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Elgendy A, AbouZeid AA, El-Debeiky M, Mostafa M, Takrouney MH, Abouheba M, Khairi A, Shehata S, Shehata SM. Management strategy and outcomes of sacrococcygeal teratoma - an Egyptian multicenter experience. World J Surg Oncol 2023; 21:294. [PMID: 37718391 PMCID: PMC10506197 DOI: 10.1186/s12957-023-03180-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVES Nationwide criteria regarding patients with sacrococcygeal teratoma (SCT) are still lacking in Egypt. We aimed to present a multicenter study regarding the management and outcomes of this tumor to evaluate our national treatment strategy. METHODS A retrospective analysis including all patients with SCT who were managed at four major Egyptian centers between 2013 and 2023. Clinical data, surgical approaches, and short- and long-term outcomes were discussed. RESULTS The study included 95 patients (74 were females). Antenatal diagnosis was reported in 25% of patients. Seventy-one patients (74.7%) were classified as Altman type I/II. Surgery was performed via a perineal approach in 75 patients, whereas the remaining 20 underwent a combined abdominoperineal approach. Vertical elliptical incision with midline closure was conducted in 51.5% of patients, followed by classic or modified chevron incisions. Benign mature teratoma was detected in 82% of patients. At a median follow-up of 57 months, eight patients (8.5%) had relapsed. The 5-year overall survival (OS) and event-free survival (EFS) of all patients were 94% and 91%, respectively. In the after-care monitoring, 19 patients (20%) had urinary or bowel dysfunctions. Nine of them were managed using medications. Clean intermittent catheterization was practiced in another five patients. The remaining five underwent further surgical interventions. CONCLUSION Favorable outcomes were achieved in our country during the last decade. Diverse perineal incisions were performed for resection, and vertical elliptical with midline closure was the commonest. During follow-up, 20% of patients developed urological or bowel dysfunctions that required medical and surgical treatment modalities to improve their quality of life.
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Affiliation(s)
- Ahmed Elgendy
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Tanta University, Tanta, 31515, Egypt.
| | | | - Mohamed El-Debeiky
- Pediatric Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Mostafa
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammed Hamada Takrouney
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Abouheba
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Khairi
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sameh Shehata
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sherif M Shehata
- Pediatric Surgery Unit, Department of Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
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Braungart S, James EC, Powis M, Gabra H, Losty PD. Sacrococcygeal teratoma: Long-term outcomes. A UK CCLG Surgeons Group Nationwide Study. Pediatr Blood Cancer 2023; 70:e29994. [PMID: 36229941 DOI: 10.1002/pbc.29994] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/03/2022] [Accepted: 08/24/2022] [Indexed: 12/25/2022]
Abstract
AIM Sacrococcygeal teratoma (SCT) is a rare paediatric germ cell tumour (1:40,000). Long-term data regarding urinary tract and bowel function after SCT resection is limited to few studies. A UK Children's Cancer and Leukaemia Group (CCLG) Surgeons multicentre study aimed to critically analyse long-term functional outcomes in patients following resection of SCT. METHODS Nationwide study of UK paediatric surgical oncology centres using a standardised data collection form. All index cases of newborn infants and children <16 years with SCT diagnosis during 2005-2015 were included. RESULTS 165 SCT patients treated at 14 UK paediatric surgical oncology centres were included. Median age at presentation was 1 day [interquartile range, IQR: 0-25]; median age at surgery was 10 days [IQR: 4-150]. One hundred seventeen (70%) were female and 48 (30%) male. Antenatal diagnosis was made in 44% index cases. Total 59% of patients were Altman Stage I or II lesions. Follow-up data were available in 83% cases. Tumour recurrence occurred in 13 (7%) patients at median age 13 months [IQR: 8.75-30 months]. Fifty-nine (36%) of 165 patients had documented adverse bladder or bowel dysfunction. Twenty-two (37%) cases required urinary clean intermittent catheterisation (CIC) urology health care, with eight patients (14%) needing operative intervention to control management of bowel dysfunction. CONCLUSION This UK CCLG study showed 36% of SCT patients develop bladder or bowel dysfunction after primary tumour resection. Functional assessment of bladder and bowel function is mandatory during after-care follow-up of all SCT patients. A multidisciplinary care pathway, with surgeon speciality groups including surgical oncology, paediatric urology and paediatric colorectal specialists, is strongly advised to facilitate 'best practice' monitoring of long-term health and improve patient quality of life (QoL) into adulthood.
