New research finds acupuncture effective in reducing postoperative complications due to a radical hysterectomy. This surgery is often used to treat some types of cervical cancers. The procedure involves removal of the uterus and connecting ligaments, cervix and approximately 1-2 inches of the deep vagina. A radical hysterectomy may affect urination while the nerves in the region of the uterus recover from surgery. Acupuncture needles used to decrease complications after surgery. The new clinical trial measured significant improvements in bladder function and reductions in urinary tract infections (UTIs) for women receiving acupuncture after a radical hysterectomy.

The randomized, sham-controlled, single-blinded clinical trial was performed at Sun Yat-sen Memorial Hospital of Sun Yat-sen University. All participants were between the ages of 20-65 years of age, had no prior acupuncture experiences and willingly signed an informed consent. A total of 120 women were randomly divided equally into an acupuncture treatment group and a sham acupuncture control group. The patient outcomes were evaluated based on bladder function and postoperative complications.

The acupuncture treatment group showed significant improvements in bladder function including improved maximal flow rate, decreased bladder sensory loss, bladder compliance, first voiding desire, maximal cystometric capacity, decreased residual urine and a decrease in both urinary retention and incontinence. The acupuncture treatment group also had a significant decrease in the frequency of UTIs. The researchers note, "By improving postoperative bladder function, early intervention of acupuncture may provide a valuable alternative method to prevent bladder dysfunctional disorders and urinary tract infection after radical hysterectomy."

The researchers provided important background data. It is estimated that approximately 500,000 new cases of cervical cancer are diagnosed annually. Surgical treatments include radical hysterectomy with pelvic lymphadenectomy for both early stage cervical cancer and stage II endometrial cancer. Postoperative complications remain a major concern in patient management. The researchers note that acupuncture is already a common procedure used to prevent complications following abdominal surgery in Chinese hospitals. As a result, the researchers initiated this most recent investigation.

The Acupuncture Treatment
All accredited acupuncturists providing patient care had a minimum of 8 years of acupuncture experience and clinical research training. Acupuncture was initiated on day 6 after the radical hysterectomy at a rate of once per day for 5 days. A protocolized acupuncture point treatment prescription was applied using 0.30 X 25mm stainless steel filiform needles. Needling of acupuncture points Sanyinjiao (SP6), Zusanli (ST36), Shuidao (ST28) and scalp acupuncture point Epangxian III (MS4) was applied bilaterally. Needle insertion depth was 20mm, perpendicularly, for both SP6 and ST36. An oblique insertion technique towards the symphysis pubis to a depth of 20mm was used for ST28. Acupuncture point MS4 was needled to a depth of 15mm, transversely. Manual needle manipulation techniques were applied to achieve the arrival of deqi, often described as a sensation of distention, heaviness and soreness. Electroacupuncture was applied to SP6, ST28 and MS4 bilaterally for a total of 30 minutes. A continuous wave of 4 Hz was adjusted to patient comfort intensity levels.

Sham acupuncture employed the insertion of acupuncture point LI14 (Binao) to a depth of 3mm. Electroacupuncture stimulator leads were attached without any electrical current applied. No manual manipulation techniques were applied to the needles. Scalp lines are depicted here.

The researchers discovered that acupuncture improves postoperative bladder function and reduces the frequency of bladder disorders. They note that both manual and electrical acupuncture stimulation at S2-S4 of pelvic splanchnic and pudendal nerves may be responsible for the beneficial patient outcomes. The researchers cite additional studies showing that, "Acupuncture has positive effects on nerve regeneration process and provides an alternative treatment on nerve-injured patients." They add that acupuncture’s therapeutic effect following a radical hysterectomy may involved nerve restoration and reconstruction.

The researchers also cite studies showing that needling acupoints ST36 and SP6 regulate neurotransmitters including catecholamines. One specific physiologic function of catecholamines is to regulate smooth muscle relaxation. The investigative team notes that this may play a role in the mechanisms of acupuncture to reduce postoperative complications.

Extended periods of catheterization increase the risk of urinary tract infections. Acupuncture successfully reduced urinary retention and the need for prolonged catheterization. This partially explains how acupuncture significantly reduced the frequency of urinary tract infections.

Reference:
Yi, Wei-min, Qing Chen, Chang-hao Liu, Jia-yun Hou, Liu-dan Chen, and Wei-kang Wu. "Acupuncture for Preventing Complications after Radical Hysterectomy: A Randomized Controlled Clinical Trial." Evidence-Based Complementary and Alternative Medicine 2014 (2014).