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JKM > Volume 37(1); 2016 > Article
Lee, Lee, Shin, Lee, Lim, Cho, and Moon: Clinical Practice Guideline for acupuncture in Post-stroke urinary retention



Objectives : This study is aimed to develop a Clinical Practice Guideline (CPG) on acupuncture treatment for the patients with Post-stroke Urinary Retention; PSUR.


Experts committee, consisting of stroke or methodology specialists, searched Medline, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and 19 Korean medicine journals. The search terms were selected to screen the randomized controlled trials (RCTs) or systematic reviews for the effectiveness of acupuncture on PSUR compared with placebo or conventional group. Levels of evidence and grades of recommendations were appraised based on Recommendations for Development of Clinical Practice Guideline in Korean Medicine.

Results & Conclusions:

4 RCT were included to build the CPG. There was a strong evidence to support the effectiveness of acupuncture treatment for PSUR. The moderate evidence was presented that over 3 times a week of the acupuncture should be performed over 4 weeks on the acupoints, such as SP6, CV3, CV6, CV4, SP9, BL28, BL23, BL22, KI3 or BL67, for 15–30 minutes. 20–140Hz frequency and 10–20 minutes of treatment is suggested if electro-acupuncture treatment is performed with. It was also suggested that the procedure should begin at the acute stage just after the vital signs of the patients are stabilized. Finally, there was a moderate evidence to support safety of acupuncture treatment for PSUR.

Table 1.
Quality of Evidence
수준 내용
I a 잘 수행된 무작위 대조 임상연구의 메타분석 및 체계적 문헌고찰로부터 얻어진 근거
I b 적어도 하나의 무작위 대조 임상연구로부터 얻어진 근거
II a 무작위 없이 적어도 하나의 잘 디자인된 대조군 연구 및 코호트 연구로부터 얻어진 근거
II b 적어도 하나의 잘 디자인된 관찰연구로부터 얻어진 근거
III 역사적 중요 문헌에 게재된 치료법으로 전문가 합의에 의한 근거
IV 연속증례연구 등 그 외의 연구로부터 얻어진 근거
V 전문가의 의견 또는 임상경험 전문가로부터 얻어진 근거
Table 2.
Grade of Recommendation
등급 내용 근거수준
A 매우권고 적어도 한 개 이상의 무작위 대조 임상연구 또는 메타분석에 의한 근거가 있는 경우 매우 권고함 I a, I b
B 권고 무작위 대조 임상연구가 아니라도 잘 수행된 연구디자인에 의한 근거이거나 역사적으로 중요 문헌에 의한 것이면 권고함. II a, II b, III
C 선택적권고 근거 자료가 부족하더라도 전문가 합의가 있을 경우 선택적으로 권고함 IV, V
GPP 임상진료지침 개발그룹의 임상적 경험에 근거하였을 경우 권고함
Table 3.
Summary of Randomized Controlled Trials of Acupuncture for Urinary Retention after Stroke
Author (year) Country Sample Size (Analyzed) Intervention Group Control Group
N (Analyzed) Range of age (Mean±SD) Types of treatment N (Analyzed) Range of age (Mean±SD) Types of treatment
Chen et al. (2000) China 64 (64) 39 (39) 55∼78 (63±NR) WA + PT 25 (25) 46∼72 (61.5±NR) PT
Gong et al. (2003) China 60 (60) 30 (30) 55∼70 (NR) NSR SA + Ginger-salt-indirect moxibustion 30 (30) 55∼70 (NR) NSR Ginger-salt-indirect moxibustion
Wang et al. (2009) China 142 (142) 74 (74) 39∼72 (55.6±8.4) NSR EA + PT 68 (68) 39∼72 (55.6±8.4) NSR PT
Zeng et al. (2012) China 60 (60) 30 (30) 50∼80 (67.66±6.78) EA + PT 30 (30) 50∼80 (69.38±5.38) PT

AT(acupuncture therapy); CT(conventional therapy); EA(electro-acupuncture); FFVB(the first filling volume of bladder); MA(manual acupuncture); MUFR(maximum urine flow rate); MVBC(maximum volume of bladder capacity); NR(not reported); NSR(not separately reported by the group); PT(physical therapy); RUV(residual urine volume); SA(scalp acupuncture); UDT(urodynamic testing); WA(warm therapy)


1.. Meng NH, Lo SF, Chou LW, Yang PY, Chang CH, Chou EC. Incomplete bladder emptying in patients with stroke: Is detrusor external sphincter dyssynergia a potential cause? Archives of physical medicine and rehabilitation. 2010; 91:1105–1109.

2.. Park DS, Choi DY, Lee JD, Kim YS, Nam SS, Lee SH. The acupuncture and moxibustion medicine. Seoul: Jipmoondang;2012. p. 479

3.. Kim TG, Chun MH, Chang MC, Yang S. Outcomes of drug-resistant urinary retention in patients in the early stage of stroke. Annals of rehabilitation medicine. 2015; 39:262–267.

