History of Neurogenic bladder

Neurogenic lower urinary tract dysfunction is a disorder of bladder filling and emptying caused by disease or injury of the nervous system, which coordinates the bladder and its outlet from the nerves of the pelvis up to the brain, as the European Association of Urology (EAU) guidelines on neuro-urology (https://uroweb.org/guidelines/neuro-urology/chapter/treatment) describe it. Where and how far the nervous system is damaged decides the pattern: a bladder muscle (the detrusor) that contracts while it should be filling, one that contracts too weakly to empty it, or a sphincter that fails to relax. The EAU names deteriorating kidney function as the most serious long-term complication. Trials of acupuncture and electroacupuncture, in which a small current runs between the needles, have mostly enrolled people after stroke or spinal cord injury. Spinal cord injury (/wiki/evidence/spinal-cord-injury) and Urinary retention (/wiki/evidence/urinary-retention) report the reviews for those two causes in detail; this page covers what applies across causes, the sham-controlled trials, and the guidelines. The Cochrane reviews This search found no Cochrane review of acupuncture for neurogenic bladder as a whole. The nearest is the 2019 Cochrane review (https://doi.org/10.1002/14651858.CD004462.pub4) by Thomas and colleagues of treatments for urinary incontinence at least a month after a stroke, searched to November 2017: 20 trials with 1,338 people, covering behavioural, specialist nursing, physical, drug and complementary treatments. Five trials, with 524 people, compared traditional acupuncture, electroacupuncture or ginger-salt-partitioned moxibustion (burning mugwort on a layer of ginger and salt) with no intervention or usual care. Those given the needle or heat treatment were about three times as likely to be continent afterwards (risk ratio 2.82, 95% CI 1.57 to 5.07), on low-quality evidence. One electroacupuncture study reported bruising and abdominal pain after treatment. None of its acupuncture comparisons was against a sham, and its authors concluded that the evidence was insufficient to guide continence care after stroke, drawn from few, usually small trials, only four of them with adequate allocation concealment. For multiple sclerosis, Cochrane published a protocol (https://doi.org/10.1002/14651858.CD013150) by Dawson and colleagues in October 2018 for a review of conservative treatments for urinary or faecal incontinence, set to compare them with no treatment, sham, usual care and drugs. The authors withdrew it, and Cochrane’s editorial note says it will not become a review. Reviews by cause After stroke, the most recent review is a 2026 meta-analysis (https://doi.org/10.3390/medicina62040708) by Hong and colleagues. It pooled 10 randomised trials with 727 people for residual urine, bladder capacity and flow, and for a total effective rate. The authors rated the evidence very low in certainty, noted that only two trials partly reported adverse events, and concluded that no definitive conclusion could be drawn. Urinary retention sets out its figures beside an earlier review of electroacupuncture for retention after stroke. After spinal cord injury, three reviews from 2016 to 2025 pooled trials of retention and incontinence; Spinal cord injury reports them and the trials behind them. Outside those two causes this search found protocols but no completed review. A 2018 protocol (https://doi.org/10.1097/MD.0000000000009821) by Kim and colleagues, registered as PROSPERO CRD42018083857, planned a review of randomised trials of acupuncture for urinary symptoms in Parkinson’s disease and stated that none existed. A 2021 protocol (https://doi.org/10.1097/MD.0000000000024573) by Dai and colleagues planned one for diabetic neurogenic bladder, also noting that no review had been done. For multiple sclerosis, a 2022 literature review (https://doi.org/10.1016/j.msard.2022.103715) by Khodaie and colleagues searched PubMed alone for articles with at least an English abstract, included 31 of them, and listed improved bladder function among the effects they reported. Sham-controlled trials A 2013 trial (https://pmc.ncbi.nlm.nih.gov/articles/PMC4145909/) by Liu and colleagues at the Fourth Hospital of Harbin Medical University randomised 66 people with detrusor overactivity after a stroke to electroacupuncture or sham. The real group was needled 3.5 to 4 cm deep through the first to fourth sacral foramina, the openings in the back of the sacrum, at BL31 (/points/bl31) (Shangliao), BL32 (/points/bl32) (Ciliao), BL33 (/points/bl33) (Zhongliao) and BL34 (/points/bl34) (Xialiao) on both sides, and at BL35 (/points/bl35) (Huiyang), with current at 30 to 40 Hz for 20 minutes, 10 times over 2 weeks. The sham needles sat in rings taped 1 cm to the side of each point, did not pierce the skin, and were wired to a lead that carried no current. A third of participants guessed their group correctly by the end. The trial measured bladder function by urodynamic testing, which measures urine flow and bladder pressure. Against sham, electroacupuncture raised maximum cystometric capacity, the volume at which a person can no longer delay passing urine, and bladder compliance, the change in bladder volume for a given change in bladder pressure. It lowered the detrusor leak point pressure, the lowest bladder pressure at which urine leaks, which the authors