Significant Rate of Lower Urinary Tract Dysfunction in Patients with Sacrococcygeal Teratomas
Alexandra Rehfuss, MD, Molly Fuchs, MD, Daryl McLeod, MD, Daniel Dajusta, MD, Seth Alpert, MD, Rama Jayanthi, MD, Christina Ching, MD.
Nationwide Childrens Hospital, Columbus, OH, USA.
Sacrococcygeal teratoma (SCT) is the most common congenital germ cell tumor and can affect the urinary tract either directly by mass effect, or indirectly by injury related to surgical resection. At our institution, several patients with a history of SCT have presented with delayed urological complications. Currently, there is no standard for urological involvement or follow-up for these patients. Our goal was to evaluate the incidence of urologic need in patients with SCTs, questioning if upfront urologic involvement is necessary in the management of this unique patient population.
After IRB approval, we performed a retrospective chart review of patients diagnosed with SCTs and managed at our institution between Jan 1990 and April 2019. Data collected included: patient demographics, date of surgery, surgical pathology, and need for urologic involvement due to urinary pathology. Urological pathology included: acute urinary retention, chronic intermittent catheterization (CIC), and/or urinary incontinence. Acute urinary retention was defined as a limited need for catheterization to empty the bladder, which eventually resolved. Chronic retention was defined as patients who required continued CIC at time of chart review. Urinary incontinence was defined as urine leakage in children older than 3 years. Patients were excluded if old records were not available for review.
Forty-nine patients were identified and 45 patients met inclusion criteria. In 25 patients, urologic consultation was needed. In two of these patients, urinary pathology was not felt to be related to their SCT. The other 23 patients (51% of all those with SCTs) required urologic involvement for urinary symptoms felt related to their SCT either directly or indirectly. This includes 9 (20% of all those with SCTs) patients with urinary incontinence and 17 (38% of all those with SCTs) with urinary retention (9 acute and 8 chronic). Two patients initially with retention went on to develop incontinence. In all but 1 case, urinary retention occurred postoperatively. One patient had acute urinary retention as their presenting symptom of SCT. Two patients (22% of those presenting with incontinence; 4% of all those with SCTs) had urinary fistulas: vesicovaginal (1) and urethrovaginal (1). The patient with vesicovaginal fistula went on to have a bladder neck closure and mitrofanoff. The patient with urethrovaginal fistula is presently managed with a vesicostomy.
Review of our cohort reveals that more than 50% of patients with SCTs required urologic consultation for urinary symptoms specific to their SCT. Two of these patients were found to have devastating consequences from their SCT requiring urinary diversion. Based on these findings, it appears prudent that a multidisciplinary team including urology should be involved upfront in the management of these patients. There should be a high level of suspicion for fistula in patients who present with postoperative incontinence.
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