© 2 0 0 3 B J U I N T E R N A T I O N A L | 9 2 , 2 8 9 – 2 9 2 | doi:10.1046/j.1464-410X.2003.04326.x 289 Original Article NEUROVESICAL DYSFUNCTION AFTER PELVIC MALIGNANCY G. MOSIELLO et al. Neurovesical dysfunction in children after treating pelvic neoplasms G. MOSIELLO, C. GATTI, M. DE GENNARO, M.L. CAPITANUCCI, M. SILVERI, A. INSERRA, G.M. MILANO, C. DE LAURENTIS and C. BOGLINO Paediatric Surgery Department, Bambino Gesù Children’s Hospital, Rome, Italy Accepted for publication 11 April 2003 patients with signs of bladder dysfunction were evaluated by a pressure-flow study. The results were analysed for surgical approach and anatomical involvement, i.e. group A, extensive surgery for complete tumour excision in the sacral area (ST and YST); group B, surgery for tumour resection in the paraspinal ganglia area (neuroblastoma and ganglioneuroma); and group C, bladder tumour with partial bladder resection (MBS). RESULTS Eight patients had signs or symptoms related to bladder sphincter dysfunction. One child refused the invasive urodynamic evaluation, leaving seven for analysis (two each ST and ganglioneuroma, one each YST, neuroblastoma and MBS). The urodynamic findings were normal in three children. On spinal and pelvic MRI a presacral lipoma with syringomyelia was discovered in one child with ST. Eight children had bladder dysfunction and two had no neurogenic damage (which was only in sacral tumours); in one child it was related to an upper motor neurone lesion from spinal dysraphism and in the other to a lower motor neurone lesion from surgical injury to the splanchnic nerves. Patients operated for paraspinal tumours had more bladder dysfunction but no signs of neurogenic damage, as did the patient with partial bladder resection. However in Group B, there may have been a transient or incomplete nerve injury in one patient. CONCLUSIONS Deficits of parasympathetic, sympathetic and somatic innervation of the bladder and the urethra may occur in children after surgery for pelvic neoplasms, related to minor or major surgical trauma. In ST, a tethered cord may be associated with mixed neurogenic damage. Knowledge of bladder dysfunction in anorectal malformations, spinal dysraphism, etc. and the clinical protocol used in these patients also seemed to be useful for understanding the development of voiding dysfunction in patients with neoplasm. KEYWORDS pelvic neoplasm, urodynamics, vesical dysfunction, children OBJECTIVE To evaluate 10 years of experience, and thus define the occurrence and causes, of neurogenic lower urinary tract dysfunction in children with pelvic neoplasms treated by surgery. PATIENTS AND METHODS From 1991 to 2000, 33 children were operated by the same surgeons for pelvic neoplasms; 11 were analysed, comprising four each with sacrococcygeal teratoma (ST) and ganglioneuroma, and one each with yolk sac tumour (YST), neuroblastoma and myofibroblastic bladder sarcoma (MBS). The other patients were not assessed because eight had died or were in severe progression, three were treated by bladder substitution and the others were lost to follow-up or refused a urological evaluation. All 11 children were evaluated at ≥ 6 months after surgery with a questionnaire about bowel and voiding habits, a neurological and orthopaedic assessment, a noninvasive urodynamic study, renal ultrasonography and spinal and pelvic magnetic resonance imaging (MRI). All INTRODUCTION The most common pelvic neoplasms in children are rhabdomyosarcomas, sacrococcygeal teratomas (STs) and germ cell tumours. In the last few years, the survival for all types of childhood pelvic malignancy has improved dramatically with the influence of the combined children’s cancer study groups [1]. Thus, particular attention must be given to the long-term quality of life of these patients, considering functional outcome for urological, digestive and orthopaedic sequelae. Permanent neurological complications associated with tumour resection may occur because of the close relationship of the tumour to major nerve trunks, and the difficult surgical approach to deep vital structures in the pelvis. Currently, for these diseases where surgery remains the mainstay, the goal is not only survival but also to avoid ‘mutilating surgery’, recognising the importance of the anatomical, histological and genetic definition of the tumour. Neurogenic bladder dysfunction has been described previously in children with ST [2] and more recently in patients surviving pelvic neuroblastoma [3] and rhabdomyosarcoma [4]. The aim of the present retrospective study was to evaluate our 10-year experience, to define the incidence and causes of neurogenic lower urinary tract dysfunction in children with different pelvic neoplasms. PATIENTS AND METHODS Between January 1991 and December 2000, 33 children with newly diagnosed pelvic neoplasms were treated in our institution by the same surgical team. Seven patients presented with rhabdomyosarcoma, six with ST, five with a yolk sac tumour (YST), four each with neuroblastoma and ganglioneuroma, one with ganglioneuroblastoma, and six with other sarcomas. The timing of surgery was defined in all children according to