Overactive bladder in adults with sickle cell disease

Abstract

Aims To characterize the prevalence and impact of nocturnal enuresis and overactive bladder (OAB) symptomatology in the adult sickle-cell disease (SCD) population. Methods We performed a single-center, cross-sectional study of adult SCD patients from October 2012 to February 2014, using the validated Pfizer OAB short form questionnaire and brief voiding history surveys. Patient responses and scores were compared to that of controls having normal or sickle cell trait hemoglobin genotypes. Results A group of 239 SCD patients (116 males, 123 females) were compared with 104 normal and 57 sickle cell trait patients. Seven of 239 (2.9%) SCD patients compared to none of the 161 patients without SCD (p = 0.04) reported current nocturnal enuresis. The median age of nocturnal enuresis cessation was higher in SCD patients (12.0, IQR 9.0–15.0 yrs) compared to that of both normal (7.5, IQR 6.0–9.8 yrs) and sickle cell trait (7.5, IQR 6.0–8.8) groups (p <0.0001). Ninety-three of 239 (38.9%) SCD patients compared to 17 of 104 (16.3%) normal and 11 of 57 (19.3%) sickle cell trait had scores indicating OAB symptomatology (p < 0.0001). Patients with SCD had higher OAB symptom severity and lower Health-Related Quality of Life scores compared to the normal and sickle cell trait groups (p < 0.0001 and p < 0.0001, respectively). Conclusions We demonstrate an elevated rate of nocturnal enuresis and OAB symptoms in the adult SCD population. An OAB phenotype may be an under-recognized complication of SCD irrespective of age.

The spectrum of sickle hemoglobin-related nephropathy: from sickle cell disease to sickle trait

“…Early studies demonstrated a dose-dependent relationship between concentration of HbS and degree of hyposthenuria, with individuals with hemoglobin SS or Sβ° genotypes (sickle cell anemia, SCA) demonstrating severely impaired concentrating ability (inability to concentrate urine to >450 mOsm/kg with water deprivation) starting in infancy and those with SCT demonstrating a later onset of impairment usually by age 10 [24]. This impaired ability to concentrate urine starting at a young age is thought to relate to the increased prevalence of nocturnal enuresis among children and adolescents with SCD [25], a phenomenon that may persist into adulthood [26]. …”

Nocturnal Enuresis in Children with Sickle Cell Anemia

“…Presumably, these hypotheses on etiopathogenesis also apply to nocturnal enuresis in children with SCA. For instance, in these children a strong link between nocturnal enuresis and urinary bladder dysfunction has been reported by several authors [8,37,38]. Another recent postulation is that SCA-related enuresis may be due to atonic detrusor muscle which results in an underactive bladder with defective emptying mechanism.…”

Nocturnal Enuresis in Children and Adolescent with Sickle cell Anemia

“…The authors concluded that polydipsia and polyuria may be caused by a lack of vitamin D [150]. Nocturnal polyuria had been reported in normal children [152,153] and children with SCA who had NE and was considered a pathogenic factor [18,41,51,52]. In …”

“…Strong association between NE and urinary bladder dysfunction (UBD) was reported in children and adults with SCA [6,14,19,47,48,51,52]. Enuresis and nocturia, as indicators of UBD, are common in individuals with sickle cell anemia [18,43,53,54].…”

“…They attributed the reduction of NE despite the persistence of nocturia to improvement of sleep arousal in those patients. An increase in the maximum functional bladder capacity with age could be another possible explanation [50][51][52][53][54][55]. In a recent report, Claudino et al [56] evaluated the urinary bladder function in a transgenic Sickle Cell Disease Mice.…”