Are acupuncture and related therapies beneficial for childhood nocturnal enuresis?
Date of publication of the systematic review: 2005
Design
Systematic review of 1 randomized controlled trial (RCT) and 3 non-randomized controlled trials.
Participants
359 children with nocturnal enuresis who were younger than 18 years old of either gender. The reviewers did not report the mean age and gender proportion of the participants.
Intervention
Acupuncture and related therapies for 3 weeks to 2 months (one trial did not state the treatment duration). The following modes of treatment might have been included: needle acupuncture, moxibustion, electro acupuncture and laser acupuncture. Details about the point selection, frequency and total number of treatment, dosage and route of administration of the interventions applied in both groups were not described by the reviewers.
Comparator
Comparison 1: Acupuncture plus other therapy versus other therapy alone;
Type of acupuncture was not clearly stated by the reviewers. Baseline treatment for both groups was auricular seed embedding or herbal medicine.
Comparison 2: Laser acupuncture versus antidiuretic medication.
Major Outcomes
Outcome 1: Enuresis cure at 6 months after the end of treatment. One trial did not report the duration of follow up. Trials reported the ‘change in number of wet nights per week following cessation of acupuncture’ as cure, however the definition was not uniformly stated.
Settings
The reviewers did not state where the trials were conducted and whether the trials were conducted in inpatient or outpatient settings.
Comparison    Acupuncture plus other therapy versus other therapy alone
Main Results
Compared to other therapy alone, acupuncture in combination with other therapy showed significant improvement on enuresis cure at 6 months after the end of treatment (pooled relative risk increment (pooled RRI): 64%, 95% CI 6% to 156%).
Comparison 1: Acupuncture plus other therapy versus other therapy alone in children with nocturnal enuresis
Outcome (units) No. of studies (Total number of participants) No. of events/No. of participants Heterogeneity test (I2) Pooled RRI (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NA) 3 (267) 94/131 59/136 70% 64% (6% to 156%) Low
Keys: RRI: relative risk incrememt; CI: confidence interval.
Comparison    Laser acupuncture versus antidiuretic medication
Main Results
Compared to antidiuretic medication, laser acupuncture did not show significant improvement on enuresis cure at 6 months after the end of treatment (RRR: 13%, 95% CI: -30% to 42%).
Comparison 2: Laser acupuncture versus antidiuretic medication in children with nocturnal enuresis
Outcome (units) No. of studies (Total number of participants) No. of events/No. of participants (Event rate) Heterogeneity test (I2) RRR (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NA) 1 (40) 13/20 15/20 Not applicable as there is only 1 study. 13% (-30% to 42%) Low
Keys: RRR: relative risk reduction; CI: confidence interval.
Comparison    Acupuncture plus other therapy versus other therapy alone
Main Results
Compared to other therapy alone, acupuncture in combination with other therapy showed significant improvement on enuresis cure at 6 months after the end of treatment (pooled relative risk increment (pooled RRI): 64%, 95% CI 6% to 156%).
Comparison 1: Acupuncture plus other therapy versus other therapy alone in children with nocturnal enuresis
Outcome (units) 1 (NA)
No. of studies (Total number of participants) 3 (267)
No. of events/No. of participants Intervention 94/131
Comparator 59/136
Pooled RRI (95% CI) 64% (6% to 156%)
Overall quality of evidence* Low
Keys: RRI: relative risk incrememt; CI: confidence interval.
Comparison    Laser acupuncture versus antidiuretic medication
Main Results
Compared to antidiuretic medication, laser acupuncture did not show significant improvement on enuresis cure at 6 months after the end of treatment (RRR: 13%, 95% CI: -30% to 42%).
Comparison 2: Laser acupuncture versus antidiuretic medication in children with nocturnal enuresis
Outcome (units) 1 (NA)
No. of studies (Total number of participants) 1 (40)
No. of events/No. of participants (Event rate) Intervention 13/20
Comparator 15/20
RRR (95% CI) 13% (-30% to 42%)
Overall quality of evidence* Low
Keys: RRR: relative risk reduction; CI: confidence interval.
Conclusion
Benefits
Compared to other therapy alone, acupuncture in combination with other therapy can benefit children with nocturnal enuresis on reducing the number of wet nights. Compared to antidiuretic medication, laser acupuncture showed similar curative effect amongst children with nocturnal enuresis on reducing the number of wet nights. For the outcomes of the two comparisons, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
None of the included trials reported on adverse events.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/15791606
The synopsis is based on the following article:
Bower, W. F., Diao, M., Tang, J. L., Yeung, C. K. Acupuncture for nocturnal enuresis in children: a systematic review and exploration of rationale. Neurourology and urodynamics. 2005;24(3), 267-272.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.