Efficacy observation on acupuncture-moxibustion for urinary retention after surgery for cervical cancer

Hong Mei (洪媚), Lu Cai-juan (鲁才娟)

Hangzhou First People’s Hospital, Zhejiang 310006, China

Efficacy observation on acupuncture-moxibustion for urinary retention after surgery for cervical cancer

Hong Mei (洪媚), Lu Cai-juan (鲁才娟)

Hangzhou First People’s Hospital, Zhejiang 310006, China

Objective:To observe the efficacy of acupuncture-moxibustion therapy in treating urinary retention after surgery for cervical cancer.

Acupuncture-moxibustion Therapy; Acupuncture Therapy; Cupping Therapy; Uterine Cervical Neoplasms; Postoperative Complications; Urinary Retention

Cervical cancer is a common type of malignant gynecological tumor, usually treated with radical or subradical hysterectomy[1]. Because of the extensive operation scope, urinary retention has become one of the common complications after surgery, and the occurrence rate is about 1.8%-32.4%[2-3]. Currently, indwelling urethral catheter (IUC) is often used to manage this complication, but innervations disturbance may still happen, not to mention about the high possibility of causing urinary infection. The complications not only affect the result of surgery, but also bring psychological, physiological and economic burden to the patients. In traditional Chinese medicine (TCM), urinary retention falls under the scope ofLong Bi(uroschesis). During recent years, the efficacy of acupuncture-moxibustion in treating urinary retention has been confirmed, but the efficacy varies due to different observation angle and criteria for evaluating therapeutic efficacy. From November 2012 to April 2014, we adopted acupuncture-moxibustion as the dominant method to treat urinary retention after surgery for cervical cancer, and the report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

The diagnosis of cervical cancer was referred to the diagnostic criteria of International Federation of Gynecology and Obstetrics (FIGO) in 1995[4].

Urinary retention was diagnosed by referring to the diagnostic criteria forLong Bi(uroschesis) in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[5].

1.2 Inclusion criteria

Age between 18 and 70 years old; diagnosed with cervical cancer and receiving IUC after laparoscopic radical hysterectomy; unable to urinate under voluntary control 2 weeks after the surgery, or able to urinate but the residual urine volume ＞100 mL; no damage of urethral tubes during the surgery, and no urinary infection or renal function injury after the surgery; without organic disorders involving heart, liver, or kidney; willing to sign the informed consent form.

1.3 Exclusion criteria

Those on medications for urinary retention; those failed to cooperate during examinations or treatments.

1.4 Statistical method

The SPSS 11.0 statistical software was adopted for data processing. The comparison of rate was examined by using Chi-square test.P＜0.05 indicates a statistically significant difference.

1.5 General data

Since November 2012 to April 2014, 50 patients having received radical hysterectomy had been recruited from the Inpatient Department when urinary diseases were excluded and bladder function was proved normal before the surgery. The subjects all received IUC with 2-way Foley catheter (size 12) after the surgery. According to the odd-even number of their visiting sequence and by coin flipping, the odd numbers were recruited into the treatment group and the even numbers into the control group, 25 in each group.

In the treatment group, the age range was 28-69 years old; according to FIGO staging, 5 cases belonged to cervical cancer stage Ⅰa, 16 of stage Ⅰb, 4 of stageⅡa. In the control group, the age range was 29-66 years old; 3 cases of cervical cancer stage Ⅰa, 17 of stage Ⅰb, and 5 of stage Ⅱa. There were no statistical significances in comparing the age, disease stage, operation type, operation time, and bleeding during operation (P＞0.05).

Table 1. Comparison of general data

2 Treatment Methods

2.1 Treatment group

2.1.1 Conventional treatment

After surgery, the indwelled catheter was kept open, perineum was sterilized once a day, and sterile urine bag was replaced every day. From the 7th day, the catheter was occluded regularly, open once every 2 h during daytime, and every 3-4 h during night, while kept open whenever there was a urination desire; bladder irrigation was also performed as a conventional management for IUC.

2.1.2 Acupuncture-moxibustion treatment

Acupuncture-moxibustion was given since the 7th day after the surgery.

Acupoints: Bilateral Zusanli (ST 36), Sanyinjiao (SP 6), Yinlingquan (SP 9) and Shuidao (ST 28); Qihai (CV 6), Guanyuan (CV 4) and Zhongji (CV 3); Pangguangshu (BL 28) and Zhibian (BL 54).

