first and second 24 hours after surgery compared to sham-acupuncture group (P＜0.05) (Table 2). Interestingly, acupuncture group demonstrated a significant lower IPSS-QoL score only in the third 24 hours after surgery compared to sham-acupuncture group (P＜0.05) (Table 2).

CRBD is a common condition in patients indwelling urinary catheter. According to the published studies, the incidence of CRBD ranged 20% to 80% and main predictors for postoperative CRBD included male, transurethral surgery, catheter diameter of more than F18. The treatments of CRBD mainly include anesthetics and anesthetic adjuvants, anticholinergic drugs, analgesics and nerve blocks (2). Unfortunately, these therapeutic strategies cannot meet the clinical need due to lack of efficacy and adverse events. Acupuncture has been widely used for management of various chronic disease. The effects of acupuncture on relieving pelvic pain and detrusor overactivity have been reported. In current study, we found that acupuncture might reduce the prevalence of CRBD in the early period of post-operation. The potential mechanism may be the regulation effect of acupuncture on pudendal nerve.

Our study suggests that acupuncture may reduce the prevalence and severity of postoperative CRBD. However, whether acupuncture can reduce the use of additional medication in patients with postoperative CRBD still needs to be investigated in future well-designed study.

Wilson M. Causes and management of indwelling urinary catheter-related pain. Br J Nurs. 2008;17(4):232-239.
LI S, LI P, WANG R,et al. Different interventions for preventing postoperative catheter-related bladder discomfort: a systematic review and meta-analysis [J]. Eur J Clin Pharmacol, 2022, 78(6): 897-906.