1. Complementary Therapies in Medicine (2011) 19, 27—31
available at www.sciencedirect.com
journal homepage: www.elsevierhealth.com/journals/ctim
Acupuncture in urological practice—–A survey
of urologists in England
Heidi Tempest a,∗, John Reynard a, Richard J. Bryant a,b,
Freddie C. Hamdy a,b, Stéphane Larré a,b
a
Urology Department, Churchill Hospital, Old Rd, Headington, OX3 7LJ Oxford, UK
b
Nuffield Department of Surgery, University of Oxford, Oxford, UK
Available online 3 December 2010
KEYWORDS Summary
Acupuncture; Objective: To determine the feasibility of obtaining cooperation from urologists in carrying out
Urology; large-scale studies on the efficacy of acupuncture for the treatment of urological conditions,
Questionnaire; based on urologists’ general views and knowledge of acupuncture.
Medical practice Methods: A questionnaire was distributed to 145 urologists within three training deaneries
within England.
Results: A response rate of 70% (n = 102) was achieved. The majority of urologists rated their
knowledge of acupuncture as low (46%, n = 46) and their general attitude towards acupuncture
was neutral (54%, n = 55). The majority of responding urologists (95%) thought that acupuncture
may be of value in urological conditions, and acupuncture was suggested to patients by 30 urol-
ogists (29%). The urologists most likely to suggest acupuncture to their patients were typically
over 40 years of age, more experienced, not in a training post, and since starting their urological
career had changed their attitude towards acupuncture. In a multivariate analysis, a change
of view regarding the efficacy of acupuncture was found to be the only variable significantly
associated with a recommendation of acupuncture to patients.
Conclusions: Although overall knowledge about acupuncture was poor, most responding urol-
ogists thought acupuncture may be useful for urological conditions. Those who had changed
their views were most likely to suggest acupuncture to their patients. Acupuncture for urolog-
ical conditions warrants further investigation and, as this study has shown high interest within
the urological community large clinical trials involving multicentres may be feasible.
© 2010 Elsevier Ltd. All rights reserved.
There is a growing interest in complementary medicine, reflect increasing frustration with the poor efficacy of many
especially acupuncture, within both Western society and conventional treatments for a range of conditions. Acupunc-
the Western medical profession. This increased interest may ture is believed to have originated in China during the Stone
Age,1 and is typically used to treat symptomatic chronic
conditions, especially pain, that are often resistant to con-
Abbreviation: OR, odds ratio. ventional therapies. One example of its more widespread
∗
Corresponding author. Tel.: +44 01865741841; use in various clinical conditions is its advocation by the
fax: +44 01865226086. National Institute for Clinical Excellence as a treatment
E-mail address: htempest@hotmail.com (H. Tempest). option for back pain.2 Nevertheless, acupuncture remains
0965-2299/$ — see front matter © 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ctim.2010.10.001

2. 28 H. Tempest et al.
a highly controversial treatment option, particularly as no Acupuncture in Urology Questionnaire
well-defined conventional pathophysiological mechanism to 1. Sex M/F
explain its efficacy has been identified.
2. Age
Numerous urological conditions can be difficult and chal-
3. Years of experience in Urology
lenging to treat symptomatically.3 The use of acupuncture
4. Grade
for urological conditions was reviewed by Ripoll and Bunn,4
and since then there have only been a limited number of 5. How would you rate your knowledge of acupuncture
studies investigating its use. These mainly focus on func- 1 2 3 4 5
tional disorders such as chronic pelvic pain,5,6 lower urinary Low high
tract symptoms,7,8 or, more recently, hot flushes following 6. What is your general attitude towards acupuncture?
androgen deprivation therapy for prostate cancer.9,10 1 2 3 4 5
Acupuncture treatments have been reported to improve very negative neutral very positive
these conditions. Although promising, especially after 7. Do you think acupuncture may help in any urological conditions ? Y/N
failure of conventional treatment options, the majority of
1 2 3 4 5
these studies are observational or contained small numbers
Very unlikely maybe very likely
of patients, and few of the studies are randomised.4 Larger
well-powered studies with multicentre involvement are
therefore needed to investigate the efficacy of acupuncture If so which ones ?
for the treatment of urological conditions. The feasibility of
such studies largely depends on the willingness of urologists 8. Have you ever suggested acupuncture to a patient?Y/N
to participate, and this may be influenced by their interest
and beliefs regarding the potential efficacy of acupuncture 9. Have your views towards acupuncture changed since you started your career?
as a treatment modality for urological conditions. Without
a strong and widespread interest within the urological Alot more positive/ more positive/ no change/ more neg ative/ Alot more negative
community for acupuncture, such studies may have little
chance of success.