Method: After standard sterilization, filiform needles of 0.25 mm in diameter and 40 mm in length were punctured at Zusanli (ST 36), Sanyinjiao (SP 6), Yinlingquan (SP 9) and Shuidao (ST 28). Even reinforcing-reducing manipulations were performed after needling qi was obtained. When Shuidao (ST 28) was punctured, the needling sensation should radiate to the perineum and meanwhile, the patient should feel that the lower abdomen was contracting. During the retaining of the needles, a 6-8 cm moxa stick was ignited at both ends and then put into a moxa box to place on the lower abdomen of the patient, covering Qihai (CV 6), Guanyuan (CV 4) and Zhongji (CV 3). The moxibustion treatment was performed for 30 min, with the temperature under patient’s tolerance. The moxa box was put away when the moxa was burnt out, and the needles were also removed. The patient was then asked to take a prone position to receive acupuncture at bilateral Pangguangshu (BL 28) with even reinforcingreducing manipulations conducted after qi arrived; afterwards, needles of 0.30 mm in diameter and 75 mm in length were used to puncture bilateral Zhibian (BL 54), with the needle tip directed towards Shuidao (ST 28) and lifting-thrusting twirling reducing manipulations performed after qi arrived. For acupuncture at Pangguangshu (BL 28) and Zhibian (BL 54), the needling sensations should radiate to the perineum, while the needles were not retained.

2.1.3 Cupping

Following acupuncture-moxibustion treatment, cupping was given to bilateral Pangguangshu (BL 28) and Zhibian (BL 54), 4 cups in total, for 15 min.

The above treatments were given once a day for successive 7 d. The catheter was then removed. The patients were asked to take as much water as possible and try hard to urinate. A urinary B-type ultrasonic inspection was prescribed to evaluate residual urine volume after 2-3 times of voluntary urination.

2.2 Control group

Patients in the control group only received conventional treatments, and the treatment protocol, duration and cautions after removal of catheter were same as those in the treatment group.

3 Therapeutic Observation

3.1 Criteria of therapeutic efficacy[6]

Recovery: Urination was smooth and under voluntary control, and the residual urine volume ＜50 mL.

Improved: Voluntary urination, residual urine volume＞50 mL, but ＜100 mL.

Invalid: Failed in voluntary urination, or difficulty urinating, or residual urine volume ＞100 mL.

3.2 Treatment results

After 7-day treatments, the total effective rate was 92.0% in the treatment group versus 72.0% in the control group, and the difference was statistically significant (P＜0.05), indicating that the efficacy of the treatment group was more significant than that of the control group.

Table 2. Comparison of therapeutic efficacy (case)

4 Experience

Modern medicine has revealed that bladder function is innervated by sympathetic nerves (majorly hypogastric nerves) and parasympathetic nerves (pelvic nerves). The two types of nerve fibers join together and form pelvic nerve plexus. After radical hysterectomy, operation trauma, hematoma and post-operation scar can all bring harm to the pelvic nerve plexus; traction of bladder during operation, and lacking of support for bladder and lower segment of urethral tubes may cause a temporary cystoparalysis, which has become a major factor in causing post-operation urinary retention[7]. Urinary retention is manifested as difficulty urinating and urine retained in the bladder[8]. In China, post-operation urinary retention is defined as being unable to urinate voluntarily or able to urinate voluntarily but the residual urine volume ＞100 mL[4].

Urinary retention falls under the scope of Long Bi (uroschesis) in TCM. After operation, weakened qi and blood and obstructed Bladder Meridian will lead to disturbance of qi activities, and Long Bi (uroschesis) will develop when bladder fails to transform qi. Therefore, acupuncture-moxibustion treatment targets to unblock meridians and collaterals, and regulate qi and blood circulation. The selected points mostly work to modulate qi activities, enhance qi transformation, unblock lower energizer and regulate water passage. Shuidao (ST 28), as referred by its name, works to regulate water passages and resolve dampness. Zhongji (CV 3), Qihai (CV 6) and Guanyuan (CV 4) are from the Conception Vessel, and Zhongji (CV 3) and Pangguangshu (BL 28) were used as a pair of Front-Mu and Back-Shu points; Qihai (CV 6) can enhance the function of bladder in qi transformation; Guanyuan (CV 4) is where the qi of triple energizers locates, working to tonify the kidney and boost the function of bladder in qi transformation. Point-toward-point needling from Zhibian (BL 54) to Shuidao (ST 28) can effectively treat some chronic diseases involving underlying tissues. Sanyinjiao (SP 6), Zusanli (ST 36) and Yinlingquan (SP 9) were selected distally along meridians to regulate the general function of the body; moreover, Sanyinjiao (SP 6) can modulate qi and blood of the three yin meridians of foot, and can unblock the triple energizers to help pass urine when used together with Yinlingquan (SP 9). As an important point for health care and consumptive problems, Zusanli (ST 36) was selected to supplement qi, assist bladder in qi transformation, specifically benefiting patients suffering from insufficient qi and blood after surgery.

