APSA Papers
Urologic and anorectal complications of sacrococcygeal teratomas: Prenatal and postnatal predictors

https://doi.org/10.1016/j.jpedsurg.2013.09.042Get rights and content

Abstract

Purpose

Anorectal and urologic sequelae are observed in long-term survivors of sacrococcygeal teratoma (SCT). In this study we evaluate the incidence and predictors of anorectal and urologic complications in SCT.

Methods

A retrospective review was performed for all SCT patients who underwent resection at a single institution between 2000 and 2012. Enrollment criteria included a minimum of 12 months follow-up. Categorical variables were analyzed by Fisher’s exact test and continuous variables by Mann Whitney test (p < 0.05).

Results

Forty-five patients were studied. Anorectal complications occurred in 29%, including severe chronic constipation (n = 13) and fecal incontinence (n = 4). Urologic complications occurred in 33%, including neurogenic bladder (n = 12), vesicoureteral reflux (n = 5), and urinary incontinence (n = 7). Prenatal imaging by fetal MRI demonstrated mass effect with obstruction of the bowel (n = 4) or bladder and collecting system (n = 7) in a subset of patients with postnatal complications (anorectal 4/4, PPV 100%; urologic 6/7, PPV 86%). Postnatal complications were associated with obstructive findings on prenatal imaging, prenatal therapeutic interventions, Altman classification, perineal reconstruction, and tumor recurrence. No anorectal or urologic complications occurred in patients with Altman type I tumors.

Conclusions

Urologic and anorectal complications are common in patients with SCT. Higher Altman classification and prenatal imaging suggestive of intestinal or urologic obstruction should prompt focused prenatal counseling and postnatal screening for anorectal and urologic dysfunction.

Section snippets

Methods

Medical records of all patients who underwent SCT resection at our institution between 2000 and 2012 were reviewed. Recorded data on patient demographics, prenatal course and imaging, preoperative imaging, surgical resection and pathology, postoperative complications during admission, and late sequelae during regular outpatient follow-up were analyzed.

Functional sequelae were evaluated at regular follow-up appointments and were assessed by detailed history and physical examination, including

Results

A total of 60 patients underwent SCT resection during the study period. 45 patients met criteria for inclusion in the study including a minimum of 12 months follow-up. 15 patients were excluded; 7 died during the neonatal period, and 8 were lost to follow-up or discharged with follow-up care arranged at outside centers. 26 of the 45 patients (58%) had no impairment of bowel or bladder function after a median follow-up period of 41.5 months (range 12–124 months), while functional sequelae were

Discussion

There is significant variability in the literature with respect to the incidence of functional sequelae after SCT resection. Urologic complications have been more widely reported, while comparatively fewer studies address anorectal function in these patients (Table 4). Variability in sample size may account for some discordance in the rates of complications observed, with the majority of studies limited to relatively small patient cohorts (n = 10–30). Additionally, while some studies limited

Cited by (40)

  • Correlation of continence with long-term patient centered outcomes in children with sacrococcygeal teratoma

    2022, Journal of Pediatric Surgery
    Citation Excerpt :

    Prenatal diagnosis of these anomalies allows for parental education and counseling prior to birth with surgical resection in the perinatal period. Previous studies have evaluated global bowel and urinary incontinence following resection of SCT. [3–7] The pathophysiology leading to poor continence is likely multifactorial secondary to extensive pelvic dissection during surgery and to mass effect.

  • Congenital urogenital sinus anomaly in a patient with sacrococcygeal teratoma

    2020, Journal of Pediatric Surgery Case Reports
    Citation Excerpt :

    Assuming the knowledge that UGS anomalies sometimes occur in patients with SCT, the precise analysis of the mass structure and its relationships with the pelvic organs and spine may lead to an accurate diagnosis [11]. Although 24–55% of patients with SCT were reported to have urinary symptoms/problems at long-term follow up [7,9,12], fortunately, our patient could void spontaneously and had no hydronephrosis at 31 months after resection of SCT. However, careful urologic evaluation and management of the genitourinary tract is important for all SCT cases including our case.

  • Significant rate of lower urinary tract dysfunction in patients with sacrococcygeal teratomas

    2020, Journal of Pediatric Urology
    Citation Excerpt :

    Unlike UDS studies, patients with SCT more commonly have imaging of the urinary tract. For patients with prenatally diagnosed SCT, Partridge et al. found that the presence of hydronephrosis on prenatal imaging (MRI or ultrasound) was prognostic for urological complications [7]. Given the retrospective nature of our study over 29 years, our patient cohort did not consistently have pre-operative imaging of the urinary tract to review and thus we chose not to specifically highlight these results in this study due to difficulties interpreting our findings given the inconsistency of their use.

  • Sacrococcygeal teratoma with intraspinal extension

    2020, Journal of Pediatric Surgery Case Reports
View all citing articles on Scopus
View full text