10. Has anything changed your views?
To date, and to our knowledge, there has been no specific
investigation either of the views of urologists in the United
Kingdom towards acupuncture or of their attitudes towards Thank you for your time in answering these questions
this unconventional treatment option for urological condi-
tions. Much of the published literature has concentrated on Figure 1 Questionnaire used to assess urologists views
the use of acupuncture in general practice, where as many regarding acupuncture.
as 83% of practitioners believe that acupuncture might be
for most of them facilitating identification of the urologists
clinically useful and may recommend it to their patients.11
and a high response rate. The three deaneries (and hospi-
A study of Norwegian doctors showed that they would rec-
tals therein) were Oxford (Churchill (Oxford), Northampton
ommend acupuncture to 38% of their patients suffering
General, Royal Berkshire (Reading) and Wycombe), Wes-
from migraine.12 With regard to surgeons, the only study
sex (Royal Bournemouth, Salisbury District, Winchester,
of acupuncture reported to date demonstrated that 63%
Southampton, Queen Alexandra (Portsmouth), St Richards
of surveyed neurosurgeons believed that complementary
(Chichester)) and Eastern (Addenbrookes (Cambridge), Nor-
medicine may have a potential role in patient management
folk and Norwich, Luton and Dunstable, Bedford, Ipswich,
but it did not elaborate fully if they recommend it in their
Peterborough and West Suffolk (Bury St Edmunds)). The
clinical practice.13
urologists working at these hospitals were identified by
The principal objective of this study was to investigate
contacting the deaneries and hospitals. The urologists as
the views of urologists in England towards acupuncture
defined for the purposes of this study were either qualified
and to ascertain their beliefs about its use for urological
urologists or urology trainees. There were no exclusion crite-
conditions. We investigated whether sufficient urologists
ria within this group. All the urologists, who worked in the
demonstrate an interest in acupuncture as a preliminary
hospitals within these training deaneries, were contacted
step such that future larger studies on acupuncture for
over a 3-month period, either directly or by telephone or
urological conditions might be feasible. We also aim to even-
e-mail. The urologists included consultants, staff grades,
tually identify a profile of urologists or their clinical centres,
associate specialists and trainees, and all were asked to
which may be more likely to recommend acupuncture to
complete a questionnaire (Fig. 1) evaluating their views
patients, such that these urologists could potentially be
regarding acupuncture and its use in urology. A profile of
requested to become co-investigators and recruiting centres
urologists more likely to have suggested acupuncture to their
for future large-scale randomised clinical trials.
patients was identified using logistic regression. Statistical
analyses were conducted using Stat View 5.0 for Windows
Methods (SAS Institute, Cary, NC, USA).
A questionnaire (Fig. 1) was designed to investigate the Results
opinion of urologists practising in three English training
deaneries. These deaneries were chosen as they covered We identified 145 urologists working within the designated
several regions and the authors had professional contacts hospitals. These included 86 consultants, 13 staff grades

3. Acupuncture in urological practice—–A survey of urologists in England 29
60 55 54 logical experience, was of non-trainee status, had greater
Number of Urologists
50 46 knowledge of acupuncture, had a greater positive attitude
40 towards acupuncture, had a greater belief in its possible
27 29 30
30 helpfulness, and if the urologist had changed their opinion
17 regarding acupuncture during their career (Table 1). In the
20 11 9 9
10 4 5 3 6 multivariate analysis, the only variable associated with a
0
0 higher probability of suggesting acupuncture to a patient
1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 was when the urologist had changed their opinion regard-
Knowledge A tude Helpfulnes ing acupuncture during their career (odds ratio (OR): 10.4
(2.5—42.4), p = 0.001). This group of urologists represents
Figure 2 Histograms representing the number of urolo-
almost half (n = 48, 48%) of the responders in this study.
gists giving each score (1—5) regarding knowledge about
Trainees (n = 15, 35%) were less likely to have changed their
acupuncture, attitude towards acupuncture and usefulness of
views regarding acupuncture compared with non-trainees
acupuncture.