In this study, Qihai (CV 6), Zhongji (CV 3) and Guanyuan (CV 4) were given moxibustion instead of acupuncture because of the operative incision. Moxa is of pure yang in nature and it can affect the twelve regular meridians. The use of moxa box was to enlarge the treated area, not only enhancing the effect of moxibustion in unblocking meridians and collaterals, activating blood circulation and resolving blood stasis, activating yang qi, transforming qi and circulating water, but also avoiding burning skin and clothes. Together with cupping therapy, acupuncture-moxibustion can work better to boost the function of bladder in qi transformation and pass of urine[9-10].

The current study shows that the efficacy of the treatment group is more significant than that of the control group, indicating that acupuncture-moxibustion plus cupping based on the conventional treatment is effective for urinary retention after surgery for cervical cancer, and is worth promoting is clinic.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

Received: 8 December 2014/Accepted: 18 January 2015

[1] Ye XY, Li XY, Ma LG. Follow-up analysis of relation between quality of life and ovary function after surgery for cervical cancer. Hebei Yiyao, 2010, 32(14): 1893-1894.

[2] Uccella S, Laterza R, Ciravolo G, Volpi E, Franchi M, Zefiro F, Donadello N, Ghezzi F. A comparison of urinary complications following total laparoscopic radical hysterectomy and laparoscopic pelvic lymphadenectomy to open abdominal surgery. Gynecol Oncol, 2007, 107(Suppl 1): S147-S149.

[3] Zakashansky K, Chuang L, Gretz H, Nagarsheth NP, Rahaman J, Nezhat FR. A case-controlled study of total laparoscopic radical hysterectomy with pelvic lymphadenectomy versus radical abdominal hysterectomy in a fellowship training program. Int J Gynecol Cancer, 2007, 17 (5): 1075-1082.

[4] Chen HZ. Clinical Series of Gynecological Tumors: Cervical Cancer. Wuhan: Hubei Science & Technology Press, 2003: 220.

[5] State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine. Nanjing: Nanjing University Press, 1994: 27-28.

[6] Jia ZL, Dai EQ, Li XZ. Controlled studies of efficacy of acupuncture and Western medicine treating with urinary retention after cervical cancer radical operation. Zhonghua Zhongyiyao Xuekan, 2012, 30(10): 2249-2250.

[7] Zhou JM, Tang CH. Relevant factor analysis of urinary retention after surgery for cervical cancer. Qiqihar Yixueyuan Xuebao, 2010, 31(20): 3236-3238.

[8] Wu JP. Urinary Surgery. Jinan: Shandong Science & Technology Press, 2004: 1244.

[9] Song XL, Yu X. Warm needling moxibustion at Zhongji (CV 3) and Zusanli (ST 36) for urinary retention after gynecological surgery. J Acupunct Tuina Sci, 2014, 12(6): 379-382.

[10] Hong M, Song SL. Acupuncture plus cupping and moxibustion for 30 cases of postpartum urinary retention. Zhongguo Zhongyiyao Keji, 2012, 19(4): 369.

Translator: Hong Jue (洪珏)

针灸治疗宫颈癌术后尿潴留疗效观察

目的：观察针灸治疗宫颈癌术后尿潴留的临床疗效。方法：符合纳入标准的50例患者, 根据就诊顺序按单、双号随机分为治疗组和对照组, 每组 25例。对照组予以妇科术后留置导尿常规处理, 治疗组在对照组基础上于术后第7天予以针灸、拔罐治疗，观察治疗后两组患者的残余尿量及总有效率。结果：经过7 d治疗, 治疗组总有效率92.0%, 对照组为72.0%, 两组总有效率差异有统计学意义(P＜0.05)。结论：常规治疗基础上加用针灸、拔罐对宫颈癌术后尿潴留有确切疗效, 值得临床推广使用。

针灸疗法; 针刺疗法; 拔罐; 宫颈肿瘤; 术后并发症; 尿潴留

R246.2 【

】A

Author: Hong Mei, master degree candidate, attending physician of Chinese medicine.

E-mail: hongmeiah@126.com

Methods:Fifty eligible patients were randomized into a treatment group and a control group by their visiting sequence, 25 in each group. The control group was intervened by indwelling urethral catheter after gynecological surgery; while the treatment group started to receive acupuncture-moxibustion and cupping treatment at the 7th day after surgery, in addition to the intervention given to the control group. The residual urine volume and total effective rate of the two groups were detected.

Results:After 7-day treatments, the total effective rate was 92.0% in the treatment group versus 72.0% in the control group, and the difference was statistically significant (P＜0.05).

Conclusion:Acupuncture-moxibustion treatment plus cupping based on the conventional intervention is effective for urinary retention after surgery for cervical cancer, worth promoting in clinic.