To investigate the association between needling sensation intensity, its sensation propagation sites, and the therapeutic efficacy of electroacupuncture combined with pelvic floor muscle training in patients with post prostatectomy incontinence.

A total of 46 patients with post prostatectomy incontinence were included and received electroacupuncture combined with pelvic floor muscle training. Acupoints included Guanyuan (CV4), Zhongji (CV3), and Dahe (KI12) on the anterior aspect, and Zhongliao (BL33) and Huiyang (BL35) on the posterior aspect. Treatment was administered three times per week for 6 weeks using continuous wave stimulation (50 Hz), with 15 minutes on the anterior acupoints and 15 minutes on the posterior acupoints per session. Patients were classified into effective (n = 29) and ineffective groups (n = 17) based on a ≥ 50% reduction in the 1-hour pad test after treatment. Needling sensation intensity was assessed using the Massachusetts General Hospital Acupuncture Sensation Scale (MASS) at the the first and last sessions (average values used for analysis), and sensation propagation sites (urethra, anus, lower limbs, local region) were recorded. Group differences were compared, and multivariable logistic regression was performed.

Of the 46 patients, 29 (63.0%) achieved treatment response, defined as a ≥ 50% reduction in the 1-hour pad test. Baseline characteristics were comparable between the two groups (all p > 0.05). Following treatment, the reduction in 1-hour pad test weight was significantly greater in the effective group compared with the ineffective group [-49.0 (−150.2, −30.3) g vs −0.5 (−6.55, 13.6) g, p < 0.001].
Regarding needling sensation characteristics, the effective group demonstrated significantly higher total needling sensation scores (13.55 ± 3.00 vs 5.79 ± 1.78, p = 0.015), anterior sensation scores (12.90 ± 3.35 vs 5.71 ± 2.05, p = 0.026), and posterior sensation scores (14.21 ± 3.17 vs 5.88 ± 2.03, p = 0.037) compared with the ineffective group.
Analysis of sensation propagation patterns revealed a significantly higher proportion of urethral propagation in the effective group than in the ineffective group (93.1% vs 29.4%, p < 0.001). In contrast, local propagation was significantly less frequent in the effective group (17.2% vs 58.8%, p = 0.005), as was lower limb propagation (31.0% vs 70.6%, p = 0.011). No statistically significant difference was observed in anal propagation between groups (69.0% vs 41.2%, p = 0.062).
In multivariable logistic regression analysis, none of the evaluated needling sensation-related variables, including total needling sensation score, urethral propagation, or lower limb propagation, were identified as independent predictors of therapeutic efficacy (all p > 0.05). Nevertheless, the total needling sensation score showed a positive but non-significant association with treatment response (OR = 32.36, 95% CI 0.48–2163.46, p = 0.105).

Patients in the effective group had significantly stronger needling sensation and more frequently showed propagation toward the urethra, whereas those in the ineffective group more often had weak propagation or propagation directed to the lower limbs. Multivariable analysis did not identify independent predictors, possibly due to collinearity among needling sensation-related variables and the limited sample size. However, the consistent findings in univariate analyses highlight the potential clinical relevance of these sensory characteristics. These findings warrant further validation in larger studies.

Electroacupuncture combined with pelvic floor muscle training significantly improved urinary incontinence symptoms in responders. Univariate analyses showed that stronger needling sensation and urethral-directed sensation propagation were associated with better outcomes. Larger studies are needed to further clarify the clinical significance of these needling sensation-related factors.