Rationale: Overactive bladder (OAB) is a common disease in the female urinary system. Refractory OAB is an indication for sacral neuromodulation (SNM) therapy, which was approved by the Food and Drug Administration (FDA) of the United States. However, SNM does not alleviate the clinical symptoms in all refractory OAB cases. Patients are required to undergo an SNM stage 1 operation, a traumatic and costly procedure, to evaluate the clinical efficacy of the treatment. If the procedure is predicted to likely be ineffective, the patient has to bear the physical and economic losses. Here, we report a patient with a 3-year course of refractory urge urinary incontinence who was treated with electroacupuncture according to traditional Chinese medicine (TCM).
Patient concerns: The patient was 73 years old and had frequent urination and urge urinary incontinence for 3 years; she had 24 to 30 counts of urination per day and 7 to 9 counts of urge incontinence. The patient was treated with multiple TCM and Western medicines and therapies. The TCM treatment consisted of several patented Chinese medicines and TCM decoctions. The Western medication comprised mainly antibiotics, alpha receptor antagonists, and muscarinic receptor antagonists. The treatment effect was unsatisfactory, and there was no apparent alleviation of symptoms; therefore, she underwent electroacupuncture.
Diagnosis: Refractory OAB.
Interventions: The patient received 30 days of TCM-based electroacupuncture with optimized acupoint positioning, which comprised a total of 10 sessions (1 electroacupuncture session every 2 days) targeting the bilateral Zhongliao and Sanyinjiao acupoints. After treatment, the patient experienced a good therapeutic outcome.
Outcomes: After 30 days of electroacupuncture treatment, the average daily count of urination in 5 days decreased from 29.3 per day before treatment to 19.8 after treatment, and the average count of urge incontinence decreased from 9.3 before treatment to 5.8 after treatment. However, good prognosis was not stable. After careful consideration, the patient accepted SNM treatment, which greatly alleviated the symptoms of frequent urination and urge incontinence. The patient received follow-up visits for 2 years, during which she manifested stable curative effects.
Lessons: The optimized positioning at the Zhongliao acupoint improves the accuracy of acupuncture. Accurate electroacupuncture alleviates the symptoms of refractory OAB by stimulating the Zhongliao and Sanyinjiao acupoints, as the underlying mechanisms are similar to those of SNM. Therefore, it is possible to use electroacupuncture to estimate the therapeutic effect of SNM, thereby providing a reference for patients and clinicians to determine whether SNM treatment will be effective.