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CASE REPORT |
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| Year : 2004 | Volume
: 20
| Issue : 2 | Page : 170-171 |
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Sacro-coccygeal chordoma: An unusual cause of retention of urine
Dilip Kumar Pal1, Manoj Kumar Chowdhury2
1 Department of Urology, Bankura Sammilani Medical College, Bankura, India
2 Department of Pathology, Bankura Sammilani Medical College, Bankura, India
Correspondence Address:
Dilip Kumar Pal
A-30 Govt. Housing Estate, Govindanagar, Side-B, Bankura - 722102
India
 Source of Support: None, Conflict of Interest: None  | Check |
Keywords: Chordoma, sacro-coccygeal
How to cite this article:
Pal DK, Chowdhury MK. Sacro-coccygeal chordoma: An unusual cause of retention of urine. Indian J Urol 2004;20:170-1 |
 Case Report | |  |
A 57-year-old male presented with urinary retention relieved by per urethral catheter. He had increased urinary 4 frequency with sensation of incomplete voiding for last six months along with constipation requiring gradual increased dose of purgative. On examination, abdomen and genitalia were normal. On digital rectal examination, a retro-rectal firm globular mass with smooth surface was palpable 3 cm above the anal opening. The upper limit of the mass could not be reached and clinically the mass was free from posterior wall of the rectum. His haemogram and renal biochemical parameters were within normal limits. X-ray pelvis showed an osteolytic lesion of the sacrum and coccyx [Figure - 1]. Contrast CT scan showed a large mass arising from the sacrum pressing on the rectum and bladder neck with destruction of bone [Figure - 2]. Truecut biopsy from the mass showed typical physaliphorous cells in a myxoid background.
Surgical resection of the tumour with partial resection of the sacrum through posterior approach with a temporary colostomy was done. Though resected margins were tumour free, but to prevent future recurrences in the postoperative period he was subjected to radiotherapy. After two weeks of operation patient voided well after removal of catheter. There was no post-void residue on USG. The colostomy wound was closed after 6 weeks, 2 weeks after radiation. The patient is doing well with normal bowel and bladder function at one-year's follow-up.
| Comments | | |
Chordoma is a rare, slow growing but locally aggressive malignant tumour derived from the primitive notochord. [1] Usually, it occurs in the axial skeleton like skull, vertebrae or sacrum. Sacro-coccygeal chordoma usually presents with low back pain. But a case of sacro-cocygeal chordoma presenting with urinary retention or detrusor areflexia is rarely reported in the literature. [2],[3] Surgical resection combined with postoperative local radiotherapy helps to prevent the delayed recurrences. We chose to excise the tumour by a posterior approach as it was familiar to us although a combined abdominoposterior approach has also been described. Moreover, there was a possibility of injury to the vesical neural plexus during mobilisation of rectum through the anterior approach which may lead to prolonged detrusor areflexia. Though presentation of sacral chordoma with urinary complaints is rare, if it is diagnosed earlier we can get a better outcome.
| References | | |
| 1. | Jeanrot C. Vinh TS. Anract P et al. Sacral chordoma: Retrospective review of 11 surgically treated cases. Rev Chir Ortho Repractie appar Mot 2000; 86: 684-93.  |
| 2. | Fukatsu Y. A case of sacral chordoma presenting as urinary retention. Hinyokiko Kiya 1999; 45: 855. |
| 3. | Carbone A. Does the neurological assessment have a decisive role in the early diagnosis of urinary disorders of uncertain etiology? Arch Ital Urol Androl 1999; 71: 37-9. |
[Figure - 1], [Figure - 2]
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