Urologic and anorectal complications of sacrococcygeal teratomas: prenatal and postnatal predictors.
OBJECTIVE
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 12months 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.
The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia PA.
Emily A
EA
Partridge
Division of Urology, Children's Hospital of Philadelphia, Philadelphia PA.
Douglas
D
Canning
Division of Urology, Children's Hospital of Philadelphia, Philadelphia PA.
Christopher
C
Long
The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia PA.
William H
WH
Peranteau
The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia PA.
Holly L
HL
Hedrick
The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia PA.
N Scott
NS
Adzick
The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia PA. Electronic address: flake@email.chop.edu.
Alan W
AW
Flake
D003050:Coccyx / Q000601:surgery; D003248:Constipation / Q000453:epidemiology / Q000209:etiology; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000209:etiology; D046128:Fetal Therapies; D006801:Humans; D006869:Hydronephrosis / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000196:embryology / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011296:Prenatal Diagnosis; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012445:Sacrococcygeal Region; D012983:Soft Tissue Neoplasms / Q000150:complications / Q000151:congenital / Q000196:embryology / Q000601:surgery*; D013724:Teratoma / Q000150:complications / Q000151:congenital / Q000196:embryology / Q000601:surgery*; D001750:Urinary Bladder, Neurogenic / Q000453:epidemiology / Q000209:etiology; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology; D014570:Urologic Diseases / Q000175:diagnosis / Q000196:embryology / Q000209:etiology; D014718:Vesico-Ureteral Reflux / Q000453:epidemiology / Q000209:etiology
Anorectal complications; Prenatal imaging; Sacrococcygeal teratoma; Urologic complications