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Affiliation(s)
- Sarah Braungart
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK.,Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Eleanor Ca James
- Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Mark Powis
- Department of Paediatric Surgery, Leeds Teaching Hospitals, Leeds, UK
| | - Hany Gabra
- Department of Paediatric Surgery, Newcastle Children's Hospital, Newcastle, UK
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- CCLG Surgeons Cancer Group, Children's Cancer and Leukaemia Group, Leicester, UK
| | - Paul D Losty
- University of Liverpool, Institute of Life Course and Medical Sciences, Liverpool, L69 3BX, UK.,Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Salim A, Raitio A, Losty PD. Long-term functional outcomes of sacrococcygeal teratoma - A systematic review of published studies exploring 'real world' outcomes. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:16-20. [PMID: 36127201 DOI: 10.1016/j.ejso.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/02/2022] [Indexed: 01/24/2023]
Abstract
Sacrococcygeal teratoma (SCT) is a rare neoplasm affecting 1:35,000 newborns. Long-term follow-up from small observational studies report impaired bladder/bowel function. This current study comprehensively analyses all published studies to better define true long-term functional sequelae. Medline/Embase databases were searched with PRISMA guidelines. Final analysis yielded 37 studies involving 1116 patients (854 female; 77%). Individual datasets were available in 14 studies (222 patients). According to Altman classification - 298/845 (35%) were Type I, 252/845 (30%) Type II, 133/845 (16%) Type III, and 128/845 (15%) Type IV tumours. Most neoplasms were benign (640/858; 75%), 77/858 (9%) immature and 141/858 (16%) malignant. Abnormal bladder function was reported in 7/39 (18%) Altman Type I, 23/61 (37.7%) Type II, 11/34 (32.4%) Type III, and 15/25 (60%) Type IV cases (p = 0.007). Adverse urological outcomes were notably common in immature/malignant neoplasms vs benign tumours and in patients requiring reoperation(s); p = 0.002 and p = 0.01. Bowel dysfunction was evident in 19% index cases and constipation in 26% with no significant association(s) with tumour characteristics. Higher Altman stage, unfavourable tumour biology and reoperation are associated with poor functional outcome(s). Multidisciplinary management from primary diagnosis of SCT is crucially important for all patients to best optimise functional outcomes across surgical specialities.
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Affiliation(s)
- Adeline Salim
- Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Arimatias Raitio
- Department of Paediatric Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Paul D Losty
- University of Liverpool, Liverpool, United Kingdom; Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Safaei N, Kamran H, Anbardar MH, Bordbar M, Zekavat OR, Forooghi M. Large Retroperitoneal Teratoma Presenting with Unilateral Hydronephrosis in an Infant: A Case Report and Review of the Literature. Case Rep Oncol 2023; 16:1041-1047. [PMID: 37900809 PMCID: PMC10601827 DOI: 10.1159/000533829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/24/2023] [Indexed: 10/31/2023] Open
Abstract
Teratoma is a type of germ cell tumor layer that appears in the gonadal, sacrococcygeal, mediastinal, and retroperitoneal regions. Primary retroperitoneal teratoma is rare and asymptomatic but can present with symptoms due to a mass effect on neighboring organs. These tumors have to be considered in the differential diagnosis of a mass in the abdominal cavity of children to distinguish between Wilms' tumor, neuroblastoma, and other intra-abdominal lesions. We presented an infant boy with protrusion of the left upper quadrant of the abdomen and a palpable abdominal mass that had progressively enlarged. An abdominal computed tomography scan revealed a large retroperitoneal cystic, solid mass on the left side of the abdominal cavity, causing pressure on the left ureter. Also, hydronephrosis of the left kidney was seen with a decreased enhancement of the left kidney due to obstruction uropathy. The mass was suspicious on imaging for a retroperitoneal teratoma. The patient underwent laparotomy, and excision of the huge retroperitoneal mass was done. The final diagnosis was an immature teratoma grade 3, and the patient was discharged in good condition. Retroperitoneal teratomas are rare tumors in infants. These tumors would be an incident diagnosis or diagnosed by the mass effect of giant tumors on other organs. They must be considered in the differential diagnosis of intra-abdominal tumors in children. Hydronephrosis and obstructive uropathy can be rare consequences of the mass effects of these tumors.
