Can a teratoma, especially one located in the pelvic region, cause urinary retention in a patient, particularly those with a history of urinary tract issues or taking medications like glycopyrrolate (anticholinergic medication)?

Can Teratoma Cause Urinary Retention?

Yes, teratomas—particularly sacrococcygeal teratomas located in the pelvic region—can definitively cause urinary retention through direct mass effect and compression of the bladder and urethra. 1, 2, 3

Mechanism of Urinary Retention

Pelvic teratomas cause urinary retention through several mechanisms:

• Direct mechanical compression: The tumor mass displaces the bladder anteriorly and superiorly, compressing the bladder outlet and urethra against the symphysis pubis 2, 3
• Pressure necrosis: In severe cases, mechanical compression between the symphysis pubis and the teratoma can cause urethral obstruction or even midurethral necrosis 4
• Bladder dysfunction: Chronic compression leads to poor bladder emptying, bladder wall trabeculation, and elevated intravesical pressures 3

Clinical Evidence and Prevalence

The association between teratomas and urinary retention is well-documented:

• Greater than 50% of patients with sacrococcygeal teratomas develop lower urinary tract dysfunction (LUTD), with urinary retention being the most common manifestation (70% of LUTD cases) 1
• Total urinary retention occurred in 21% (6 of 29 patients) in one surgical series of sacrococcygeal teratomas 3
• Type IV sacrococcygeal teratomas (presacral location with no external component) are particularly prone to causing urinary retention due to their anatomic position 1, 2

Imaging Findings

When teratoma causes urinary retention, characteristic imaging features include:

• Cystic retrorectal lesions with intralesional calcifications on ultrasonography 3
• Anterior and superior displacement of the bladder 2, 3
• Bladder wall trabeculation in chronic cases 3
• Secondary hydronephrosis (occurring in 21-26% of cases) related to poor bladder emptying and high intravesical pressures 1, 3

Additional Risk Factors in Your Patient

The presence of glycopyrrolate (anticholinergic medication) significantly compounds the risk, as anticholinergics impair detrusor contractility and can precipitate or worsen urinary retention in patients with mechanical obstruction 5. This creates a "double hit" scenario where both mechanical compression from the teratoma and pharmacologic bladder dysfunction coexist.

Associated Complications

Beyond simple retention, teratomas can cause:

• Acute urinary retention requiring temporary catheterization (39% of LUTD cases) 1
• Chronic urinary retention requiring long-term intermittent catheterization (30% of LUTD cases) 1
• Urinary fistulas (vesicovaginal or urethrovaginal) in 4% of all sacrococcygeal teratoma patients 1
• Tethered cord syndrome: 78% of patients with concomitant tethered cord develop LUTD, suggesting neurogenic contribution in some cases 6, 1

Management Implications

Immediate bladder decompression via urethral catheterization is warranted when urinary retention is present 5. However, the definitive treatment requires:

• Surgical resection of the teratoma with meticulous attention to pelvic plexus preservation to maintain normal voiding and bowel function 2
• Multidisciplinary team involvement including urology upfront in management 1
• Post-resection monitoring: Hydronephrosis typically resolves spontaneously after tumor resection once bladder emptying normalizes 3

Critical Pitfall

Only 22% of patients with sacrococcygeal teratoma-related LUTD have their dysfunction recognized preoperatively 1. This highlights the importance of proactive urologic assessment in all patients with pelvic teratomas, regardless of presenting symptoms. Routine evaluation for urinary fistulas should occur if urinary incontinence develops 1.