title: Patient-Reported Defecation and Micturition Problems Among Adults Treated for Sacrococcygeal Teratoma During Childhood--The Need for New Surveillance Strategies.
abstract: BACKGROUND
  To evaluate defecation and micturition complaints in adults treated for sacrococcygeal teratoma (SCT) during childhood and to identify risk factors for soiling, urinary incontinence, and constipation beyond childhood.
  
  
  METHODS
  Records of patients aged ≥18 treated for SCT during infancy in the Netherlands were retrospectively reviewed. Frequency and severity of soiling, constipation, and urinary incontinence were evaluated using questionnaires designed in line with the Krickenbeck classification. Problems during childhood were compared to outcomes at adult age in part of the cohort. Associations between patient- and disease-related factors with complaints beyond childhood were analyzed with the chi-square test or Fisher's exact test, when appropriate.
  
  
  RESULTS
  Of 47 included patients (mean age 26.2 years, SD ±6.5), 49% reported at least one defecation or micturition complaint. Urinary incontinence was present in 30% and had a greater negative impact than soiling (24%). Ten patients (21%) reported constipation; five found this severely bothering. Three patients reported social restrictions due to defecation or micturition complaints (6.4%). While sex and tumor histology were not identified as risk factors, a tumor diameter of >10 cm and Altman type I or type II SCT were associated with constipation during adulthood.
  
  
  CONCLUSIONS
  One-third of the patients treated for SCT during childhood reported urinary and defecation problems beyond childhood. In only a minority of cases, these led to social restrictions. A greater tumor diameter was associated with a higher risk of constipation during adulthood. Prolonged surveillance strategies are advised for all patients with SCT.
authors.affiliation: Department of Pediatric Surgery, Maastricht University Medical Center, The Netherlands.
authors.forename: Marijke E B
authors.initials: ME
authors.lastname: Kremer
authors.affiliation: Department of Pediatric Surgery, Maastricht University Medical Center, The Netherlands.
authors.forename: Joep P M
authors.initials: JP
authors.lastname: Derikx
authors.affiliation: Department of Pediatric Surgery, University Medical Center Groningen, The Netherlands.
authors.forename: Robertine
authors.initials: R
authors.lastname: van Baren
authors.affiliation: Pediatric Surgical Center of Amsterdam, Emma Children's Hospital University Medical Center and VU Medical Center, The Netherlands.
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Heij
authors.affiliation: Department of Pediatric Surgery, University Medical Center Nijmegen, The Netherlands.
authors.forename: Marc H W A
authors.initials: MH
authors.lastname: Wijnen
authors.affiliation: Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, The Netherlands.
authors.forename: René M H
authors.initials: RM
authors.lastname: Wijnen
authors.affiliation: Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
authors.forename: David C
authors.initials: DC
authors.lastname: van der Zee
authors.affiliation: Department of Pediatric Surgery, Maastricht University Medical Center, The Netherlands.
authors.forename: Ernest L W E
authors.initials: EL
authors.lastname: van Heurn
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003672:Defecation; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012445:Sacrococcygeal Region / Q000601:surgery*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data*; D013724:Teratoma / Q000601:surgery*; D014555:Urination Disorders / Q000453:epidemiology* / Q000209:etiology; D013520:Urologic Surgical Procedures / Q000009:adverse effects
keywords: bowel function; germ cell tumor; late effect of cancer treatment; micturition complaints