4.. Yu KW, Lin CL, Hung CC, Chou EC, Hsieh YL, Li TM, et al. Effects of electroacupuncture on recent stroke inpatients with incomplete bladder emptying: A preliminary study. Clinical interventions in aging. 2012; 7:469–474.

5.. Curtis LA, Dolan TS, Cespedes RD. Acute urinary retention and urinary incontinence. Emergency medicine clinics of North America. 2001; 19:591–619.

6.. Kim Y, Han T, Jung H, Chun M, Lee J, Kim D, et al. Clinical practice guideline for stroke rehabilitation in korea. Brain and NeuroRehabilitation. 2009; 2:1–38.

7.. Lee M, Lee J, Choi T, Choi J, Jeon J. Preferred reporting items for development of clinical practice guideline in korean medicine. Elsevier Korea: YJ Lee;2015.

8.. Lee MS. Preferred reporting items for development of clinicla practice guidline in korean medicine(pride-cpg-km). Daejeon: Korea Institute of Oriental Medicine;2013. p. 118

9.. Chen S, Chen H, Yu S, LW D. Therapeutic effect of warm acupuncture for treating post-stroke urinary retention. Modern Journal of Integrated Traditional Chinese and Western Medicine. 2000; 9:6. 530–531.

10.. Gong Y. Treatment of post-stroke uriary retention with scalp acupuncture and ginger-partioned moxibustion. Zhejiang Jornal of Integrated Traditional Chinese and Western Medicine. 2003; 13:8. 511

11.. Wang Z, Yang B. Clinical observation of effect of electro-acupuncture with physical bladder traning for post-stroke urinary retention. Journal of Mordern Urology. 2009; 14:2. 121–122.

12.. Zeng C, Zhou E. Clinical efficacy of electroacupuncture combined with bladder training in the treatment of post-stroke neurogenic bladder. Journal of Shandong University of Traditional Chinese Medicine. 2012; 36:6. 513–515.

13.. Park BW, Yoon JM, Moon BS. Review of clinical research on acupuncture treatment of voiding difficulty in stroke patients. J. Int. Korean Med. 2015; 36:153–164.

14.. McGee MJ, Grill WM. Selective co-stimulation of pudendal afferents enhances bladder activation and improves voiding efficiency. Neurourology and urodynamics. 2014; 33:1272–1278.

15.. Liu Y, Liu L, Wang X. Electroacupuncture at points baliao and huiyang (bl35) for post-stroke detrusor overactivity. Neural Regen Res. 2013; 8:1663–1672. doi: 1610.3969/j.issn.1673-5374.2013.1618.1004

16.. Wang H, Deng D, Huang X. Clinical observation of 43 cases of post-stroke urinary incontinence treated by electro-acupuncture and pelvic floor muscle training. Journal of Qilu Nursing. 2011; 17:12. 12–13.

17.. Zhang Q, Cui Q, Song B. 50 cases of post-stroke urinary incontinence treated by electro-acupuncture and pelvic floor muscle exercise. Chinese Journal of Traditional Medical Science and Technology. 2012; 19:1. 83–84.

18.. Zhu Z. Clinical observation on 39 cases of urinary incontinence after stroke treated by acupuncture. Chinese journal of practical nervous diseases. 2012; 15:3. 75–76.

19.. Chu J, Bao Y, Zou C, Zhao H, Gong Y, Wang C. Clinical observation of electric acupuncture in treatment of non - inhibitory neurogenic bladder. Chinese Archives of Traditional Chinese Medicine. 2012; 30:10. 2293–2294.

20.. Feng X, Bai J. Clinical observation of electroacupuncture in the treatment of urinary incontinence after stroke. Guangming Journal of Chinese Medicine. 2011; 26:2. 321–322.

21.. Wu HM, Tang JL, Lin XP, Lau JTF, Leung PC, Woo J, et al. Acupuncture for stroke rehabilitation. Cochrane Database of Systematic Reviews. 2006; CD004131

22.. Li L, Zhang H, Meng SQ, Qian HZ. An updated meta-analysis of the efficacy and safety of acupuncture treatment for cerebral infarction. PloS one. 2014; 9:e114057

23.. Shen PF, Kong L, Ni LW, Guo HL, Yang S, Zhang LL, et al. Acupuncture intervention in ischemic stroke: A randomized controlled prospective study. The American journal of Chinese medicine. 2012; 40:685–693.

24.. Huang F, Liu Y, Yao GX, Zhou FX, Wang XY. Clinical observations on treatment of ischemic stroke with acupuncture at back-shu points. Shanghai J Acupunct Moxibust. 2008; 10:4–7.

25.. Schuler MS, Durdak C, Hol NM, Klink A, Hauer KA, Oster P, et al. Acupuncture treatment of geriatric patients with ischemic stroke: A randomized, double-controlled, single-blind study. Journal of the American Geriatrics Society. 2005; 53:549–550.

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