Is moxibustion safe and effective in treating female stress urinary incontinence? A systematic review and meta-analysis

Abstract

Abstract Background Stress urinary incontinence (SUI) in women is a female urogenital disease in which urine leaks out involuntarily due to increased abdominal pressure during coughing or sneezing or physical activity. As one of complementary and alternative medicine, moxibustion therapy has been widely used in the clinical treatment of female SUI, but its efficacy and safety have not been systematically evaluated. Therefore, this study aimed to systematically evaluate the efficacy and safety of moxibustion in the treatment of female SUI. Methods The following electronic databases were searched from database establishment to December 2021: PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), VIP Database, Wanfang Database, and China Biology Medicine Disc (CBM). All randomized controlled trials (RCTs) with moxibustion as an intervention for the treatment of female SUI were included in this study. The primary outcome of included studies was the change from baseline in urine leakage measured by the 1-hour pad test. Secondary outcomes included clinical efficacy, the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) score, mean 24-hour frequency of incontinence episodes, and adverse events. The meta-analysis was performed by STATA software (version 15.0) in this study. Results A total of 13 RCTs were included in this meta-analysis, involving 822 female SUI patients, of which 413 in the experimental group received moxibustion, and 409 in the control group received other conservative treatments (pelvic floor muscle training or acupuncture or Chinese medicine). The results of the meta-analysis showed that compared with receiving pelvic floor muscle training (PFMT) or acupuncture or Chinese medicine treatment, moxibustion intervention for female SUI reduced urine leakage in the one-hour pad test [SMD=-0.86, 95%CI (-1.03,-0.58)], significantly improved clinical efficacy [OR = 3.42, 95%CI (2.32,5.04)], decreased the ICIQ-SF score [SMD=-0.80, 95%CI (-1.03,-0.57)], and reduced average 24-hour incontinence episode frequency [SMD=-0.78, 95%CI (-1.05,-0.54)]. At the same time, no adverse events occurred during the moxibustion intervention. Conclusions Based on this meta-analysis, moxibustion, as one of the complementary and alternative medicine therapies, can be effective and safe in the treatment of female SUI. Moxibustion intervention can reduce urine leakage in the one-hour pad test, improve clinical efficacy, reduce the ICIQ-SF score, and reduce the average 24-hour frequency of urinary incontinence episodes. However, due to the low quality of evidence in this study, higher-quality RCTs are needed for further demonstration. Registration of systematic review: This systematic review and meta-analysis has been registered in the INPLASY International Registry of Prospective Systematic Reviews under the registration number INPLASY2021120052.