Background: Sacrococcygeal Teratoma (SCT) is the most prevalent neoplasm in the neonatal population. Despite significant advancements in diagnostic imaging and surgical management, long term functional outcomes remain a critical concern due to the high incidence of complications. These include neurogenic pelvic organ dysfunction, urodynamic dysfunction, and orthopedic pathologies.

Objective: To investigate the prevalence and structural patterns of associated congenital anomalies in pediatric patients with sacrococcygeal teratomas, as well as to evaluate the efficacy of primary tumor resection and strategies for managing postoperative dysfunctions.

Materials and Methods: A retrospective cohort analysis was conducted on 113 medical records of patients diagnosed with SCT between 2007 and 2023. The demographic distribution included 84 females (74%) and 29 males (26%). Prenatal detection via fetal ultrasonography occurred in 89 cases (78.7%), with a mean gestational age at diagnosis of 37.3 ± 1.5 weeks. Mean birth weight was recorded at 3496.25 ± 347.64 g. The standardized diagnostic protocol encompassed Ultrasound (US), Computed Tomography (CT), Echocardiography (EchoCG), comprehensive laboratory workup, and mandatory quantification of Alpha Fetoprotein (AFP) levels. Tumor classification according to the Altman system yielded the following distribution: Type I, 45 patients (39.8%); Type II, 28 (24.8%); Type III, 23 (20.3%); Type IV, 17 (15.1%). The median age at definitive surgery was 16 ± 5 days. All subjects underwent complete excision of the mass with en bloc coccygectomy. Postoperative trajectories, histopathological characteristics of excised specimens, and functional sequelae were analyzed.

Results: Overall survival rate reached 97.3%. Three fatalities occurred in the early postoperative period resulting from massive hemorrhage secondary to giant tumor burden. Enteral nutrition was initiated on postoperative day 5–6. The average duration of hospitalization was 17 days. Early postoperative complications manifested in 7 patients; notably, rectal perforation necessitating diverting colostomy formation occurred in 4 cases. Histopathological examination classified tumors as follows: Mature teratoma 72 cases (63.7%); Immature teratoma - 38 (33.6%); Malignant transformation - 3 (2.7%). Associated morbidities identified: Orthopedic 4.4%: – 5 patients presented with developmental dysplasia of the hip managed conservatively via Pavlik harness or abduction bracing. Neurological 6.2%: – 3 patients exhibited lower paraparesis; 4 patients demonstrated tethered cord syndrome requiring subsequent untethering procedures. Urological 31%: Upper urinary tract dystonia was observed in 7 children (Managed via minimally invasive endoscopic correction). Neurogenic bladder dysfunction affected 23 patients, treated based on voiding dysfunction type with intermittent catheterization, antispasmodics, energy metabolism support, and membrane stabilizers. Bladder outlet obstruction required cystostomy creation in 5 individuals. No defecatory disorders were documented.

Conclusions: Mature teratomas, predominantly of type I, occur in the overwhelming majority of newborns. Within the spectrum of associated comorbidities, neurogenic urinary disturbances and neurological deficits prevail, mandating prompt therapeutic intervention subsequent to surgical excision of the neoplasm. Further investigation is warranted to elucidate the timeframe for necessary rehabilitation and the potential for functional recovery.

Nadezhda Erokhina is a pediatric surgeon at N.F. Filatov Children’s City Clinical Hospital in Moscow, Russia, and head of the pediatric surgery Sector within the organizational and methodological department for surgery of the Moscow city department of healthcare. In 2013, she graduated from Pirogov Russian National Research Medical University (RNRMU) with a degree in pediatrics. She completed her residency in pediatric surgery in 2015 and postgraduate studies in the same specialty in 2018. In 2018, she also completed professional retraining in pediatric urology-andrology, followed by further training in endoscopy in 2026. From 2015 to 2017, she worked in the department of urology and elective surgery at N.F. Filatov Children’s City Clinical Hospital. Since 2017, she has been working in the hospital’s surgical department for newborns and premature infants. Her professional interests include neonatal surgery, pediatric urology-andrology during the neonatal period, antenatal diagnostics, and major vascular cannulation for extracorporeal membrane oxygenation (ECMO) procedures in newborns. Her patents include No. 2789283 (2022), describing a method for removing internal ureteral stents in infants, and No. 2850366, covering vascular cannulation for prolonged ECMO procedures in newborns.