Purpose To evaluate our experience of 45 patients with SCT (in Upper Egypt) over a period of 10 years (2001–2011), and to determine of the outcome of the management and recommendations for treatment’s strategies.

Patients and Methods The records were reviewed for age at presentation, clinical manifestations and investigations, time of surgical approach, histopathology, recurrences, bladder and anorectal function, and cosmetic outcome.

Results The time of referral was immediately after birth in 5 patients, at the 1^st week in 17, later in infancy in 22, and at age of 1.5 years in one child. Excision of the lesion was done for 41 patients. Teratomas were type I (n=9), type II (n=20), type III (n=11), type IV (n=1) (Altman’s classification). The age of operation ranged from 2 days to 1.5 years. Histology of results were: mature teratoma (n=27), immature teratoma (n=9), malignant teratoma (n=5). Coccyx remained in two cases of early period of study.

FU ranged from 3 months to 10 years. Recurrence rate in 13 (31.7%), wound infection occurred in 4 (9.7%), diarrhea occurred in 2 (4.8%). AFP was high in 35 and normal in two patients, it decreased after excision. Fetal diagnosis was made in 5 cases by prenatal sonography.

Conclusion Prenatal diagnosis of SCT is important and recommended to save the baby from obstructed labor. Early diagnosis allows early surgical intervention avoids malignant transformation. The coccyx should be excised to decrease the risk of recurrence. Skin flap modification is feasible for large teratomas with healthy skin.