Lower urinary tract dysfunction following sacrococcygeal teratoma resection in neonates: a long-term clinical follow-up study.

BACKGROUND: Sacrococcygeal teratoma (SCT) is one of the most common solid neonatal tumors, surgical resection is the primary curative treatment. The mass effect of the tumor and surgical intervention affect urinary function. However, there are no clear guidelines for postoperative assessment of lower urinary tract dysfunction (LUTD), and the literature on this subject is scarce-especially in neonates. This study aimed to investigate the incidence of LUTD in neonates following SCT surgery during long-term follow-up, evaluate lower urinary tract function using urodynamic studies (UDS), explore its influencing factors, and propose early clinical interventions. METHODS: A retrospective cohort study was conducted on 46 neonates who underwent SCT resection. Their clinical data were collected, and the follow-up period was 3 to 7 years. The occurrence of LUTD after surgery was evaluated in combination with UDS. RESULTS: Among 46 neonates (67.4% female), the mean age at admission was 9.7±10.1 days, and the mean duration of follow-up was 4.9±1.4 years. Altman type II teratomas (56.5%) and mature histology (93.5%) were the most prevalent subtypes; surgery was performed within 14 days of birth in 69.6% of cases, and the sacrococcygeal approach was used in 89.1%. LUTD developed in 19.6% of patients, presenting predominantly as urinary frequency and urge incontinence; no statistically significant differences were observed between the LUTD and non-LUTD groups with respect to sex, timing or method of surgery, Altman classification, tumor diameter, or histopathological subtype (all P>0.05). Only type II SCT showed significant tumor size difference between LUTD and non-LUTD patients (t=-2.781, P<0.05). UDS revealed abnormalities in 8 of 9 LUTD patients (88.9%), including detrusor overactivity (DO), neurogenic bladder, and elevated post-void residual urine volume (PVR). CONCLUSIONS: Lower urinary tract evaluation is recommended for symptomatic patients with SCT or those harboring large tumors. Routine urodynamic screening in asymptomatic patients is not currently supported by evidence and warrants prospective validation. Within the Altman type II subgroup, larger tumor size was significantly associated with LUTD, suggesting that mechanical mass effect merits further investigation as a potential pathophysiological contributor to LUTD. Early UDS evaluation is recommended for selected symptomatic patients.