(n = 33, 57%) (p = 0.03). Of those who had changed their
view, the change was always either ‘‘more positive’’ (n = 45,
93%) or ‘‘a lot more positive’’ (n = 15, 7%), and was never
or associate specialists and 46 trainees. A completed ques-
‘‘negative’’ or ‘‘a lot more negative.’’ Within the group of
tionnaire was obtained in 102/145 cases, giving a response
urologists, who had changed their views regarding the possi-
rate of 70%. These were 41 from the Eastern deanery, 39
ble efficacy of acupuncture, 27 (56%) suggested acupuncture
from the Oxford deanery and 22 from the Wessex deanery.
as a treatment to their patients, although 3 out of 53
Of the 43 non-responders, 10 were due to incorrect e-mail
respondents (6%), who had not changed their views had
address or phone number, leading to an adjusted response
also suggested acupuncture. Reasons identified as factors
rate of 76%, if this group is not included. The response rate
causing a change of view included feedback from patients
was higher from trainees (93%) compared with non-trainees
(n = 16), reading literature/media (n = 4) and personal expe-
(60%) (p < 0.001). The male to female ratio was 10:1 (4:1 for
rience (n = 1).
trainees and 58:1 for non-trainees). The overall mean age
There was no significant difference among the three
(range) was 40 years (29—66) whilst the mean (range) age
deaneries for all data analysed except for the number of
was 33 years (29—41) for trainees and 46 years (36—66) for
urologists, who had their view changed about acupuncture,
non-trainees.
which was higher (p = 0.025) in the Eastern group (n = 25,
Results concerning knowledge, attitude and usefulness of
63%) compared with the others (n = 23, 38%).
acupuncture are outlined in Fig. 2. The majority of urologists
rated their knowledge of acupuncture as low (n = 46, 46%)
and their general attitude towards acupuncture as neutral Discussion
(n = 55, 54%). Nevertheless, 95 (95%) urologists thought that
acupuncture may be a useful treatment modality for urolog- This study demonstrates that despite most urologists hav-
ical conditions, including chronic pain, overactive bladder, ing poor knowledge about acupuncture, many believe that
prostatitis and hot flushes. At least one urological condi- it may play a role in the urological management of some
tion was mentioned as being treatable through acupuncture patients. Half of the urologists in this study had changed
by 78 urologists (76%), with pain being the most frequently their views regarding the effectiveness of acupuncture and,
quoted of these (n = 76, 75%). in general, this was in a positive manner.
Acupuncture was suggested as a therapeutic option Generally, poor knowledge about acupuncture is unsur-
for patients by 30 urologists (29%). This was significantly prising given that acupuncture is not routinely taught to
more frequent among non-trainees (42%) than trainees medical students in universities in the UK. Specialised train-
(12%) (p < 0.001). Univariate analysis demonstrated that the ing is available from institutions such as the British Medical
chance of acupuncture being suggested as a treatment Acupuncture Society (a registered charity); however, this
option for patients was significantly higher if the urologist is only within fee-paying courses. Interestingly, it has been
was of a higher age (>40 years), had more years of uro- shown that when a medical course includes some tuition on
Table 1 Univariate analysis indicating the odds ratio (OR) of having suggested acupuncture to a patient with a 95% confidence
interval.
OR 95% inf. 95% sup. p-Value
Sex: male 0.818 0.191 3.511 0.7871
Age: >40 4.126 1.604 10.617 0.0033
Experience: >10 years 3.417 1.327 8.796 0.0109
Status: non-training 5.59 1.92 16.13 0.0016
Knowledge: score >3 5.098 1.366 19.021 0.0153
Attitude: score >3 4.818 1.941 11.958 0.0007
Helpful: score >3 5.588 2.226 14.03 0.0002
Views changed: yes 21.429 5.856 78.411 <0.0001
OR: odds ratio.