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Affiliation(s)
- Negar Safaei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Omid Reza Zekavat
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Forooghi
- Department of Pediatric Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
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O'Guinn M, GarzaSerna U. Type IV sacrococcygeal teratoma presenting with complete urinary obstruction. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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A rare presentation of Sacrococcygeal Teratoma as recurrent natal cleft abscess in childhood. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rehfuss A, Halleran DR, Aldrink JH, Ching C. Significant rate of lower urinary tract dysfunction in patients with sacrococcygeal teratomas. J Pediatr Urol 2020; 16:546.e1-546.e5. [PMID: 32563692 DOI: 10.1016/j.jpurol.2020.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/30/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Sacrococcygeal teratoma (SCT) is the most commonly occurring presacral tumor and can affect the lower urinary tract by direct mass effect, or as a sequela from surgical resection. Despite the potential impact on urologic function, there is no current standard for urological involvement or follow-up for these patients. The purpose of this study was to evaluate the need for urologic involvement for lower urinary tract dysfunction (LUTD) in patients with SCTs at our institution. METHODS We performed a retrospective chart review of patients diagnosed with SCT and managed at our institution between 1990 and 2019. Data collected included: patient demographics, surgical and pathology reports, presence of tethered cord or anorectal malformation, and need for urologic involvement for LUTD. LUTD included acute urinary retention, need for chronic intermittent catheterization, and/or urinary incontinence. Acute urinary retention was defined as requiring catheterization to empty the bladder for a limited time (outside the standard post-operative indwelling catheter time period) and the eventual return to spontaneous voiding. Chronic intermittent catheterization was defined as those with urinary retention that has persisted and required continued catheterization at the time of chart review. Urinary incontinence was defined as urine leakage in children older than 3 years of age. Patients with unavailable records were excluded. Comparison between groups was performed with Mann Whitney and chi-squared tests. RESULTS Forty-five patients with SCTs were identified. LUTD was identified in 23 patients (51%). The most common reason for LUTD was urinary retention (n = 16, 70%): 9 patients had acute retention and 7 had chronic retention (Fig. 1). Nine patients (39%) had urinary incontinence: 2 of these patients (4% of all SCT patients) had urinary fistulas (vesicovaginal (n = 1) and urethrovaginal (n = 1)). Only 5 patients (22%) had LUTD recognized preoperatively. Nine patients had concomitant tethered cord, and 7 of these (78%) had LUTD. Of patients with LUTD, Altman type IV was the most common location (n = 10, 43%). There was no significant difference in tumor type between those with and without LUTD. Patients without LUTD had significantly shorter follow-up. CONCLUSIONS Greater than 50% of patients with SCTs have known LUTD. Two of these patients were found to have urinary fistulas requiring urinary diversion. A multidisciplinary team including urology should be involved upfront in the management of patients with SCTs, and LUTD should be routinely assessed at follow-up visits. Evaluation for a urinary fistula should occur in the presence of urinary incontinence.
