Dysfunctional Elimination in Children Operated for Sacrococcygeal Teratoma

INTRODUCTION: Sacrococcygeal teratoma is a rare condition (1: 35.000-40.000 for the newborn). We report single-center experiences about it focusing on functional sequelae.
METHODS: From December 1997 to November 2007, 2 boys and 14 girls were treated in our department for Sacrococcygeal teratoma. Their hospital records were analysed retrospectively. Only 12 of these cases were evaluated prospectively, the others were not assessed because they were not available for follow-up. They were evaluated by a physical exam, an uroflowmetry- EMG and cystometry. A questionnaire was administered about bowel and voiding habits.
RESULTS: 9 out of 12 were operated at an average age of 8.4 days and were diagnosed in the neonatal period, their histopathology proving benign. Tumor manifestation occurred in 2 months, 11 months and 19 months of age in the remaining 3 children. Histopathology was mature in 8, immature in 3, malignant in 1 case. Surgery comprised tumor excision with coccygectomy. The child with the malignant tumor received chemotherapy after colostomy. During follow-up AFP levels were normal for all patients. None of children had reccurrences. Overall survival rate was 100%. 5 children had voiding dysfunction. 3 children was voiding in urgency and also squatting down. 3 children had been reported for enuresis nocturna and 1 for enuresis diurna. Functional bladder capacity was low in 2 cases. One patient with a high functional bladder capacity had strained and interrupted voiding. Abnormal EMG potentials were observed in 4 patients. Detrussor instability was seen in 3 children. None of children had anal stenosis and fecal soiling, 4 had constipation. Satisfaction levels of parents about operation cavity and scar of their children were found 5 out of 12 null, 4 medium and 3 mildly high.
DISCUSSION AND CONCLUSION: Follow-up after surgery for SCT should include a careful examination of voiding and anorectal dysfunctions because of neuorourological and/or anorectal dysfunction. Detailed information about cosmetic reconstruction after teen age should be made available to the parents.

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