Background Monosymptomatic nocturnal enuresis (MNE) is a common childhood condition that can negatively impact the daily lives of children and their families. Although treatment options are available, therapy selection at initial presentation is shaped not just by clinical considerations, but also by parental expectations and beliefs. Objective This study aimed to evaluate parental treatment preferences at initial presentation of MNE using a structured survey and to examine their association with selected clinical and demographic variables. Methods This prospective cross-sectional survey was performed among parents of 126 children newly diagnosed with MNE at a tertiary pediatric urology clinic following ethics committee approval on October 17, 2025, with recruitment and data collection continuing through February 2026. Parents completed a 10-item questionnaire assessing demographic and socioeconomic characteristics, expectations, and concerns regarding treatment. At the initial outpatient visit, before completing the questionnaire, parents received standardized counseling regarding MNE and available treatment options. The questionnaire was not formally validated or pilot-tested. Based on parental treatment preference, participants were categorized into pharmacological or non-pharmacological management groups. Enuresis severity was classified using a threshold of ≥17 wet nights per month. Results Among 126 children, the median age was 9.1 years (IQR: 7.1–11.5); 51 (40.5%) were female and 75 (59.5%) were male. Of the parents, 74 (58.7%) preferred conservative management, while 52 (41.3%) opted for pharmacological treatment. Treatment preference was not significantly associated with demographic or socioeconomic factors. Although education levels did not significantly influence treatment choice, fathers with university-level education reported significantly higher expectations for the effectiveness of conservative management (p = 0.013). In addition, parents who preferred conservative management more frequently reported belief in the effectiveness of conservative methods than those who chose medication (p < 0.001). Enuresis severity had no significant impact on treatment preference. Overall, 71.4% of parents expected complete dryness, with no significant difference between treatment groups. Discussion Parental treatment choice at initial MNE presentation was not associated with enuresis severity or demographic/socioeconomic factors. Treatment preference was associated with perceived effectiveness of conservative management, while paternal educational level was associated with expectations regarding conservative treatment effectiveness. Enuresis severity was not significantly associated with treatment preference. These findings underscore the need for early, expectation-focused counseling and shared decision-making. Conclusions Parents’ educational background may be associated with treatment expectations in children with MNE. Taking these expectations into account through a collaborative approach involving the child, parents, and physician may support more individualized treatment discussions and shared decision-making.
Background Urological anomalies (UAs) are major congenital disorders of the urinary tract and are the leading cause of pediatric end-stage renal disease. Although household spray formulations are widely used during pregnancy, concerns have been raised regarding their potential developmental toxicity. In this work, we aimed to assess the association between maternal spray-formulation use and UAs in offspring aged ≤2 years. Objective We analyzed 80,658 mother–child pairs from the Japan Environment and Children's Study (JECS), a nationwide birth cohort. The maternal use of waterproof, insect-repellent, and insecticide sprays during pregnancy was identified via self-administered questionnaires. Data on UAs diagnosed by physicians up to age 2 years were collected and categorized into vesicoureteral reflux (VUR), hydronephrosis, hypospadias, cryptorchidism, and others. Multivariable logistic regression analyses were performed, adjusting for relevant maternal and neonatal covariates. Analyses stratified by age (0–1 and 1–2 years) and sex were performed. Results Overall, 1078 UAs were diagnosed (13.4 per 1000 births), predominantly in boys. The maternal use of waterproof and insect-repellent sprays was associated with an increased risk of total UAs among boys during the 0–1-year (adjusted odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.08–1.66) and 1–2-year periods (OR: 1.31, 95% CI: 1.00–1.71). Insecticide spray exposure was associated with hydronephrosis during the 0–1-year period in girls (OR: 2.15, 95% CI: 1.07–4.34). Among boys, the use of waterproof spray was associated with increased VUR during the 0–2-year period. Conclusions Prenatal exposure to certain spray formulations may contribute to the development of UAs in a sex- and age-dependent manner. These findings highlight the need to limit unnecessary chemical exposure during pregnancy and warrant further mechanistic and longitudinal studies to confirm causality and identify specific harmful agents.
Double-J (DJ) ureteral stents are essential tools in pediatric urology; however, infectious complications remain a major clinical challenge. Although clinicians frequently administer continuous antibiotic prophylaxis (CAP), data on breakthrough symptomatic urinary tract infections (UTIs) and the burden of antimicrobial resistance across diverse pediatric cohorts remain scarce. We aimed to evaluate the incidence, risk factors, and microbiological profiles of symptomatic UTIs in children with DJ stents who received routine CAP. Materials and methods We retrospectively reviewed 124 pediatric patients (72 males, 52 females; mean age 4.8 ± 3.6 years) who underwent DJ stent placement for various upper urinary tract pathologies between February 2020 and February 2026. All patients received continuous antibiotic prophylaxis throughout the indwelling period. Symptomatic UTI was defined as fever (≥38.0 °C) or acute urinary symptoms combined with a positive urine culture yielding ≥105 CFU/mL of a predominant uropathogen. Clinical risk factors, including underlying pathology, surgical approach, stent indwelling duration, age category, and preoperative UTI history, were analyzed. Results Symptomatic breakthrough UTI occurred in 34 of 124 patients (27.4%) during the indwelling period. Prolonged stent indwelling duration (>4 weeks) was significantly associated with a higher UTI rate compared to ≤4 weeks (38.1% vs. 16.4%; p = 0.006). Similarly, a history of preoperative UTI significantly increased the risk of stent-associated UTI (40.4% vs. 19.5%; p = 0.010). While infants demonstrated the highest crude infection rate (36.4%), age category and surgical approach (open vs. minimally invasive) were not statistically significant predictors. Microbiological analysis revealed Escherichia coli (47.1%), Klebsiella pneumoniae (20.6%), and Enterococcus species (14.7%) as the predominant isolates. Notably, multidrug-resistant (MDR) was identified in 32.4% of breakthrough episodes, with 26.5% displaying extended-spectrum beta-lactamase (ESBL) production. Conclusions Breakthrough symptomatic UTI occurs in more than one-quarter of pediatric patients with DJ stents despite continuous antibiotic prophylaxis. Prolonged stent dwell time (>4 weeks) and prior UTI history were significantly associated with symptomatic UTI in this cohort. The notable prevalence of MDR pathogens underscores the need for strict limitation of stent duration and tailored, culture-directed management rather than reliance on empirical antimicrobial coverage.
