The Effect of Transcutaneous Electrical Acupoint Stimulation on Postoperative Catheter-Related Bladder Discomfort in Patients Undergoing Transurethral Resection of the Prostate

Abstract

Background: Catheter-related bladder discomfort (CRBD), an extremely distressing complication secondary to an indwelling urinary catheterization, is frequently reported in patients with transurethral resection of the prostate (TURP), postoperatively. A prospective, randomized, controlled, double-blind study was designed to assess the efficacy of transcutaneous electrical acupoint stimulation (TEAS) as a treatment for CRBD in patients undergoing TURP.

Methods: Seventy benign prostatic hyperplasia male patients undergoing TURP under general anesthesia requiring intraoperative urinary catheterization were enrolled for the trial. An experienced acupuncturist performed TEAS for 30 minutes before general anesthesia with acupoints RN7, RN6, RN5, RN4, and RN3 and bilateral BL32, BL33, and BL34. Mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SPO2), body temperature (T), and blood samples were collected during the surgery. A series of assessments included the incidence and severity of CRBD, postoperative pain, nausea and vomiting, and physical and mental state measurements.

Results: The incidence of CRBD was significantly lower in TEAS group than in control group at the time T5 [9(26%) vs. 28(80%), P < 0.001], T9 [20(57%) vs. 28(80%), P=0.039], T11 [7(20%) vs. 31(89%), P < 0.001], and T12 [4(11%) vs. 7(20%), P=0.003]. The severity of CRBD was significantly lower in TEAS group than in control group at the time T5 [0 vs. 10 (29%), P < 0.001], T9 [2(6%) vs. 10(29%), P=0.011], and T11 [0 vs .9(26%), P=0.002]. The QoR-40 total score was higher in TEAS group at time T11 [191.7(4.4) vs. 189.1(4.3), P=0.007] and T12 [195.3(1.9) vs. 193.3(3.0), P < 0.001]. The postoperative analgesia requirement was higher in control group [5.0(2.9) vs. 3.8(1.9), P=0.045].

Conclusions: TEAS could significantly prevent the incidence and severity of CRBD, reduce the postoperative analgesic requirement in the early postoperative period, and promote the quality of early recovery in patients undergoing TURP.

Figure 1

Chinese traditional acupoints location. 1 cun represents the width of the first joint of the thumb in patient. 1.5 cun represents the width of the second stripe of the index finger and middle finger in patients. 3 cun represents the sum of the width of the second joint of the index finger, middle finger and ring finger, and the first joint of the small finger in patient. Yinjiao (RN7), 1 cun below the umbilicus; Qihai (RN6),1.5 cun below the umbilicus; Shimen (RN5), 2 cun below the umbilicus; GuanYuan (RN4), 3 cun below the umbilicus; Zhongji point (RN3), 4 cun below the umbilicus; bilateral ciliao (BL32), second posterior sacral hole, away from the midline by 2 cm, 1.3 cm–1.5 cm below the posterior superior iliac spine; zhongliao (BL33), third sacral posterior hole, 2 cm below the ciliao point, away from the midline about 2 cm; xialiao (BL34), fourth sacral posterior hole, 1.5 cm below the ciliao point, away from the midline about 1 cm.

Figure 2

The flow diagram of study procedures. TEAS, transcutaneous electrical acupoint stimulation; Yinjiao (RN7); Qihai (RN6); Shimen (RN5); GuanYuan (RN4); Zhongji point (RN3); bilateral ciliao (BL32); bilateral zhongliao (BL33); and bilateral xialiao (BL34).