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Affiliation(s)
- Alexandra Rehfuss
- Division of Urology, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Devin R Halleran
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer H Aldrink
- Department of Surgery, Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Christina Ching
- Division of Urology, Nationwide Children's Hospital, Columbus, OH, USA
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Need for urodynamic evaluation as a regular follow-up tool in assessment of long-term urological outcomes in patients with sacrococcygeal teratoma. J Pediatr Surg 2019; 54:2107-2111. [PMID: 30686521 DOI: 10.1016/j.jpedsurg.2018.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/21/2018] [Accepted: 11/01/2018] [Indexed: 11/22/2022]
Abstract
AIM To assess the long-term urologic outcomes in follow-up of patients of sacrococcygeal teratoma (SCT) using urodynamic study (UDS) in addition to clinical and radiologic evaluation. METHODS A prospective study of clinical, radiological and urodynamic evaluation in patients with SCT who underwent resection between January 2002-June 2015 and were followed up till January 2016 was conducted. RESULTS Total 57 patients, 42 (73.7%) females and 15 (26.3%) males with 35 (62.4%) following treatment for benign and 22 (38.5%) for malignant disease were included. Twenty-eight of 57 (49.12%) had urological problems. Clinical complaints in 21 (36.8%) patients included stress urinary incontinence-14 (66.7%), enuresis-9 (42.9%), and poor stream or dribbling of urine-6 (28.6%). Eight of 51 patients (15.7%) had abnormal ultrasound findings, which included contracted, trabeculated thick walled bladder (3), bilateral hydronephrosis (3) and significant post void residue (PVR) (6). Seven of 57 underwent micturating cystourethrogram (MCU), 5 had an abnormal report[significant PVR (4), small trabeculated bladder (3), reflux (2) and large capacity bladder (1)]. Urodynamic study was done in 27 patients, 18/27 (66.7%) had abnormalities. Six patients without any clinical or ultrasonographic abnormalities had abnormal UDS. Total 28 (49.12%) had urological comorbidities. Three patients had overactive bladder, five dysfunctional voiding, one underactive bladder and one had giggle incontinence. Children were managed by behaviour therapy and pharmacotherapy. CONCLUSION Urodynamic evaluation could detect abnormalities in patients who had no urinary complaints or abnormality on ultrasound. The abnormalities have a potential for progressive upper tract damage. Urodynamics should be an integral part of urological surveillance in patients operated for SCT. TYPE OF STUDY Prognostic study. LEVEL OF EVIDENCE Level II (Prospective cohort study).
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Kremer MEB, Althof JF, Derikx JPM, van Baren R, Heij HA, Wijnen MHWA, Wijnen RMH, van der Zee DC, van Heurn LWE. The incidence of associated abnormalities in patients with sacrococcygeal teratoma. J Pediatr Surg 2018; 53:1918-1922. [PMID: 29453131 DOI: 10.1016/j.jpedsurg.2018.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/14/2018] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Gross genetic causes for SCT are unknown; however, it might be associated with other abnormalities. We assessed the incidence of associated abnormalities in a large national cohort of neonates with SCT and aimed to identify predictive risk factors. PROCEDURE The medical records were reviewed of 235 consecutive neonates with SCT treated at the six pediatric surgical centers in the Netherlands from 1970 to 2010. Potential risk factors for associated abnormalities analyzed included sex, gestational age, tumor-volume/histology and Altman-classification. RESULTS In 76 patients (32.3%) at least one associated abnormality was diagnosed, with hydronephrosis as the most common (16.2%) and hip dysplasia in 4.3%. Multiple abnormalities were documented for 21 (9.0%). Prematurity and Altman type IV SCT were associated with an increased risk of any associated abnormality. No association between increased tumor-volume and hydronephrosis or hip dysplasia was found. Patients with type IV Altman SCT had a fourfold risk of suffering from hydronephrosis compared to Altman type I SCT. CONCLUSIONS SCT was associated with other abnormalities in one-third of children. Some were tumor-related while others were related to prematurity or occurred sporadically. In contrast to clinically obvious anomalies, hip dysplasia or hydronephrosis might be latently present with more subtle clinical presentation. We therefore suggest renal- and hip-ultrasound in all patients, certainly those with Altman type IV SCT. LEVEL OF EVIDENCE RATING Level II (retrospective study).
