This is the first Cochrane Review to address the use of acupuncture to treat symptoms of overactive bladder in adults. The abstract is based on a post-editorial review version of the review.  Upon completion and approval, the final version is expected to be published in the Cochrane Database of Systematic Reviews (www.cochranelibrary.com)."

Overactive bladder (OAB) is a symptom complex including frequency of micturition, urgency with or without associated incontinence, and nocturia (1). It is a common, long-term complaint with around 11% of the population having symptoms; this figure increases with age. Symptoms can be linked to social anxiety and adaptive behavioural change. The cost of treating OAB is considerable. Medication for OAB is poorly tolerated or ineffectual in many cases (2). Botox injections and sacral nerve stimulation are invasive treatments and are associated with side effects. Therefore, it is imperative that alternative strategies are tested. Researchers have studied the effect of acupuncture as a treatment for OAB, and it is postulated to influence afferent and efferent nerve signalling to the bladder and central nervous system.

The aims of the review were to assess the effects and safety of acupuncture for treating OAB in adults; and to summarise the priorities for further research.

This review drew on the search strategy developed for Cochrane Incontinence.  We identified relevant trials from the Cochrane Incontinence Specialised Register. We also searched the Allied and Complementary Medicine database (AMED) on OvidSP. In addition, electronic bibliographic databases where knowledge of the Chinese language was necessary were searched, China National Knowledge Infrastructure (CNKI); Chinese Medical Literature Database (CBM); Chinese Medical Current Content (CMCC)VIP, and WANFANG (China Online Journals). The date of the most recent search of the Cochrane Incontinence Specialised Register for this review is 1 March 2021
We included randomised controlled trials (RCTs), quasi-RCTs, and cross-over studies of acupuncture for treating OAB in adults. Four review authors formed pairs to review studies and extract data (two for English-language studies; two for Chinese-language studies). Both pairs of review authors used Covidence software (3) and the same screening and data extraction processes. Risk of bias was assessed using Cochrane's 'Risk of bias' tool and heterogeneity was assessed using the Chi2 and I2 statistics generated in the meta-analyses.  A fixed effects model was used unless there was a moderate or high level of heterogeneity when a random effects model was employed. The GRADE approach was used to assess the certainty of evidence.

We included 15 studies involving 1395 participants in the review. Of these, 14 were RCTs and 1 was a quasi-RCT. 
Acupuncture versus no treatment
One study compared acupuncture to no treatment to establish feasibility for a larger study. The evidence is very uncertain regarding the effect of acupuncture compared to no treatment in terms of cure or improvement in OAB symptoms. 
Acupuncture versus sham acupuncture
Five studies compared acupuncture with sham acupuncture. The evidence is uncertain about the effect of acupuncture on cure or improvement in OAB symptoms compared to sham acupuncture (SMD -0.36, 95%CI -1.03 to 0.31; 3 studies; 151 participants; I2 = 65%; very low-certainty evidence).
Acupuncture versus medication
Eleven studies compared acupuncture with medication for OAB symptoms. Low certainty evidence suggests that acupuncture may slightly increase cure or improvement in OAB symptoms compared to medication for OAB (RR 1.25; 95% CI 1.10 to 1.43; 5 studies; 258 participants; I2 =19%; low certainty evidence).
Safety of acupuncture for OAB
There were no incidences of major adverse events in any of the included studies. However, major adverse events are rare in acupuncture trials and the numbers included in this review may be insufficient to detect these events. 
There is no evidence of a difference between true and sham acupuncture in terms of minor adverse events. There is low-certainty evidence that acupuncture may slightly reduce the incidence of minor adverse events when compared to medication for OAB (OR 0.25; 95% CI 0.18 to 0.35; 8 studies; 1004 participants; I² = 73%; low certainty evidence).

This review provides low-certainty evidence that acupuncture may result in a slight increase in cure or improvement of OAB symptoms when compared with medication for OAB.  In addition, it may reduce the incidence of minor adverse effects compared to medication. 
It is uncertain if there is any difference between acupuncture and sham acupuncture for cure or improvement in OAB symptoms.
The evidence is very uncertain about the effect acupuncture has on cure or improvement in OAB symptoms compared to no treatment.

The conclusions of this review were limited by the certainty of the current evidence. The review team identified that many of the included studies recruited small numbers of participants, had design flaws, and were conducted over a short time-period. The evidence does suggest that acupuncture may have similar outcomes to medication for OAB but with a lower side effect profile. This finding must remain tentative until larger, high‐quality studies, that use comparable and relevant outcomes, are completed. Timing and frequency of treatment, point selection, application and long- term follow up are all relevant topics for research. Acupuncture could be offered as a treatment option to OAB sufferers who are not suitable for, or do not wish to consider more invasive treatments or those who wish to avoid the use of medication.

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Covidence [Computer program] Veritas Health Innovation. Covidence. Version accessed 2 January 2020. Melbourne, Australia: Veritas Health Innovation

Continence 2S2 (2022) 100360
DOI: 10.1016/j.cont.2022.100360