Systematic review and meta-analysis of moxibustion on urinary incontinence among women

Background

Urinary incontinence (UI) is a common condition that bothers women's lives, including stress urinary incontinence (SUI), urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI). The current non-surgical treatment of Western medicine includes pelvic floor muscle training (PFMT), medication, electric stimulation, etc., all of which have varied limitations. For instance, the patients are poor in compliance with PFMT and medication results in frequent adverse effects. Being one of the featured treatments of TCM, moxibustion has several merits including safety, low cost and simple operation. In recent years, the clinical evidences prove increasingly that moxibustion may be effective for women with UI. However, there is no high-quality systematic review of moxibustion for this disease.

Objective

To evaluate the effect and safety of moxibustion on UI (including SUI, UUI and MUI) among women.

Methods

From the inception to October 13, 2022, the data of the randomized controlled trials (RCTs) of moxibustion on UI among women were collected from CNKI, WanFang Data, VIP, SinoMed, Web of Science, Pubmed, EMBASE and Cochrane Library databases. Two investigators screened the articles independently and extracted the data according to the inclusion and exclusion criteria developed in advance. Using the risk of bias assessment tool of Cochrane Handbook, the included RCTs were evaluated. With RevMan 5.3 software, meta-analysis was performed, and the GRADE tool was adopted to assess evidence certainty of different outcomes.

Results

A total of 1176 articles were retrieved and 19 of them with 1397 patients were eligible and included in the review. In experimental groups, moxibustion combined with PFMT was used, while in control groups PFMT was applied alone. And the subjects were all women with SUI. Meta-analysis showed that compared with PFMT alone, moxibustion combined with PFMT reduced the urine leakage volume (1-hour pad test) (MD = -1.95g, 95%CI [-2.32, -1.57], P < 0.001), the frequency of UI in 24-hour (MD = -0.64, 95%CI [-0.88, -0.40], P < 0.001) and the score of the short form of International Consultation on Incontinence Questionnaire (ICIQ-SF) of women with SUI (MD = -2.53, 95%CI [-3.43, -1.63], P < 0.001); and this combined intervention measure did not increase significantly the adverse events (RR = 0.82, 95%CI [0.15, 4.6], P = 0.82). GRADE assessment showed that the UI frequency in 24-hour and the incidence of adverse events were rated as low quality, the urine leakage volume of 1-hour pad test and ICIQ-SF score were very low quality.

Conclusion

Compared with PFMT alone, the intervention combined with moxibustion greatly reduced the urine leakage volume and UI frequency and improved the quality of life (QoL) among women with SUI with favorable safety. Moxibustion could be effective supplementary therapy on SUI among women. However, due to the high risk of bias of the included trials and low certainty of evidence, more high-quality clinical studies are needed to verify the above findings.

Registration

Registered on PROSPERO: CRD42022297643.