Electroacupuncture pubic nerve stimulation therapy for stress urinary incontinence

  Stress incontinence is the involuntary flow of urine from the urethra when there is a sudden increase in abdominal pressure (e.g. coughing, sneezing, laughing, running, strenuous activity) in a normally incontinent state. It is most commonly seen in middle-aged women who have given birth.  Possible causes of stress urinary incontinence include 1, birth and delivery injuries, obstructed labor; 2, postmenopausal sex hormone changes resulting in pelvic floor tissue atrophy; 3, history of vaginal, urethral, and prostate surgery; 4, perineal and urethral injuries; 5, increased abdominal pressure due to intrapelvic masses. One or more etiologies can coexist and cause relaxation of the pelvic floor support tissues or/and urethral sphincter injury, resulting in urinary incontinence.  Stress urinary incontinence can be treated conservatively with Western medicine, which has the advantage of being safe and minimally invasive, with a much lower incidence and severity of complications than surgical treatment. Two of the most commonly used treatments are pelvic floor exercises and electrical stimulation. Pelvic floor muscle exercise has the effect of enhancing the pelvic floor muscle support strength, improving neuromuscular function, preventing the proximal urethra and bladder base from falling and increasing urethral pressure when intra-abdominal pressure increases, and is an effective treatment for stress urinary incontinence. However, many patients (especially women) have difficulty identifying the pelvic floor muscles and are unable to perform pelvic floor exercises correctly; long-term compliance of patients is poor. Transvaginal or anal electrical stimulation is a noninvasive, passive method of pelvic floor muscle exercise that has good compliance. However, it is less effective than pelvic floor exercises because it uses surface electrodes and acts indirectly).  Stress urinary incontinence can also be treated with acupuncture in Chinese medicine, which has the advantage of being safe, convenient, and free of side effects and complications. Acupuncture points are mainly in the abdomen and lumbosacral region. However, because of the general acupuncture method, it is difficult to induce rhythmic contraction of the pelvic floor muscles by excitation of the pubic nerves and enhance the strength of the pelvic floor muscles to improve urinary control as in electrical stimulation therapy.  Electroacupuncture pubic nerve stimulation therapy is a new method of combining Chinese and Western medicine in the treatment of stress urinary incontinence, and has been recognized by the urological community at home and abroad. The therapy incorporates the advantages of two Western medical treatments, pelvic floor muscle exercise and electrical stimulation (passive pelvic floor muscle exercise), and combines the long-needle deep-pricking technique of Chinese medicine, using a special acupuncture method (needle tip in a specific direction) for four specific points in the caudal-sacral area so that the needle tip reaches the vicinity of the pubic nerve, and electrical stimulation directly excites the pubic nerve to induce rhythmic contraction of the pelvic floor muscle (including the urethral sphincter), thereby enhancing pelvic floor muscle support This enhances pelvic floor muscle support, improves neuromuscular function, prevents the proximal urethra and bladder base from dropping when intra-abdominal pressure increases, and improves urinary control by increasing urethral closure pressure. Clinical studies and simultaneous perineal ultrasound testing have confirmed that this therapy does contract the pelvic floor muscles, replacing pelvic floor muscle exercise, and has excellent immediate and long-term efficacy in stress urinary incontinence without significant side effects or complications. After an average of 25 treatments, about 55% of patients had complete disappearance of symptoms; about 85% of patients had ≥50% improvement in symptoms.