Improvement of Urinary Retention Symptoms With Electroacupuncture Therapy
Condition: Urinary Retention
MeSH terms: Urinary Retention
Study type: Interventional

Summary: 
      Postpartum urinary retention (PPUR) can occur in women who deliver vaginally. The incidence
      of this occurrence varies from 1.7 - 17.9%, this different variation due to different
      definitions of PPUR and the methods used to measure it. There are 2 categories of RUPP,
      namely covert and overt, in overt PPUR the prevalence ranges from 0.3 to 4.7%, while covert
      PPUR can reach up to 45%. In Indonesia alone, the incidence of PPUR is around 14.8%3, where
      vaginal PPUR is around 70% more higher than sectio caesarean patients. A study conducted at
      the RSCM in 2009 by Yustini, et al stated that the incidence of PPUR was 9-14%, and if the
      delivery was using forceps it would increase to 38%. Other studies conducted by Suskhan at
      the RSCM in 2015, it was stated that the incidence of urinary retention was 13.6% of 500
      research subjects. Another study conducted by Chen, et al in 2020 in China, stated that the
      most common cause of urinary retention in hospitals was surgery. gynecological cases, which
      is 69% while for obstetric cases by 18.6% where the main cause of this retention is due to
      vaginal delivery. The high number of PPUR can increase the incidence of postpartum
      hemorrhage, urinary tract infections, mental fatigue during the puerperium and result in
      delays in breastfeeding. Bladder catheterization which is one of the treatments for PPUR is
      also closely related to the risk the occurrence of morbidity and complications, where 17.5%
      of urinary tract infections are infections obtained from hospitals or HAIs (Healthcare
      Associated Infections) and 80% of these infections are caused by the installation of urethral
      catheters, especially the installation of urethral catheters in the ER which is carried out
      without clear indications such as described in a study conducted by Gokula et al in Michigan
      in 2007.

      According to Sudhakaran, symptomatic RUPP (overt) is defined as the absence of a spontaneous
      voiding process or the inability to urinate since 6 hours after vaginal delivery or 6 hours
      after catheter removal after caesarean section. Asymptomatic (covert) PPUR is defined as a
      post-void residual volume (PVRV) 200 ml after the first spontaneous urination as measured by
      ultrasound or catheter, which indicates incomplete voiding.6 Asymptomatic PPUR may occur due
      to reduced sensation and contractility that occurs as a result of trauma from the innervation
      to the bladder. Symptoms of this RUPP according to Suskhan are unexplained urination,
      prolonged urination, more frequent urination, inability to urinate, feeling of full bladder
      and abdominal distension. The presence of the above symptoms will cause the bladder to
      enlarge during a physical examination of the abdomen.

      Acupuncture as a non-medical therapy has been widely used both in China and in other
      countries, especially to treat pain and neurological disorders. Urination is a neural reflex
      activity. Acupuncture points that correspond to the innervation of the bladder can stimulate
      conduction of parasympathetic nerve impulses, resulting in bladder detrusor contraction,
      increased intravesical pressure and relaxation of the internal sphincter. Thus, acupuncture
      can regulate bladder function in the process of urination.

      Based on the study of Zhao, et al, it was stated that electroacupuncture can stimulate
      afferent and efferent nerves in the pelvic cavity of rats, increase detrusor contraction and
      encourage urination. Other studies have shown that electroacupuncture can also reduce the
      myoelectric activity of abnormal contraction of the external urethral sphincter during
      urination, reduce resistance during urination, improve coordination between the bladder
      detrusor and urethral sphincter and reduce residual urine volume. As for the side effects
      caused by acupuncture based on a systematic study conducted almost none.

      Based on the description above, acupuncture can be considered as a supportive therapy that
      can overcome the problem of PPUR with minimal side effects to prevent worsening of the
      condition. In this study, researchers wanted to determine the effectiveness of acupuncture
      interventions using electroacupuncture modalities to accelerate urination after delivery and
      reduce residual urine volume in patients after vaginal delivery with electroacupuncture
      intervention for 30 minutes / session, 2 sessions in 1 x 24 hours.
    


Intervention name(s): true electroacupuncture; sham electroacupuncture
Intervention type(s): Other; Other
Intervention description(s): the investigators use stainless steel acupuncture needle, disposable : Huanqiu® 0.25 x 0.40 mm Electroacupuncture device : Hwato-SDZ V®, continuous wave, 2 Hz, for 30 minutes; the investigators use the same device like true electroacupuncture group, but the acupuncture needle not puncture on the skin and only attached.
electroacupuncture device, with no electrical stimulation
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Study divided into 2 arms, true electroacupuncture group and sham electroacupuncture group
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Urinary Retention; Postpartum urinary retention; electroacupuncture; vaginal delivery; acupuncture