Postoperative bladder and rectal function in children with sacrococcygeal teratoma.
BACKGROUND
In patients with sacrococcygeal teratoma, the location of the tumor and surgical intervention affects bladder and rectal function. However, there are no clear guidelines for postoperative assessment of bladder function, and the literature on this subject is scarce especially for children requiring multiple surgical interventions. The aim of this study is to evaluate postoperative bladder and rectal function in children with sacrococcygeal teratoma.


METHODS
Retrospective analysis was performed of 25 patients (6 male, 19 female) with sacrococcygeal teratoma operated at our institution from 1998 to 2009. Functional assessment of the bladder and rectum was carried out by clinical follow-up, rectomanometry, and urodynamic studies. Data of 24 children were available for follow-up.


RESULTS
Of the 24 children, twelve had bladder dysfunction (50%). Ten children (42%) required more than one surgical intervention. Of the 14 children operated on only once, three developed bladder dysfunction (21%), compared to nine of the 10 children who underwent multiple surgical interventions (90%). All four Altman stages were represented, and bladder dysfunction was found for all tumor types. All children with clinical bladder dysfunction showed abnormalities on urodynamic studies, with seven cases of neurogenic bladder. In contrast, no rectal dysfunction was found.


CONCLUSIONS
Bladder dysfunction is a common risk of sacrococcygeal tumors. The risk increases particularly if multiple surgical interventions are needed in order to excise the tumor. Therefore, the need for meticulous and complete excision upon first intent is crucial in order to avoid bladder dysfunction.
Department of Pediatric Surgery, Dr. von Hauner Childrens Hospital, Munich, Germany. michael.berger@med.uni-muenchen.de
Michael
M
Berger
Martina
M
Heinrich
Martin
M
Lacher
Jochen
J
Hubertus
Maximilian
M
Stehr
Dietrich
D
von Schweinitz
D000293:Adolescent; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery; D008175:Lung Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery; D008297:Male; D011184:Postoperative Period; D012002:Rectal Diseases / Q000209:etiology / Q000503:physiopathology*; D012189:Retrospective Studies; D012445:Sacrococcygeal Region; D015996:Survival Rate; D013724:Teratoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000503:physiopathology*; D014563:Urodynamics