Lower urinary tract and bowel functions in patients operated for sacrococcygeal teratoma

Sacrococcygeal teratomas (SCT), which are the most common germ cell tumours in the neonatal period, have frequent long-term complications including gastrointestinal and urological problems due to the anatomical region of origin. This study evaluates the lower urinary tract and bowel functions in patients who underwent surgery for SCT.

Fifteen patients who underwent sacrococcygeal teratoma surgery between 2007 and 2021 were retrospectively evaluated for lower urinary tract and bowel functions. Bladder function was assessed using patient interviews, urinalysis, voiding diaries, uroflowmetry, ultrasonography, and pressure-flow studies. In the bowel function evaluation, constipation and continence were assessed. Descriptive statistics were used to present the results as mean, standard deviation, median, frequency, and percentage.

Consequently, 15 patients were included, with a mean follow-up period of 8.5 years. The majority of patients were female, with a female-to-male ratio of 2.75:1. Based on the Altman classification, 73.3 % of the patients had type I SCT, 20 % had type II, and 6.6 % had type IV. The mean follow-up period of the patients was 8.5 years (2 years-15 years). Of the 15 patients whose lower urinary tract functions were assessed, 13 achieved full urinary continence and exhibited normal voiding volumes and frequency for their age. Ultrasonography findings were normal in all evaluated patients, with no residual urine or bladder abnormalities detected. Urodynamic tests showed normal detrusor activity and bladder capacities in most cases, though one patient exhibited a higher-than-expected bladder capacity during the filling phase. Voiding phase assessments revealed normal patterns in most patients, except for an 8-year-old case with Altman type IV SCT showing staccato voiding pattern and pelvic floor electromyography (EMG) activity. Anorectal examinations revealed normal anal anatomy, though fecalomas were detected in two cases. (Altman type II and IV SCT). Constipation, based on Rome IV criteria, was identified in 3 patients (1 Altman type I, 1 type II, and 1 type IV SCT). Based on the Holschneider scale, 11 patients achieved normal scores, while 3 (2 Altman type I, 1 Altman type II SCT). demonstrated good scores, reflecting overall satisfactory bowel control.

Bladder function was uneffected in Altman type I and II cases, except for dysfunction in one type IV case. Constipation was noted in one case each of types I, II, and IV, with no other bowel abnormalities detected. Non-invasive investigations should be prioritized for type I and II cases, while invasive methods may be necessary for those with intrapelvic extension.