The investigators plan to conduct this multi-center, three-armed, randomized controlled trial to evaluate the efficacy of electroacupuncture (EA), compared with sham electroacupuncture (SA) and waiting list (WL) on participants with stress-predominant mixed urinary incontinence (MUI).
MUI tends to present with more severe symptoms and put greater burden on the health of individual and economy of society. Current European Association of Urology (EAU) guideline on incontinence recommends to initiate treatment targeted at predominant component of MUI. However, as to whether the interventions for stress urinary incontinence (SUI) can be effectively generalized to stress-predominant MUI, there is still no powerful evidence to support it. It is necessary to seek for interventions specific to stress-predominant MUI. Results of previous studies indicated that acupuncture might help to relieve the incontinence symptoms.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
232
BL33 is located in the third posterior sacral foramen; BL35, 0.5 cun (≈10mm) lateral to the extremity of the coccyx; and SP6 posterior to the medial border of the tibia, 3 cun superior to the prominence of the medial malleolus. BL33 will be inserted by needles of 0.30×75mm size at the angle of 45°, inward and downward, till the depth of 60-70mm. BL35 will be inserted by needles of 0.30×75mm size, slightly outward and upward, till the depth of 60-70mm. SP6 will be inserted by needles of 0.30×40mm till the depth of 25-30mm. All the needles will be lifted, thrust and twisted evenly for three times, right after insertion, to induce the sensation of deqi. Electronic acupuncture apparatus (Yingdi KWD 808 I electro pulse acupuncture therapeutic apparatus, Changzhou Yingdi Electronic Medical Device Co., Ltd) will be connected to the three pairs of needles transversally, with continuous wave of 20 Hertz (Hz), electric current of 2-6.5 milliampere (mA) for BL33 and BL35, and 1mA-3.5mA for SP6.
Sham BL33 is in the area of 1 cun (≈20mm) horizontally outside BL33; sham BL35, 1 cun (≈20mm) horizontally outside BL35; Sham SP6, in the middle of SP6 and tendons. The three pairs of acupoints will be inserted by needles of 0.30×40mm size to a depth of 2-3mm till the needles can stand still. No manipulations will be conducted, and the sensation of deqi will not be induced. Electronic acupuncture apparatus (Yingdi KWD 808 I electro pulse acupuncture therapeutic apparatus, Changzhou Yingdi Electronic Medical Device Co., Ltd) will be connected to the three pairs of needles transversally, with continuous wave of 20Hz and minimal electric current (ideally at a degree which participant can just percept). In about 30 seconds, the electric current will be turned down, leaving the indicator light and ticking sound on.
Guang'anmen Hospital, China Academy of Chinese Medical Sciences
Beijing, Beijing Municipality, China
RECRUITINGThe third affiliated hospital of Beijing university of Chinese Medicine
Beijing, Beijing Municipality, China
RECRUITINGHengyang Hospital Affiliated to Hunan University of Chinese Medicine
Hengyang, Hunan, China
Proportion of participants with at least 50% reduction of mean 24-hour stress incontinence episode frequency (IEF) from baseline.
The stress IEF will be documented in 3-day voiding diary.
Time frame: week 8
Proportion of participants with at least 50% reduction of urinary leakage amount from baseline.
The urinary leakage amount will be measured by 1 hour pad test.
Time frame: week 8
Change of urinary leakage amount from baseline
The urinary leakage amount will be measured by 1 hour pad test.
Time frame: week 8
Proportion of participants with at least 50% reduction of mean 24-hour stress IEF from baseline.
The stress IEF will be documented in 3-day voiding diary.
Time frame: week 4，week 20 and week 32
Change of mean 24-hour IEF from baseline.
The IEF will be documented in 3-day voiding diary.
Time frame: week 4，week 8, week 20 and week 32.
Change of mean 24-hour stress IEF from baseline
The stress IEF is documented in 3-day voiding diary.
Time frame: week 4，week 8, week 20 and week 32.
Proportion of participants with at least 50% reduction of mean 24-hour IEF from baseline
The IEF will be documented in 3-day voiding diary.
Time frame: week 4，week 8, week 20 and week 32
Change of total and sub-score of International Consultation on Incontinence Questionnaire-short form (ICIQ-SF) from baseline.
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Jiangxi Provincial Hospital of traditional Chinese Medicine
Nanchang, Jiangxi, China
RECRUITINGYantai Hospital of Traditional Chinese Medicine
Yantai, Shandong, China
RECRUITINGICIQ-SF questionnaire is a validated questionnaire to assess the severity of incontinence symptoms and influence on QoL in the past four weeks. The questionnaire includes items of IEF, urinary leakage amount and general influence on life to be scored. Total number of the score ranges from 1 to 21, with higher scores representing greater severity and 2.52 as minimal clinically important differences.
Time frame: week 4，week 8, week 20 and week 32
Change of total and sub-score of Overactive Bladder Questionnaire short form (OAB-q SF) from baseline
OAB-q SF is a validated questionnaire used to assess the OAB symptom bother and the health-related quality of life (HRQL) in the past 4 weeks. The domains include coping, concern, sleep and emotional interactions. The scores are transformed to a 0- to 100-point scale, with higher scores indicating severe symptoms and better HRQL.
Time frame: week 4，week 8, week 20 and week 32
Change of mean 24-hour pad consumption from baseline
The pad consumption will be documented in 3-day voiding diary.
Time frame: week 4，week 8, week 20 and week 32
Proportion of participants with adequate improvement assessed by Patient global impression improvement (PGI-I).
PGI-I is a global index, with only one item, used to rate the participants' subject perception on symptom improvement. Participants will describe their impression from very much better to very much worse. Adequate Improvement is defined as the response of"much better" or "very much better".
Time frame: week8, week 20
Change of mean 24-hour urgency episodes from baseline
The urgency episodes will be documented in 3-day voiding diary.
Time frame: week 4，week 8, week 20 and week 32
Change of mean 24-hour micturition episodes from baseline
The micturition episodes will be documented in 3-day voiding diary.
Time frame: week 4，week 8, week 20 and week 32