Need for urodynamic evaluation as a regular follow-up tool in assessment of long-term urological outcomes in patients with sacrococcygeal teratoma

Kashish Khanna; Sandeep Agarwala; Sameer Bakhshi; M Srinivas; Manisha Jana; K Devasenathipathy; Minu Bajpai; Veereshwar Bhatnagar

doi:10.1016/j.jpedsurg.2018.11.020

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 Oct;54(10):2107-2111. doi: 10.1016/j.jpedsurg.2018.11.020. Epub 2018 Dec 29.

Authors

Kashish Khanna¹, Sandeep Agarwala², Sameer Bakhshi³, M Srinivas¹, Manisha Jana⁴, K Devasenathipathy⁴, Minu Bajpai¹, Veereshwar Bhatnagar¹

Affiliations

¹ Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India.
² Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: sandpagr@hotmail.com.
³ Department of Medical Oncology, BRAIRCH, All India Institute of Medical Sciences, New Delhi 110029, India.
⁴ Department of Radiology, All India Institute of Medical Sciences, New Delhi 110029, India.

PMID: 30686521
DOI: 10.1016/j.jpedsurg.2018.11.020

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).

Keywords: Long-term; Outcomes; Sacrococcygeal teratoma; Urodynamic study; Urological co-morbidities.

MeSH terms

Adolescent
Behavior Therapy / methods
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Hydronephrosis / diagnosis
Hydronephrosis / physiopathology
Infant
Male
Prospective Studies
Sacrococcygeal Region
Spinal Neoplasms / physiopathology
Spinal Neoplasms / surgery*
Teratoma / physiopathology
Teratoma / surgery*
Ultrasonography
Urinary Bladder Diseases / diagnosis
Urinary Bladder Diseases / physiopathology
Urinary Bladder, Overactive / diagnosis
Urinary Bladder, Overactive / physiopathology
Urinary Incontinence / diagnosis
Urinary Incontinence / physiopathology
Urodynamics / physiology*