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Affiliation(s)
- Marijke E B Kremer
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands
| | - Jessica F Althof
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands
| | - Joep P M Derikx
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands
| | - Robertine van Baren
- Department of Paediatric Surgery-University Medical Centre, Groningen, The Netherlands
| | - Hugo A Heij
- Pediatric Surgical Centre of Amsterdam (Emma Children's Hospital University Medical Centre and VU Medical Centre), The Netherlands
| | - Marc H W A Wijnen
- Department of Paediatric Surgery-University Medical Centre, Nijmegen, The Netherlands
| | - René M H Wijnen
- Department of Paediatric Surgery, Sophia Children's Hospital-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - David C van der Zee
- Department of Paediatric Surgery, Wilhelmina Children's Hospital-University Medical Centre, Utrecht, The Netherlands
| | - L W Ernest van Heurn
- Department of Paediatric Surgery-Maastricht University Medical Centre, The Netherlands.
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Güler S, Demirkaya M, Balkan E, Kırıştıoğlu İ, Kılıç N, Sevinir B. Late effects in patients with sacrococcygeal teratoma: A single center series. Pediatr Hematol Oncol 2018; 35:208-217. [PMID: 30346857 DOI: 10.1080/08880018.2018.1504151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The aim of this study is to evaluate late side effects that affect quality of life in children with sacrococcygeal teratoma (SCT). PATIENTS AND METHODS The patients with SCT were evaluated retrospectively. The data were expressed by percentage and the subgroups were compared statistically. RESULTS A total of 40 children with SCT were identified with median age 12 days (range: 1 day-14.6 years), 27 of whom were analyzed in this study with urodynamic data available for 24 and anal manometric evaluations for 20. Chronic constipation with need for laxative was reported in (7/27) 25.9%, fecal incontinence was present in (1/27) 3.7%, and urodynamic abnormalities were reported in (16/24) 66%. Among those with urodynamic abnormalities, low bladder capacity, dyssyergia and neurogenic bladder were observed in (21/24) 87.5% and anticholinergic treatment was applied. Urinary incontinence was present in (2/27) 7%, with clean intermittent catheterization utilized in (7/27) 25.9%. While defecation was observed more in the patients with Altman types II, III, and IV, micturation problems were observed more in the patients with Altman types II and IV. It was found that urodynamic dysfunctions were more frequent in the patients with increased number of operations. DISCUSSION Although the rate of symptomatic patients was low, abnormalities determined by radiological and urodynamic evaluations were high.
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Affiliation(s)
- Salih Güler
- a Department of Pediatric Hematology and Oncology , Konya Training and Research Hospital, University of Health Sciences , Konya , Turkey
| | - Metin Demirkaya
- b Department of Pediatric Oncology , Uludag University Faculty of Medicine , Bursa , Turkey
| | - Emin Balkan
- c Department of Pediatric Surgery , Uludag University Faculty of Medicine , Bursa , Turkey
| | - İrfan Kırıştıoğlu
- c Department of Pediatric Surgery , Uludag University Faculty of Medicine , Bursa , Turkey
| | - Nizamettin Kılıç
- c Department of Pediatric Surgery , Uludag University Faculty of Medicine , Bursa , Turkey
| | - Betül Sevinir
- b Department of Pediatric Oncology , Uludag University Faculty of Medicine , Bursa , Turkey
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Villamil V, Girón Vallejo O, Fernández-Ibieta M, Sánchez Sánchez Á, Reyes Ríos PY, Martínez Castaño I, Rojas-Ticona J, Ruiz Pruneda R, Ruiz Jiménez JI. [Functional and aesthetic evaluation of sacrococcygeal teratomas. Not everything ends with surgery]. An Pediatr (Barc) 2018; 88:39-46. [PMID: 28669487 DOI: 10.1016/j.anpedi.2017.