Sacrococcygeal teratoma (SCT) is a rare neonatal tumor that typically requires early surgical procedure. Prenatal diagnosis can provide direct access to centralized care pathways, enabling early multidisciplinary involvement and proactive planning rather than reactive management. Even though the advancement in prenatal detection, long-term urinary outcomes remain scarce. Aim of the study was to evaluate functional outcomes in patients with prenatal diagnosis of SCT and to explore whether early diagnosis combined with multidisciplinary care at a referral center influences urinary comorbidities or other sequelae.

This was an observational retrospective study. We reviewed prenatally diagnosed SCT patients who underwent surgery between 2010 and 2021. A minimum follow-up of three years was required, to ensure that all patients had reached the age for toilet training. Clinical, surgical, histological, and functional outcomes were analysed. Correlations between urinary comorbidities and prenatal findings, Altman classification, tumor histology and size, and surgical approach were explored.

A total of 30 SCT patients were treated at our center within the study period, 25 (83.3%) had a prenatal diagnosis. Twenty-four patients out of 25 were included (one patient died at birth). The female-to-male ratio was 17:7. Median follow-up time was 5.59 (IQR 4.81–6.28) years.
Most tumors were classified as Altman type I (66.7%), and half of the cases showed immature histology. Urinary comorbidities were identified in 3/24 (12.5%) patients (1 had urinary retention, and 2 experienced urinary incontinence), primarily in those with immature tumors and larger lesions, although they did not emerge as statistically significant predictors (rs = −0.37, p = 0.08; rs = 0.33, p = 0.17, respectively). All of these 3 patients developed urinary tract infections (UTIs), resulting in UTI incidence of 12%. One other patient experienced an isolated postoperative UTI.
Gastroenterological follow-up showed functional complications in several patients. Seven out of 24 (29.2%) experienced constipation, and 3 (12.5%) had fecal incontinence or soiling.

No statistically significant associations were found between urinary comorbidities and previously proposed poor outcome predictors. Immature SCT (rs = −0.37, p = 0.08) and a tumor size larger than 9 cm (rs = 0.33, p = 0.17) were not statistically significant predictors. Similarly, no clear association was found between Altman type and bladder dysfunction: two patients with urinary issues were classified as Altman type I, and one as type IV. The surgical approach did not appear to influence urinary outcomes.

Prenatal imaging still have a major role for SCT early detection, surgical correction planning, and comprehensive multidisciplinary management, which may contribute to favorable long-term functional outcomes in these patients.