Acupuncture and moxibustion treating lower urinary tract symptoms due to benign prostatic hyperplasia: a systematic review and network meta-analysis

Abstract Objective: Lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) affect the quality of life of elderly individuals. Acupuncture and moxibustion are used in the clinic in China for improving LUTS symptoms due to BPH. However, there is no evidence to suggest which is the best option. We compared the efficacy of acupuncture and moxibustion to provide evidence for clinical decision-making. Methods: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang Data, and VIP databases were searched from inception to July 2020 to identify the randomized controlled trials (RCTs) of acupuncture and moxibustion for LUTS due to BPH. Two researchers filtered studies and extracted the information independently. This study conducted a network meta-analysis using the Bayesian random method. The interventions ranking was evaluated using the surface under the cumulative ranking curve (SUCRA). Results: We finally included 40 studies comprising 10 treating therapies and 3655 patients with LUTS caused by BPH. In terms of the International Prostate Symptom Score, maximum urinary flow rate, and quality of life, electroacupuncture (EA) (MD = −3.6, 95% credible interval [CrI] [−5.5, −1.8], very low certainty of evidence; MD = 2.2, 95% CrI [1.1, 3.3], low certainty of evidence; MD = −1.3, 95% CrI [−2.2, −0.43], very low certainty of evidence) may be consistently the optimal treatment compared with other interventions, with SUCRA values of 84%, 81%, and 89%, respectively. Conclusions: Of all treatments, EA may have the best efficacy with fewer adverse events for LUTS due to BPH. The quality of evidence supporting this result is low to very low certainty of the evidence due to limitations of primary studies; thus, more high-quality RCTs are needed for further evidence.