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/03/2017] [Accepted: 03/16/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Sacrococcygeal teratoma is the most common solid neonatal tumour. The improvement in survival has meant that postoperative sequelae can be diagnosed and treated. The aim of this article is to evaluate the long-term outcomes of patients treated in our centre. MATERIAL AND METHODS Records of patients treated for a sacrococcygeal teratoma in our hospital from 1977 to 2014 were retrospectively reviewed. Personal data was collected and a telephone questionnaire was used to assess long-term bowel and urinary habits, as well as an aesthetic and functional self-assessment. RESULTS A total of 14 patients were treated during the study period, of whom 11 were females and 3 males, with a mean age at the time of the survey of 17 years (8 months-37 years). Eight patients completed the questionnaire (57.1%). The mean age of the 8 patients was 23 years (4-37 years), of whom 37.5% were operated on due to a sacrococcygeal teratoma type i, 25% type ii, 25% type iii, and 12.5% type iv. Two of them (25%) had constipation, and one (12.5%) had faecal incontinence. Two (25%) patients suffered from recurrent urinary tract infections, and 3 (37.5%) patients had urinary incontinence. Five patients (62.5%) had a perception of being physically impaired, with limitation of their social life. CONCLUSIONS The incidence of constipation does not differ from that found in the literature. Faecal incontinence is slightly improved compared to what has been published. However, urinary tract infections and incontinence are more prevalent in our series. Five patients out of the eight that responded suffered from psychosocial problems, according to DAS-59 questionnaire. Patients with SCT require urological, bowel, and psychological counselling, until they have a complete functional and emotional development.
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Affiliation(s)
- Vanesa Villamil
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.
| | - Oscar Girón Vallejo
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - María Fernández-Ibieta
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Ángela Sánchez Sánchez
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Paulo Y Reyes Ríos
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Irene Martínez Castaño
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Javier Rojas-Ticona
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Ramón Ruiz Pruneda
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - José I Ruiz Jiménez
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
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Villamil V, Girón Vallejo O, Fernández-Ibieta M, Sánchez Sánchez Á, Reyes Ríos PY, Martínez Castaño I, Rojas-Ticona J, Ruiz Pruneda R, Ruiz Jiménez JI. Functional and aesthetic evaluation of sacrococcygeal teratomas. Not everything ends with surgery. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Type IV Sacrococcygeal Teratoma Displacing the Urinary Bladder: Unique Magnetic Resonance Imaging. Case Rep Urol 2016; 2016:1423157. [PMID: 27413571 PMCID: PMC4931098 DOI: 10.1155/2016/1423157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/10/2016] [Indexed: 11/18/2022] Open
Abstract
Type IV sacrococcygeal teratoma is a rare pediatric tumor that is confined to the presacral area with no external component. The signs and symptoms often arise due to mass effect and compression of adjacent organs. Urinary retention is an uncommon presenting symptom in these patients. A wide spectrum of imaging findings may be encountered in cases with sacrococcygeal teratoma because of variability of tumor size and components. We hereby present a unique magnetic resonance urography finding in a type IV sacrococcygeal teratoma which caused bladder displacement. A meticulous and complete resection of tumor with special attention to the pelvic plexus led to preservation of normal voiding function and normal bowel function in this patient.
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Kremer MEB, Derikx JPM, van Baren R, Heij HA, Wijnen MHWA, Wijnen RMH, van der Zee DC, van Heurn ELWE. Patient-Reported Defecation and Micturition Problems Among Adults Treated for Sacrococcygeal Teratoma During Childhood--The Need for New Surveillance Strategies. Pediatr Blood Cancer 2016; 63:690-4. [PMID: 26739142 DOI: 10.1002/pbc.25857] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/03/2015] [Indexed: 11/05/2022]
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. PROCEDURE 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.
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Affiliation(s)
- Marijke E B Kremer
- Department of Pediatric Surgery, Maastricht University Medical Center, The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, Maastricht University Medical Center, The Netherlands
| | - Robertine van Baren
- Department of Pediatric Surgery, University Medical Center Groningen, The Netherlands
| | - Hugo A Heij
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital University Medical Center and VU Medical Center, The Netherlands
| | - Marc H W A Wijnen
- Department of Pediatric Surgery, University Medical Center Nijmegen, The Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
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