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RESEARCH AND PRACTICE |
Terje Alraek and Anders Baerheim are with the Department of Public Health and Primary Health Care, Section for General Practice, University of Bergen, Bergen, Norway. Liv Inger Fosli Soedal and Siri Urnes Fagerheim are medical students in the Department of Public Health and Primary Health Care, Section for General Practice, University of Bergen. Asbjørn Digranes is with the Department of Microbiology and Immunology, Gade Institute, Haukeland Hospital, Bergen, Norway.
Correspondence: Requests for reprints should be sent to Terje Alraek, BAc, Department of Public Health and Primary Health Care, University of Bergen, Ulriksdal 8C, N-5009 Bergen, Norway (e-mail: terje.alrek{at}isf.uib.no).
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INTRODUCTION |
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 TOP INTRODUCTION METHODSRESULTSDISCUSSIONReferences |
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A recent study indicated that the rate of cystitis among cystitis-prone women treated with acupuncture was one third the rate among untreated women and half the rate among women treated by sham acupuncture (shallow needling outside known acupuncture points).4 In the present study, we sought to evaluate the effect of acupuncture treatment in preventing uncomplicated recurrent lower UTIs among adult nonpregnant women.
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METHODS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Two women failed to meet the inclusion criteria. Of the 98 women included in the study, 4 subsequently dropped out (2 in the acupuncture group and 2 in the control group).
After written informed consent had been obtained, baseline measurements had been taken, and a diagnosis had been made according to principles of traditional Chinese medicine (TCM), a closed envelope containing the patient’s randomized assignment to acupuncture treatment or no treatment was opened. Participants were randomized in blocks of 4 (at a ratio of 3:1) to acupuncture treatment (n = 67) or no treatment (n = 27).
Treatment consisted of insertion of needles and obtaining of deqi (a sensation described as numbness, heaviness, and distention). Acupuncture points were chosen according to the patient’s TCM diagnosis. Points were located on the lower abdomen or back (CV-3 or CV-4 and BL-23 or BL-28) or on the lower extremities (KI-3, SP-6, SP-9, ST-36, or LR-3). Treatments were administered twice weekly for 4 weeks.
The primary effect measure was number of occurrences of acute lower UTI during a 6-month follow-up. Residual urine was measured with the automatic Bladder BVI Scan 2500 (Diagnostic Ultrasound Corporation, Wash). Measurements were repeated at 2, 4, and 6 months.
Samples used in bacteriological examinations were collected from clean-voided urine via a dip slide (Uricult; Orion Diagnostica, Finland). Specimens were examined, by bacteriologists unaware of group assignment, at the Gade Institute, Haukeland Hospital, in Bergen, Norway. Acute lower UTI was defined as the presence of (1) the distal urinary symptoms described earlier and (2) bacteriuria (105 or more colony-forming units per milliliter of uropathogen or any amount of Staphylococcus saprophyticus).
We used Fisher exact tests and 
2 tests (categorical data) or independent t tests (parametric data) to assess differences between groups; differences within groups were examined with paired t tests. We report incidence rates of acute lower UTIs in the observation period as number of episodes per person-month, and results of comparisons between groups as incidence rate ratios (IRRs).
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RESULTS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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, there were no statistical differences between groups in regard to mean age or mean number of acute lower UTIs in the preceding 12 months. Following treatment, 73% of women in the acupuncture group were free of UTIs during the 6-month observation period, as compared with 52% of women in the control group (P = .08). During the observation period, half as many UTI episodes per person-month occurred in the acupuncture group as in the control group (IRR = 0.45; 95% confidence interval [CI] = 0.23, 0.86; P 
.05; Table 1).
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.01; Table 1
).
Women in the acupuncture group experienced a 50% reduction in residual urine after 6 months relative to baseline (35.4 vs 18.2 mL; P .01), whereas women in the untreated group exhibited no significant change in residual urine (35.5 vs 38.8 mL). As can be seen in Table 2, the number of women in the treated group with residual urine levels below 10 mL had doubled by the 6-month follow-up, compared with no change among women in the untreated group (P .05).
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DISCUSSION |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Typically, only 10% of a normal adult female population without specific urinary symptoms will have residual urine levels above 10 mL7; 75% of our participants had levels above 10 mL at study entry. Residual urine is a risk factor in the pathogenesis of recurrent lower UTIs among postmenopausal women.8,9 Our data indicate that this also may be the case among adult women in general.
In summary, our results, as well as previous findings,4 indicate that acupuncture treatment may be effective in preventing recurrent lower UTIs in healthy adult women.
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Acknowledgments |
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We thank Norbert Cools, the participating acupuncturist, and Gerd Anne Wincentsen, the nurse who carried out all physical measurements. We also thank Roger Martin for linguistic support.
Human Participant Protection
This study was approved by the Regional Ethical Committee and the Norwegian Data Inspectorate.
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Footnotes |
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Accepted for publication June 7, 2002.
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References |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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2. Foxman B, Barlow R, D’Arcy H, Gillespie B, Sobel JD. Urinary tract infection, self-reported incidence and associated cost. Ann Epidemiol. 2000;10:509–515.[Medline]
3. Schaeffer AJ. Urinary tract infections: antimicrobial resistance. Curr Opin Urol. 2000;10:23–24.[Medline]
4. Aune A, Alraek T, Huo L, Baerheim A. Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women. Scand J Prim Health Care. 1998;16:37–39.[Medline]
5. Baerheim A, Larsen E, Digranes A. Vaginal application of lactobacilli in the prophylaxis of recurrent lower urinary tract infection in women. Scand J Prim Health Care. 1994;12:239–243.[Medline]
6. O’Grady F, Cattell WR. Kinetics of urinary tract infection, II: the bladder. Br J Urol. 1966;38:156–162.[Medline]
7. Raz R, Gennesin Y, Wasser J, et al. Recurrent urinary tract infections in postmenopausal women. Clin Infect Dis. 2000;30:152–156.[Medline]
8. Stamm WE, Raz R. Factors contributing to susceptibility of postmenopausal women to recurrent urinary tract infections. Clin Infect Dis. 1999;28:723–725.[Medline]
This article has been cited by other articles:
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  A. R. Katz URINARY TRACT INFECTIONS AND ACUPUNCTURE Am J Public Health, May 1, 2003; 93(5): 702 - 702. [Full Text] [PDF]
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T. Alraek and A. Baerheim ALRAEK AND BAERHEIM RESPOND Am J Public Health, May 1, 2003; 93(5): 702 - 703. [Full Text] [PDF]
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