Background: Sacrococcygeal teratoma (SCT) is considered the most common congenital neoplasm in neonates. This study aimed to assess long-term impacts on urinary and anorectal functions and quality of life (QoL) in patients who underwent surgery for SCT and to identify predictive factors for these outcomes, with a focus on the Intrapelvic Tumor Height (ITH). Methods: This retrospective study included patients treated surgically for SCT, between 1984 and 2017 at the Armand Trousseau Hospital. Urologic and anorectal functions were evaluated through clinical assessments and patient-reported outcomes through questionnaires. Statistical analysis was performed to explore correlations between these factors and long-term functional outcomes. Results: Twenty-six patients (median age=17 years) were identified. With a median follow-up of 180 months [96-444 months], 12 patients (46%) presented functional impairments: seven had isolated anorectal dysfunction and five had both urinary and anorectal dysfunctions, including neurogenic bladder (n=2) and/or detrusor-sphincter dyssynergia (n=3). A significant correlation was observed between adverse outcomes and intrapelvic tumor height (ITH) (median ITH was 27 mm in patients with impairments versus 15 mm in those without, p<0.05). Of the 12 questionnaire respondents, two patients experienced urinary and anorectal dysfunctions and five experienced isolated anorectal dysfunction. Most patients reported a good QoL, only one patient reporting a severe impact on daily life. Conclusions: This study highlights that long-term urologic and anorectal dysfunctions are prevalent in patients treated for SCT, although the overall impact on quality of life remains moderate. Importantly, ITH emerged as a more objective and accurate predictor of functional outcomes than tumor size or Altman classification.