4. 30 H. Tempest et al.
complementary therapies, doctor’s views become more pos- within the National Health Service. This may explain why
itive towards such treatments.14 It has also been shown that only a third of the urologists in this study suggest acupunc-
the majority of doctors and medical students believe that ture to their patients, and why trainees are less likely to
alternative therapies should be taught during their under- discuss this treatment modality during patient consulta-
graduate medical degree course.15 tions.
Whilst the overall interest in acupuncture by respondents Most urologists believe acupuncture may play a role in the
in this study was neutral, 95% of urologists believed in a management of urological conditions, some having already
useful potential role of acupuncture in the management of suggested it to their patients. Urologists declaring the most
some urological conditions, suggesting that most urologists knowledge and positive attitudes regarding acupuncture
would be keen on referring patients to acupuncture clin- were also most likely to find this treatment helpful for
ics. In practice, however, only around one-third of urologists their patients. Urologists, who changed their views about
have suggested it to their patients. The exact reasons for the acupuncture, were unsurprisingly more likely to have sug-
discrepancy between urologists’ beliefs regarding acupunc- gested the treatment to their patients. The most powerful
ture, and the frequency with which they recommend this predictor for an urologist to recommend acupuncture was
treatment, are unknown but may potentially be explained them ‘‘having changed their views,’’ and this increased
by the fact that the majority of patients may be successfully the chance of this treatment being offered 21-fold. Many
treated by conventional medicine. It is also possible that urologists tend to develop more favourable views towards
urologists may have reservations about suggesting a treat- acupuncture later in their career, which may reflect the
ment with minimal high-quality research and little scientific existing limited efficacy of conventional treatment options
evidence. for some chronic conditions, in particular.
The study results presented herein apply only to the three Although the questionnaire in this study did not directly
English deaneries investigated, and may not represent the question whether urologists would be willing to participate
views of other urologists in the United Kingdom or else- in acupuncture research, it has supplied the preliminary
where. That said, we did not observe significant differences knowledge to future researchers that there is considerable
between deaneries, making geographical location unlikely interest within the urological community about the possi-
to result in differences of opinion between regions. We also ble positive effects of acupuncture in the management of
did not investigate any ethnical or economic backgrounds of urological conditions.
respondents that may have had an effect on views. In conclusion, this survey indicates that studies on
More experienced urologists, who had completed their acupuncture may be largely accepted among the urologi-
training, were more likely to suggest acupuncture to their cal community and that cooperation from urologists may be
patients. This was, however, not statistically significant in expected, such as mentioning the existence of a trial and the
a multivariate analysis, suggesting that years of experience possibility of referring patients to an investigator for more
may be a confounding factor. More experienced urologists details and inclusion. This study has also defined the pro-
are more likely to have seen the same patients on many file of urologists more likely to have suggested acupuncture
occasions, especially in the outpatient setting, and they to their patients. This group of urologists may be suggested
may realise the limits that conventional medicine can offer as being the most appropriate for researchers to initially
their patients. Curative treatment of chronic prostatitis, approach with regarding recruitment of patients for large-
for example, may not be realistic in some patients, leaving scale high-quality future clinical studies of acupuncture in
symptom management to be the only route to an improve- urology.
ment in quality of life. The current treatment strategies for
chronic prostatitis including antibiotics, -blockers, anti-
inflammatory agents and other medical agents are not Competing interest
effective for many patients3 ; therefore, they may be offered
alternative treatments, such as acupuncture, after poor None.
results of standard treatments or to avoid more invasive
treatments. Intriguingly, the use of acupuncture has resulted
in good results for patients with this condition.5,6 Our results Acknowledgements
showed that good feedback from patients was the reason
for 16 urologists to have changed their views concerning The authors are grateful to all the urologists who answered
acupuncture. This highlights the fact that patient satisfac- the questionnaire in this study.
tion with acupuncture has a significant impact on a doctor’s
views and prescribing practice.
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