note is a risk factor for upper urinary tract damage above 40 cm of water. Urination and incontinence fell by 3.6 and 2.7 episodes a day in the electroacupuncture group and did not fall significantly with sham. The differences held at follow-up, which the paper reports in one place as 3 months and in another as at least 5. In diabetes, a 2009 pilot (https://doi.org/10.1089/acm.2009.0062) by Tong and colleagues compared 30 people given acupuncture for diabetic bladder dysfunction with 15 given sham acupuncture, over 15 days. After treatment the groups differed on four urodynamic measures, including bladder compliance and capacity, and the incontinence score fell from 2.4 to 1.4 in 25 of the acupuncture group and rose from 2.2 to 2.3 with sham. A larger sham-controlled trial has been planned: a 2020 protocol (https://doi.org/10.1097/MD.0000000000019843) by Han and colleagues, registered as ChiCTR2000030421, set out to randomise 150 people with diabetic neurogenic bladder to what the authors call basic Western medicine, alpha-lipoic acid and methylcobalamin, alone, with electroacupuncture at BL23 (/points/bl23) (Shenshu), BL32, BL33 and BL35 twice a week for 12 weeks, or with sham electroacupuncture. This search found no results from it. Other trials A 2024 crossover study (https://doi.org/10.1002/nau.25534) by Lu and colleagues, in Neurourology and Urodynamics, applied electroacupuncture at CV04 (/points/cv04) (Guanyuan), CV03 (/points/cv03) (Zhongji) and SP06 (/points/sp06) (Sanyinjiao) to people with neurogenic bladder after spinal cord injury during urodynamic testing, in random order with a washout between. In those with detrusor overactivity, capacity rose and peak detrusor pressure fell during stimulation, more at CV04 and CV03 than at SP06. In those with an underactive detrusor, flow and voiding pressure did not change significantly. A 2025 trial (https://doi.org/10.22037/uj.v22i.8280) by Wang and colleagues in Urology Journal randomised 60 previously untreated people with what the authors call central neurogenic bladder to 4 weeks of rehabilitation training or the same training plus low-frequency acupuncture at SP06 on both sides, CV03 and SP08 (/points/sp08) (Diji), timed by what the authors call the Midnight-Noon Ebb-Flow concept. The overall efficacy rate was 96.67% against 86.67%, with lower residual urine and better symptom scores in the acupuncture group and no difference in adverse events. The control group had no needling of any kind. A 2024 study (https://doi.org/10.56434/j.arch.esp.urol.20247707.102) by Yi and colleagues compared 57 people with incontinence after stroke given electroacupuncture at four sacral points with 60 given the same plus moxibustion at three abdominal points, and reported a higher total effective rate with the combination (88.33% against 64.91%); the abstract does not say the groups were randomised. What guidelines say The EAU guidelines on neuro-urology, in their 2026 edition, a limited update dated March 2026, state in their section on bladder rehabilitation that electroacupuncture might improve lower urinary tract function in people with spinal cord injury or stroke. They cite the Yi and Lu studies above and a 2024 review of electroacupuncture for retention after stroke, conclude that high-level evidence for bladder rehabilitation is very limited, and make no recommendation on electroacupuncture. NICE’s guideline CG148 (https://www.nice.org.uk/guidance/cg148/chapter/Recommendations) on urinary incontinence in neurological disease, published on 8 August 2012 and last updated on 2 October 2023, does not mention acupuncture. It suggests pelvic floor muscle training for people with multiple sclerosis, stroke or other conditions who can still contract the pelvic floor, possibly combined with biofeedback or electrical stimulation of the pelvic floor. The Canadian Urological Association’s 2019 guideline (https://doi.org/10.5489/cuaj.5912) on neurogenic lower urinary tract dysfunction does not mention acupuncture either. Overactive bladder and nocturia (/wiki/evidence/overactive-bladder-and-nocturia) sets out how tibial nerve stimulation, a needle-delivered nerve stimulation at the ankle, relates to acupuncture. What the reviews could not settle The pooled evidence compares acupuncture added to rehabilitation, catheterisation or drugs with that care alone, so it cannot separate the needling from the extra attention. Cochrane’s stroke review contained no sham-controlled acupuncture trial, and Hong’s rated every outcome very low in certainty. The two sham-controlled trials here, after stroke and in diabetes, enrolled 66 and 45 people, and this search found no results from the larger diabetic trial. Which kind of neurogenic bladder might respond is also open: the Lu study saw immediate changes in an overactive detrusor and none in an underactive one. For Parkinson’s disease, diabetes and multiple sclerosis, no completed review turned up in this search. AcuiQ’s neurogenic bladder (/symptoms/neurogenic-bladder) and neurogenic bladder dysfunction (/symptoms/bladder-dysfunction-neurogenic) pages list the protocols individual studies prescribed, each with its citation. Urinary incontinence (/wiki/evidence/urinary-incontinence) covers the sham-controlled sacral electroacupuncture trials in people without neurological disease, and Stroke recovery (/wiki/evidence/stroke-recovery) the trials for other effects of stroke.